Advertisement

European Spine Journal

, Volume 16, Issue 12, pp 2133–2142 | Cite as

Midterm outcome after unilateral approach for bilateral decompression of lumbar spinal stenosis: 5-year prospective study

  • Halit ÇavuşoğluEmail author
  • Ramazan Alper Kaya
  • Osman Nuri Türkmenoglu
  • Cengiz Tuncer
  • İbrahim Çolak
  • Yunus Aydın
Original Article

Abstract

The aim of our study is to evaluate the results and effectiveness of bilateral decompression via a unilateral approach in the treatment of degenerative lumbar spinal stenosis. We have conducted a prospective study to compare the midterm outcome of unilateral laminotomy with unilateral laminectomy. One hundred patients with 269 levels of lumbar stenosis without instability were randomized to two treatment groups: unilateral laminectomy (Group 1), and laminotomy (Group 2). Clinical outcomes were assessed with the Oswestry Disability Index (ODI) and Short Form–36 Health Survey (SF-36). Spinal canal size was measured pre- and postoperatively. The spinal canal was increased to 4–6.1-fold (mean 5.1 ± SD 0.8-fold) the preoperative size in Group 1, and 3.3–5.9-fold (mean 4.7 ± SD 1.1-fold) the preoperative size in Group 2. The mean follow-up time was 5.4 years (range 4–7 years). The ODI scores decreased significantly in both early and late follow-up evaluations and the SF-36 scores demonstrated significant improvement in late follow-up results in our series. Analysis of clinical outcome showed no statistical differences between two groups. For degenerative lumbar spinal stenosis unilateral approaches allowed sufficient and safe decompression of the neural structures and adequate preservation of vertebral stability, resulted in a highly significant reduction of symptoms and disability, and improved health-related quality of life.

Keywords

Laminectomy Laminotomy Lumbar spinal stenosis Unilateral approach Vertebral stability 

Abbreviation

LSS

Lumbar spinal stenosis

ODI

Oswestry disability index

SF-36

36-item short-form health survey

References

  1. 1.
    Adachi K, Futami T, Ebihara A, Yamaya T, Kasai N, Nakazawa T, et al (2003) Spinal canal enlargement procedure by restorative laminoplasty for the treatment of lumbar canal stenosis. Spine J 3(6):471–478PubMedCrossRefGoogle Scholar
  2. 2.
    Adams MA, Hutton WC, Stott JR (1980) The resistance to flexion of the lumbar intervertebral joint. Spine 5(3):245–253PubMedCrossRefGoogle Scholar
  3. 3.
    Adams MA, Hutton WC (1983) The mechanical function of the lumbar apophyseal joints. Spine 8(3):327–330PubMedCrossRefGoogle Scholar
  4. 4.
    Airaksinen O, Herno A, Kaukanen E, Saari T, Sihvonen T, Suomalainen O (1996) Density of lumbar muscles 4 years after decompressive spinal surgery. Eur Spine J 5(3):193–197PubMedCrossRefGoogle Scholar
  5. 5.
    Airaksinen O, Herno A, Turunen V, Saari T, Suomlainen O (1997) Surgical outcome of 438 patients treated surgically for lumbar spinal stenosis. Spine 22(19):2278–2282PubMedCrossRefGoogle Scholar
  6. 6.
    Aryanpur J, Ducker T (1990) Multilevel lumbar laminotomies: an alternative to laminectomy in the treatment of lumbar stenosis. Neurosurgery 26(3):429–432 discussion 433PubMedCrossRefGoogle Scholar
  7. 7.
    Askar Z, Wardlaw D, Choudhary S, Rege A (2003) A ligamentum flavum-preserving approach to the lumbar spinal canal. Spine 28(19):E385–E390PubMedCrossRefGoogle Scholar
  8. 8.
    Cammisa FP Jr, Girardi FP, Sangani PK, Parvataneni HK, Cadag S, Sandhu HS (2000) Incidental durotomy in spine surgery. Spine 25(20):2663–2667PubMedCrossRefGoogle Scholar
  9. 9.
    Deyo RA, Nachemson A, Mirza SK (2004) Spinal-fusion surgery-the case for restraint. N Engl J Med 350(7):722–726PubMedCrossRefGoogle Scholar
  10. 10.
    diPiero CG, Helm GA, Shaffrey CI, Chadduck JB, Henson SL, Malik JM et al (1996) Treatment of lumbar spinal stenosis by extensive unilateral decompression and contralateral autolougs bone fusion: operative technique and results. J Nuerosurg 84(2):166–173Google Scholar
  11. 11.
    Epstein NE (1998) Decompression in the surgical management of degenerative spondylolisthesis: advantages of a conservative approach in 290 patients. J Spinal Disord 11(2):116–122 discussion 123PubMedCrossRefGoogle Scholar
  12. 12.
    Epstein NE, Maldonado VC, Cusick JF (1998) Symptomatic lumbar spinal stenosis. Surg Neurol 50(1):3–10PubMedCrossRefGoogle Scholar
  13. 13.
    Fox MW, Onofrio BM, Hanssen AD (1996) Clinical outcomes and radiological instability following decompressive lumbar laminectomy for degenerative spinal stenosis: a comparison of patients undergoing concomitant arthrodesis versus decompression alone. J Neurosurg 85(5):793–802PubMedGoogle Scholar
  14. 14.
    Goel VK, Fromknecht SJ, Nishiyama K, Weinstein J, Liu YK (1985) The role of the lumbar spinal elements in flexion. Spine 10(6):516–523PubMedCrossRefGoogle Scholar
  15. 15.
    Grob D, Humke T, Dvorak J (1995) Degenerative lumbar spinal stenosis. Decompression with and without arthrodesis. J Bone Joint Surg Am 77(7):1036–1041PubMedGoogle Scholar
  16. 16.
    Guiot BH, Khoo LT, Fessler RG (2002) A minimally invasive technique for decompression of the lumbar spine. Spine 27(4):432–438PubMedCrossRefGoogle Scholar
  17. 17.
    Haba K, Ikeda M, Soma M, Yamashima T (2005) Bilateral decompression of multilevel lumbar spinal stenosis through a unilateral approach. J Clinical Neurosci 12(2):169–171CrossRefGoogle Scholar
  18. 18.
    Herno A, Saari T, Suomalainen O, Airaksinen O (1999) The degree of decompressive relief and its relation to clinical outcome in patients undergoing surgery for lumbar spinal stenosis. Spine 24(10):1010–1014PubMedCrossRefGoogle Scholar
  19. 19.
    Herron LD, Mangelsdorf C (1991) Lumbar spinal stenosis: results of surgical treatment. J Spinal Disord 4(1):26–33PubMedGoogle Scholar
  20. 20.
    Hindle RJ, Pearcy MJ, Cross A (1990) Mechanical function of the human lumbar interspinous and supraspinous ligaments. J Biomed Eng 12(4):340–344PubMedCrossRefGoogle Scholar
  21. 21.
    Hopp E, Tsou PM (1988) Postdecompression lumbar instability. Clin Orthop Relat Res 227:143–151PubMedGoogle Scholar
  22. 22.
    Javid MJ, Hadar EJ (1998) Long-term follow-up review of patients who underwent laminectomy for lumbar stenosis: a prospective study. J Neurosurg 89(1):1–7PubMedGoogle Scholar
  23. 23.
    Ji YC, Kim YB, Hwang SN, Park SW, Kwon JT, Min BK (2005) Efficacy of Unilateral Laminectomy for bilateral decompression in elderly lumbar spinal stenosis. J Korean Neurosurg Soc 37:410–415Google Scholar
  24. 24.
    Johnsson KE, Willner S, Johnsson K (1986) Postoperative instability after decompression for lumbar spinal stenosis. Spine 11(2):107–110PubMedCrossRefGoogle Scholar
  25. 25.
    Kalbarczyk A, Lukes A, Seiler RW (1998) Surgical treatment of lumbar spinal stenosis in the elderly. Acta Neurochir (Wien) 140(7):637–641CrossRefGoogle Scholar
  26. 26.
    Katz JN, Lipson SJ, Larson MG, McInnes JM, Fossel AH, Liang MH (1991) The outcome of decompressive laminectomy for degenerative lumbar stenosis. J Bone Joint Surg Am 73(6):809–816PubMedGoogle Scholar
  27. 27.
    Khoo LT, Fessler RG (2002) Microendoscopic decompressive laminotomy for the treatment of lumbar stenosis. Neurosurgery 51(5 Suppl):S146–S154PubMedGoogle Scholar
  28. 28.
    Kleeman TJ, Hiscoe AC, Berg EE (2000) Patient outcomes after minimally destabilizing lumbar stenosis decompression: the “Port-Hole” technique. Spine 25(7):865–870PubMedCrossRefGoogle Scholar
  29. 29.
    Lin PM (1982) Internal decompression for multiple levels of lumbar spinal stenosis: a technical note. Neurosurgery 11(4):546–549PubMedCrossRefGoogle Scholar
  30. 30.
    Lipson SJ (2004) Spinal-fusion surgery-advances and concerns. N Engl J Med 350(7):643–644PubMedCrossRefGoogle Scholar
  31. 31.
    Mackay DC, Wheelwright EF (1998) Unilateral fenestration in the treatment of lumbar spinal stenosis. Br J Neurosurg 12(6):556–558PubMedCrossRefGoogle Scholar
  32. 32.
    Mariconda M, Fava R, Gatto A, Longo C, Milano C (2002) Unilateral laminectomy for bilateral decompression of lumbar spinal stenosis: a prospective comparative study with conservatively treated patients. J Spinal Disord Tech 15(1):39–46PubMedGoogle Scholar
  33. 33.
    Mayer TG, Vanharanta H, Gatchel RJ, Mooney V, Barnes D, Judge L, et al (1989) Comparison of CT scan muscle measurements and isokinetic trunk strength in postoperative patients. Spine 14(1):33–6PubMedCrossRefGoogle Scholar
  34. 34.
    McCulloch JA (1991) Microsurgical spinal laminotomies in the adult spine: principles and practice. J.W. Frymoyer (ed) Raven Press, New YorkGoogle Scholar
  35. 35.
    Nakai O, Ookawa A, Yamaura I (1991) Long-term roentgenographic and functional changes in patients who were treated with wide fenestration for central lumbar stenosis. J Bone Joint Surg Am 73(8):1184–1191PubMedGoogle Scholar
  36. 36.
    Palmer S, Turner R, Palmer R (2002) Bilateral decompression of lumbar spinal stenosis involving a unilateral approach with microscope and tubular retractor system. J Neurosurg 97(2 Suppl):213–217PubMedGoogle Scholar
  37. 37.
    Pinar R (2005) Reliability and construct validity of the SF-36 in Turkish cancer patients. Qual Life Res 14(1):259–264PubMedCrossRefGoogle Scholar
  38. 38.
    Prestar FJ (1982) Morphology and function of the interspinal ligaments and the supraspinal ligament of the lumbar portion of the spine. Morphol Med 2:53–58PubMedGoogle Scholar
  39. 39.
    Postacchini F, Cinotti G, Perugia D, Gumina S (1993) The surgical treatment of central lumbar stenosis. Multiple laminotomy compared with total laminectomy. J Bone Joint Surg Br 75(3):386–392PubMedGoogle Scholar
  40. 40.
    See DH, Kraft GH (1975) Electromyography in paraspinal muscles following surgery for root compression. Arch Phys Med Rehabil 56(2):80–83PubMedGoogle Scholar
  41. 41.
    Sengupta DK, Herkowitz HN (2003) Lumbar spinal stenosis. Treatment strategies and indications for surgery. Orthop Clin North Am 34(2):281–295PubMedCrossRefGoogle Scholar
  42. 42.
    Sihvonen T, Herno A, Paljarva L, Airaksinen O, Patanen J, Tapaninaho A (1993) Local denervation atrophy of paraspinal muscles in postoperative failed back syndrome. Spine 18(5):575–581PubMedCrossRefGoogle Scholar
  43. 43.
    Silvers HR, Lewis PJ, Asch HL (1993) Decompressive lumbar laminectomy for spinal stenosis. J Neurosurg 78(5):695–701PubMedCrossRefGoogle Scholar
  44. 44.
    Spetzger U, Bertalanffy H, Naujokat C, von Keyserlingk DG, Gilsbach JM (1997) Unilateral laminotomy for bilateral decompression of lumbar spinal stenosis. Part I: Anatomical and surgical considerations. Acta Neurochir 139(5):392–396CrossRefGoogle Scholar
  45. 45.
    Spetzger U, Bertalanffy H, Reinges MH, Gilsbach JM (1997) Unilateral laminotomy for bilateral decompression of lumbar spinal stenosis. Part II: Clinical experiences. Acta Neurochir 139(5):397–403CrossRefGoogle Scholar
  46. 46.
    Thomas NW, Rea GL, Pikul BK, Mervis LJ, Irsik R, McGregor JM (1997) Quantitative outcome and radiographic comparisons between laminectomy and laminotomy in the treatment of acquired lumbar stenosis. Neurosurgery 41(3):567–574 discussion 574–75PubMedCrossRefGoogle Scholar
  47. 47.
    Thome C, Zevgaridis D, Leheta O, Bazner H, Pockler-Schoniger C, Wohrle J et al (2005) Outcome after less-invasive decompression of lumbar spinal stenosis: a randomized comparison of unilateral laminotomy, bilateral laminotomy, and laminectomy. J Neurosurg Spine 3(2):129–141PubMedGoogle Scholar
  48. 48.
    Tsai RY, Yang RS, Bray RS Jr (1998) Microscopic laminotomies for degenerative lumbar spinal stenosis. J Spinal Disord 11(5):389–394PubMedCrossRefGoogle Scholar
  49. 49.
    Tuite GF, Stern JD, Doran SE, Papadopoulos SM, McGillicuddy JE, Oyedijo DI et al (1994) Outcome after laminectomy for lumbar spinal stenosis: Part I: Clinical correlations. J Neurosurg 81(5):699–706PubMedGoogle Scholar
  50. 50.
    Tuite GF, Doran SE, Stern JD, McGillicuddy JE, Papadopoulos SM, Lundquist CA et al (1994) Outcome after laminectomy for lumbar spinal stenosis. Part II: Radiographic changes and clinical correlations. J Neurosurg 81(5):707–715PubMedGoogle Scholar
  51. 51.
    Turner JA, Ersek M, Herron L, Deyo R (1992) Surgery for lumbar spinal stenosis. Attempted meta-analysis of the literature. Spine 17(1):1–8PubMedCrossRefGoogle Scholar
  52. 52.
    Wang JC, Bohlman HH, Riew KD (1998) Dural tears secondary to operations on the lumbar spine. Management and results after a two-year-minimum follow-up of eighty-eight patients. J Bone Joint Surg Am 80(12):1728–1732PubMedGoogle Scholar
  53. 53.
    Weiner BK, Walker M, Brower RS, McCulloch JA (1999) Microdecompression for lumbar spinal canal stenosis. Spine 24(21):2268–2272PubMedCrossRefGoogle Scholar
  54. 54.
    White AA, Panjabi MM (1990) Clinical biomechanics of the spine, 2nd edn. JB Lippincott, PhiladelphiaGoogle Scholar
  55. 55.
    Yakut E, Duger T, Oksuz C, Yorukan S, Ureten K, Turan D, et al (2004) Validation of the Turkish version of the Oswestry Disability Index for patients with low back pain. Spine 29(5):581–585 discussion 585PubMedCrossRefGoogle Scholar
  56. 56.
    Yone K, Sakou T (1999) Usefulness of Posner’s definition of spinal instability for selection of surgical treatment for lumbar spinal stenosis. J Spinal Disord 12(1):40–44PubMedCrossRefGoogle Scholar
  57. 57.
    Young S, Veerapen R, O’Laoire SA (1988) Relief of lumbar canal stenosis using multilevel subarticular fenestrations as an alternative to wide laminectomy: preliminary report. Neurosurgery 23(5):628–633PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Halit Çavuşoğlu
    • 1
    Email author
  • Ramazan Alper Kaya
    • 1
  • Osman Nuri Türkmenoglu
    • 1
  • Cengiz Tuncer
    • 1
  • İbrahim Çolak
    • 1
  • Yunus Aydın
    • 1
  1. 1.Department of NeurosurgeryŞişli Etfal State HospitalIstanbulTurkey

Personalised recommendations