Skip to main content

Advertisement

SpringerLink
Log in

Clinical results of microsurgical bilateral decompression via unilateral approach for lumbar canal stenosis with multiple-level involvement

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Object

Microsurgical decompression of the lumbar spine is a beneficial approach for selected patients of lumbar spinal stenosis (LSS). The purpose of this prospective study was to describe the clinical results of surgical treatment for microsurgical bilateral decompression via unilateral approach on patients with LSS with multiple-level involvement.

Materials and methods

Seventy-three consecutive patients who had microsurgical bilateral decompression via unilateral approach of more than two spinal levels were included in this study. Seventy-seven patients who had surgery at a single level over the same time periods were compared as a single-level LSS group.

Results

The preoperative Japanese Orthopaedic Association scores averaged 11.7 points, and the postoperative scores averaged 21.2 points with an average recovery rate (RR) of 56 % in the multiple-level LSS group. There was no significant difference in the RR between the groups. There were no major complications related to the surgery in the both groups.

Conclusion

Microsurgical bilateral decompression via unilateral approach was a useful and safe operative procedure for LSS patients. Sufficient clinical results that were comparable to single-level LSS patients were obtained even in the patients with multiple-level LSS, if the patient were correctly selected and the microsurgical decompression surgery were carefully performed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Postacchini F, Gumina S, Cinotti G et al (1994) Ligamenta flava in lumbar disc herniation and spinal stenosis. Light and electron microscopic morphology. Spine 19(8):917–922

    Article  CAS  PubMed  Google Scholar 

  2. Jönsson B, Annertz M, Sjöberg C et al (1997) A prospective and consecutive study of surgically treated lumbar spinal stenosis. Part I: clinical features related to radiographic findings. Spine 22(24):2932–2937

    Article  PubMed  Google Scholar 

  3. Herno A, Airaksinen O, Saari T (1993) Long-term results of surgical treatment of lumbar spinal stenosis. Spine 18(11):1471–1474

    Article  CAS  PubMed  Google Scholar 

  4. Jönsson B, Annertz M, Sjöberg C et al (1997) A prospective and consecutive study of surgically treated lumbar spinal stenosis. Part II: five-year follow-up by an independent observer. Spine 22(24):2938–2944

    Article  PubMed  Google Scholar 

  5. Baba H, Uchida K, Maezawa Y et al (1996) Microsurgical nerve root canal widening without fusion for lumbosacral intervertebral foraminal stenosis: technical notes and early results. Spinal Cord 34(11):644–650

    Article  CAS  PubMed  Google Scholar 

  6. Ikuta K, Tono O, Oga M (2008) Clinical outcome of microendoscopic posterior decompression for spinal stenosis associated with degenerative spondylolisthesis–minimum 2-year outcome of 37 patients. Minim Invasive Neurosurg 51(5):267–271 Epub 2008 Oct 14

    Article  CAS  PubMed  Google Scholar 

  7. Mayer HM, Korge A (2009) Microsurgical decompression of degenerative lumbar spinal stenosis. Eur Spine J 18(12):1989–1990

    Article  PubMed  Google Scholar 

  8. Schillberg B, Nyström B (2000) Quality of life before and after microsurgical decompression in lumbar spinal stenosis. J Spinal Disord 13(3):237–241

    Article  CAS  PubMed  Google Scholar 

  9. Tsai RY, Yang RS, Bray RS Jr (1998) Microscopic laminotomies for degenerative lumbar spinal stenosis. J Spinal Disord 11(5):389–394

    Article  CAS  PubMed  Google Scholar 

  10. Cavusoglu H, Kaya RA, Turkmenoglu ON et al (2007) Midterm outcome after unilateral approach for bilateral decompression of lumbar spinal stenosis: 5-year prospective study. Eur Spine J 16:2133–2142

    Article  PubMed Central  PubMed  Google Scholar 

  11. Sasai K, Umeda M, Maruyama T et al (2008) Microsurgical bilateral decompression via a unilateral approach for lumbar spinal canal stenosis including degenerative spondylolisthesis. J Neurosurg Spine 9(6):554–559

    Article  PubMed  Google Scholar 

  12. Weiner BK, Walker M, Brower RS et al (1999) Microdecompression for lumbar spinal canal stenosis. Spine 24:2268–2272

    Article  CAS  PubMed  Google Scholar 

  13. Jönsson B, Akesson M, Jönsson K et al (1992) Low risk for vertebral slipping after decompression with facet joint preserving technique for lumbar spinal stenosis. Eur Spine J 1:100–104

    Article  PubMed  Google Scholar 

  14. Haba K, Ikeda M, Soma M et al (2005) Bilateral decompression of multilevel lumbar spinal stenosis through a unilateral approach. J Clin Neurosci 12(2):169–171

    Article  PubMed  Google Scholar 

  15. Sato K, Kikuchi S (1997) Clinical analysis of two-level compression of the cauda equina and the nerve roots in lumbar spinal canal stenosis. Spine 22(16):1898–1903

    Article  CAS  PubMed  Google Scholar 

  16. Hirabayashi K, Miyakawa J, Satomi K et al (1981) Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament. Spine 6(4):354–364

    Article  CAS  PubMed  Google Scholar 

  17. Lee CK, Hansen HT, Weiss AB (1978) Developmental lumbar spinal stenosis. Pathology and surgical treatment. Spine 3(3):246–255

    Article  CAS  PubMed  Google Scholar 

  18. Drew R, Bhandari M, Kulkarni AV et al (2000) Reliability in grading the severity of lumbar spinal stenosis. J Spinal Disord 13(3):253–258

    Article  CAS  PubMed  Google Scholar 

  19. Lurie JD, Tosteson AN, Tosteson TD, Carragee E et al (2008) Reliability of readings of magnetic resonance imaging features of lumbar spinal stenosis. Spine 33(14):1605–1610

    Article  PubMed Central  PubMed  Google Scholar 

  20. Boden SD, Davis DO, Dina TS et al (1990) Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am 72(3):403–408

    CAS  PubMed  Google Scholar 

  21. Carroll SE, Wiesel SW (1992) Neurologic complications and lumbar laminectomy. A standardized approach to the multiply-operated lumbar spine. Clin Orthop Relat Res 284:14–23

    PubMed  Google Scholar 

  22. Smith EB, Hanigan WC (1992) Surgical results and complications in elderly patients with benign lesions of the spinal canal. J Am Geriatr Soc 40(9):867–870

    Article  CAS  PubMed  Google Scholar 

  23. Okuda T, Fujimoto Y, Tanaka N et al (2005) Morphological changes of the ligamentum flavum as a cause of nerve root compression. Eur Spine J 14(3):277–286 Epub Oct 2, 2004

    Article  PubMed Central  PubMed  Google Scholar 

  24. Papavero L, Thiel M, Fritzsche E, Kunze C, Westphal M, Kothe R (2009) Lumbar spinal stenosis: prognostic factors for bilateral microsurgical decompression using a unilateral approach. Neurosurgery 65(6 Suppl):182–187

    PubMed  Google Scholar 

  25. Hamasaki T, Tanaka N, Kim J et al (2009) Biomechanical assessment of minimally invasive decompression for lumbar spinal canal stenosis: a cadaver study. J Spinal Disord Tech 22(7):486–491

    Article  PubMed  Google Scholar 

  26. Hilibrand AS, Rand N (1999) Degenerative lumbar stenosis: diagnosis and management. J Am Acad Orthop Surg 7(4):239–249

    CAS  PubMed  Google Scholar 

  27. Lu WW, Luk KD, Ruan DK et al (1999) Stability of the whole lumbar spine after multilevel fenestration and discectomy. Spine 24(13):1277–1282

    Article  CAS  PubMed  Google Scholar 

  28. Nakamura M, Miyamoto K, Shimizu K (2009) Difference in evaluation of patients with low back pain using the Japanese Orthopaedic Association Score for Back Pain and the Japanese Version of the Roland-Morris Disability Questionnaire. J Orthop Sci 14(4):367–373 Epub 2009 Aug 7

    Article  PubMed  Google Scholar 

  29. Eguchi Y, Ohtori S, Orita S et al (2011) Quantitative evaluation and visualization of lumbar foraminal nerve root entrapment by using diffusion tensor imaging: preliminary results. AJNR Am J Neuroradiol 32(10):1824–1829 Epub 2011 Sep

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima, 734-8551, Japan

    Nobuhiro Tanaka, Kazuyoshi Nakanishi, Naosuke Kamei, Risako Yamamoto, Toshio Nakamae, Bunichiro Izumi, Ryo Ohta, Yuki Fujioka & Mitsuo Ochi

Authors
  1. Nobuhiro Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kazuyoshi Nakanishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Naosuke Kamei
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Risako Yamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Toshio Nakamae
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Bunichiro Izumi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ryo Ohta
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yuki Fujioka
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Mitsuo Ochi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nobuhiro Tanaka.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tanaka, N., Nakanishi, K., Kamei, N. et al. Clinical results of microsurgical bilateral decompression via unilateral approach for lumbar canal stenosis with multiple-level involvement. Eur J Orthop Surg Traumatol 25 (Suppl 1), 191–198 (2015). https://doi.org/10.1007/s00590-014-1532-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-014-1532-y

Keywords

Search

Navigation