AIm:The carpal tunnel syndrome (CTS) is the commonest compressive neuropathy. Electromyography (EMG) is accepted as gold standard in diagnosis of CTS. However, pathologies and variations that are associated with a various findings may lead to failure. sOnuÇ: Klinik ve EDT ile KTS tanısı alan hastalarda bilek MRİ eşlik eden patolojileri ortaya koyabilmektedir. Ek patolojiler uygulanacak cerrahi şeklini değiştirebileceği gibi, postoperatif başarısızlığı da azaltılacaktır. Özellikle belirgin predispozan faktörü olmayan, tek taraflı KTS öyküsü bulunan, kliniğinde şüpheli semptomları olan olgularla ve endoskopik cerrahi planlanan hastalara el bileği MRİ önerilir.

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Bilateral decompression via a unilateral approach (BDUA) was initially described by Young et al. (4) and then was modified by McCulloch (5). In this technique, the risk of iatrogenic instability is reduced by preserving the facet joints. Unilateral stabilization and contralateral decompression were considered to be effective in terms of operation time, surgical complications, and patient benefit visual analogue scale in comparison to other surgical techniques for the treatment of lumbar spinal stenosis. There is no doubt that a fusion procedure should be performed in the presence of accompanying instability. However, in spinal stenosis cases without instability and spondylolisthesis less than grade 1, the role of spinal fusion is controversial. This is so because spinal instrumentation in degenerative spine may cause adjacent segment degeneration and disease. Therefore, procedures such as bilateral foraminotomy, BDUA, and

for microsurgical treatment are laminectomy (24,32), unilateral laminotomy, bilateral laminotomy, and open door laminoplasty (5). Depending on the extent of decompression, the addition of fusion and stabilization has become more common recently as well. Furthermore, minimally invasive procedures, such as microsurgical or endoscopic decompression and bilateral decompression via unilateral approach (BDUA), have become more common (2,8,11,18). BDUA was first described by Young AIM: To compare the clinical and economic results of two different surgical approaches (bilateral decompression via unilateral approach and instrumented total laminectomy and fusion) in the treatment of lumbar spinal stenosis. MATERIAL and METHODS:The clinical, surgical, and economic aspects of 100 surgically treated patients with lumbar spinal stenosis were retrospectively reviewed. RESULTS:Decompression was performed at 158 levels in 100 patients. The most commonly decompressed levels were L4-5 and L3-4. Significant difference was observed between pre-and postoperative visual analog scale scores in both groups (p<0.05). In Group 1 (instrumented total laminectomy and fusion), the mean surgery cost was 2539.2 USD (mean procedure cost: 1440.1 USD, mean implant cost: 1099.2 USD). In Group 2 (bilateral decompression via unilateral approach) the mean surgery cost was 998.5 USD. The cost difference was significant (p<0.05). CONCLUSION:Both instrumented total laminectomy and fusion and bilateral decompression via unilateral approach performed with and without stabilization showed similar clinical results in patients with lumbar spinal stenosis. However, the cost of surgery was found to be 2.5-fold higher in the instrumented total laminectomy and fusion group. This study supports the concept that minimally invasive spine surgery is cost-effective.