A comparison of bilateral decompression via unilateral approach and classic laminectomy in patients with spinal stenosis

Abstract

AIm: Bilateral decompression via unilateral approach is one of the minimally invasive methods used for degenerative spinal stenosis. The aim of this retrospective study was to observe the clinical and radiological results of classic laminectomy and bilateral decompression via unilateral approach applied for lumbar stenosis. mATERIAl and mEThods:The data of 40 patients who underwent surgical treatment for lumbar spinal stenosis with different techniques was reviewed retrospectively. The patients were divided into 2 groups according to the surgical technique. In the first group, patients underwent classic laminectomy, while in the second group patients underwent bilateral decompression via unilateral approach. Preoperative and postoperative computed tomography section areas of both groups were examined. Visual analogue scale (VAS) was used to evaluate low back and leg pain in preoperative and postoperative 1, 6, and 12 months. The two groups were compared in respect of surgery time and bleeding. REsulTs:In both groups, postoperative low back and leg pain VAS scores declined compared to the preoperative condition. Low back pain VAS scores were lower at postoperartive 1, 6, and 12 months. The bleeding was higher in the 1st group, whereas the surgery time was higher in the 2nd group.CoNClusIoN: Bilateral decompression through unilateral approach is an effective method without instability effect, which provides sufficient decompression in the degenerative stenosis and increases patient comfort in the postoperative period.KEywoRds: Lumbar stenosis, Unilateral approach, Minimally invasive ÖZ AmAÇ: Dejeneratif lomber dar kanalda kullanılan minimal invaziv yöntemlerden bir tanesi tek taraflı girişimle iki taraflı dekompresyondur. Bu retrospektif çalışmada, klasik laminektomi ile tek taraflı girişimle iki taraflı dekompresyon sağlanan lomber dar kanal hastalarının klinik ve radyolojik sonuçlarını karşılaştırdık. yÖNTEm ve GEREÇlER: Lomber stenoz tanısı olan ve farklı tekniklerle opere edilen 40 hastanın verileri retrospektif olarak değerlendirildi. Hastalar uygulanan cerrahi tekniğe göre 2 ayrı gruba ayrıldı. Birinci gruptaki hastalar klasik laminektomi uygulanan hastalar iken, ikinci gruptaki hastalar ise tek taraflı girişimle iki taraflı dekompresyon yapılan olgulardı. Her iki grup için ameliyat öncesi ve sonrası aksiyel bilgisayarlı tomografi görüntüleri elde edildi. Hastaların bel ve bacak ağrıları 1. ayda, 6. ayda ve 12. ayda vizüel analog skalası (VAS) ile değerlendirildi. Her iki grup ameliyat süresi ve kanama miktarı ile de karşılaştırıldı.BulGulAR: Her iki grupta da ameliyat sonrası bel ve bacak ağrıları için VAS değerlerinde azalma görüldü. İkinci grup için bel ağrısı VAS değerleri 1. ayda, 6. ayda ve 12. ayda birinci gruba göre düşüktü. Kanama miktarı birinci grupta daha fazlayken ameliyat süresi ikinci grupta daha fazlaydı. soNuÇ: Tek taraflı girişimle iki taraflı dekompresyon lomber dar kanal hastalarında kullanılan minimal invaziv, instabilite yaratmadan yeterli dekompresyon sağlayan ve hastanın cerra...

Comparison of Three Different Surgical Treatment Procedures Used in the Treatment of Lumbar Spinal Stenosis; Retrospective Clinical Study

“…Cavuşoğlu et al (14) found the patient's satisfaction rate to be 94% and the recovery rate to be 96% during the 18-24-month follow-up periods of patients with BDUA. In their study comparing clinical and radiological results of BDUA and classical laminectomy, Yaman et al (15) found differences in VAS scores of leg pain in the postoperative 6 th and 12 th months. However, low back pain VAS scores in patients with BDUA were found to be significantly lower.…”

The effects of microdecompression on quality of life in patients who have lumbar degenerative spinal stenosis with or without degenerative spondylolisthesis

“…This technique incorporates a midline incision, opening the fascia, retracting the muscles, hemilaminectomy, bilateral flavectomy, and decompression (5,18). Since BDUA has several advantages such as less blood loss, a shorter stay in hospital, lower complication rates, and less traumatization of surrounding tissues, it has been increasingly applied by neurosurgeons for the treatment of LSS over the past two decades (1,4,13,14,16,19,22). However, this technique has some disadvantages such as accidental dural tears, root…”

“…Machado et al reviewed different surgical methods for decompression and widening the spinal canal in LSS and reported that decompression plus fusion, or expanding the interspinous process spaces was not superior to conventional decompression alone (12,17). Many current articles have suggested the avoidance of bilateral laminectomy and instrumentation because bilateral decompression with a unilateral approach (BDUA) has been shown to be effective in reducing pain, increasing walking distance, and improving disability (1,13,14,16,19,22). However, some reports have demonstrated that although unilateral laminectomy is effective in the early postoperative period, it has poor outcomes in the long term (approximately 5 years) (6,10).…”

The clinical comparison between the patients operated for unilateral radiculopathy via contralateral(facet-sparing)and ipsilateral side approach

“…Many minimally invasive methods have been developed with rapidly increasing use to overcome this condition (7,14). The most important of these methods is bilateral decompression with a unilateral approach (15). However, in order to perform decompression on the side with facet joint hypertrophy, the facet joints must still be shaved.…”