A Comparison of Unilateral and Bilateral Laminotomies for Decompression of L4–L5 Spinal Stenosis

Hong, Seongwon; Choi, Ki Young; Ahn, Yong; Baek, Oon Ki; Wang, Jeffrey C.; Lee, Sang-Ho; Lee, Hoyeon

doi:10.1097/brs.0b013e3181db998c

Cited by 69 publications

(66 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The postoperative CT scans demonstrated sufficient decompression with no residual stenosis. Mean preoperative measurement of dural sac diameter on MRI in millimeters was 63.3±19.6 compared to 181.3±35.5 post-operatively with mean improvement of 118 which mirror results obtained by Hong et al, 19 Nonetheless, no statistical relationship between decompression magnitude and clinical outcome. 36 The minimally invasive nature of MEDL for LCS goes hand in hand with lower EBL (estimated blood loss), and shorter days of hospitalization compared to open laminectomy.…”

supporting

confidence: 71%

“…Clinical and Functional outcomes were analyzed utilizing Visual analogue scale for back and leg pain (VAS score from 0 to 10 where 0 indicate no pain and 10 points out the worst possible pain) as well as Japanese Orthopedic Association (JOA) score (maximum 29 points) 19 for low back pain. Both measures were applied pre-procedural and 3 months post-operative.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Microendoscopic bilateral Decompression via Unilateral Approach in Single and Multiple Level Lumbar Canal Stenosis: A Series of 583 Cases

Kabil

Ebrahim

2017

Egyptian Spine Journal

View full text Add to dashboard Cite

Background Data: Traditionally, lumbar canal stenosis (LCS) has been treated with conventional laminectomy involving wide resection of posterior supporting structures of the lumbar spine such as the supraspinous and inter-spinous ligamentum complex, the spinous process as well as wide areas of the lamina. In addition, this required a large incision of the skin and underlying musculoligamentous complex (posterior tension band). Purpose: The current study focuses on the clinical outcome and utility of minimally invasive microendoscopic decompression from a unilateral approach in surgical management of patients with single and multiple level lumbar canal stenosis. The objective is to describe the indications, significance and applications of endoscopic spine surgery in patients with single and multiple level LCS. Additionally, to highlight important anatomical perspectives of the technique and share surgical experience and results. Study Design: A retrospective clinical case study. Patients and Methods: From May 2008 to January 2016, 583 consecutive patients were treated for LCS and included in this study. Patients' main complaint was bilateral neurogenic claudication in addition to back pain and sciatic neuralgia. Single level decompression was performed in 468 (80%) patients and multiple level decompressions in 115 (20%) patients. Magnetic resonance imaging (MRI), computed tomography (CT) scan and plain X-rays were performed for all patients to confirm evidence of central stenosis and then repeated postoperatively. All patients were followed up for at least 3 months and their data collected. Clinical and functional outcomes were assessed using Visual Analogue Scale (VAS) and the Japanese Orthopedic Association Score (JOA) score for lumbar disease. Results: Compared to preoperative complaint, there was an improvement of back pain in 77.9% of patients and in radiating leg pain in 86.3%. With regards to functional outcomes, median preoperative JOA score was 14.93 ± 0.48 and improved postoperatively to 27.17 ± 1.45 (p < 0.001). The mean operating time per level was 78 minutes, and the mean intraoperative blood loss per level was 18 ml. Complications mainly included dural tears in 27 (4.6%) patients, transient postoperative dysesthesia in 46/583 (7.9%) patients and excess bony work in the form of unintended medial facetectomy in 38/583 (6.5%) patients and fracture of the spinous process in 3 (0.5%) patients.

show abstract

supporting

confidence: 71%

Section: Methodsmentioning

confidence: 99%

Microendoscopic bilateral Decompression via Unilateral Approach in Single and Multiple Level Lumbar Canal Stenosis: A Series of 583 Cases

Kabil

Ebrahim

2017

Egyptian Spine Journal

View full text Add to dashboard Cite

show abstract

“…9,10 In this study, the VAS was used to measure pain intensity. Patients were asked to rate their current level of pain ranging from 0 to 10 with 0 indicating no pain and 10 indicating the worst pain they can imagine.…”

Section: Outcome Measuresmentioning

confidence: 99%

Outpatient minimally invasive spine surgery using endoscopy for the treatment of lumbar spinal stenosis among obese patients

Hudak

Perry

2015

Journal of Orthopaedics

View full text Add to dashboard Cite

“…Celik et al [10] observed an increased spinal instability after total laminectomy, leading to a bilateral microdecompressive approach to reduce this problem. Hong et al confuted this fact in their study [11], showing that bilateral decompression also increases the translational stress, thereby increasing the acquired listhesis. In their opinion, a unilateral decompression might reduce the risk of late instability.…”

Section: Radiological Outcomementioning

confidence: 90%

“…In particular, mechanical overload, devascularisation and decortication of the pars interarticularis seem to be important factors in developing a spondylolisthesis after spinal fusion [4,5]. In decompressive surgery, extensive bony resection can lead to post-operative lumbar instability and thus to spondylolisthesis [3,[9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Early results of stand-alone anterior lumbar interbody fusion in iatrogenic spondylolisthesis patients

et al. 2013

View full text Add to dashboard Cite

Background Iatrogenic spondylolisthesis is a challenging condition for spinal surgeons. Posterior surgery in these cases is complicated by poor anatomical landmarks, scar tissue adhesion of muscle and dural structures and difficult access to the intervertebral disc. Anterior interbody fusion provides an alternative treatment method, allowing indirect foraminal decompression, reliable disc clearance and implantation of large surface area implants. Materials and methods A retrospective chart review of patients with iatrogenic spondylolisthesis including preand post-operative Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) scores was performed. Imaging criteria were pelvic incidence, overall lumbar lordosis and segmental lordosis. In addition, the fusion rate was investigated after 6 months. Results Six consecutive patients treated between 2008 and 2011 (4 female, 2 male, mean age 61 ± 7.1 years) were identified. The initially performed surgeries included decompression with or without discectomy; posterior instrumented and non-instrumented fusion. The olisthetic level was in all cases at the decompressed level. All patients were revised with stand-alone anterior interbody fusion devices at the olisthetic level filled with BMP 2. Average ODI dropped from 49 ± 11 % pre-operatively to 26.0 ± 4.0 at 24 months follow-up. VAS average dropped from 7 ± 1 to 2 ± 0. Mean total lordosis of 39.8 ± 2.8°i ncreased to 48.5 ± 4.9°at pelvic incidences of 48.8 ± 6.8°pre-operatively. Mean segmental lordosis at L4/5 improved from 10.5 ± 6.7°to 19.0 ± 4.9°at 24 months. Mean segmental lordosis in L5/S1 increased from 15.1 ± 7.4°to 23.2 ± 5.6°. Cage subsidence due to severe osteoporosis occurred in one case after 5 months, and hence there was no further follow-up. Fusion was confirmed in all other patients. Conclusion Anterior interbody fusion offers good stabilisation and restoration of lordosis in iatrogenic spondylolisthesis and avoids the well-known problems associated with reentering the spinal canal for revision fusions. In this group, ODI and VAS scores were improved.

show abstract

A Comparison of Unilateral and Bilateral Laminotomies for Decompression of L4–L5 Spinal Stenosis

Cited by 69 publications

References 19 publications

Microendoscopic bilateral Decompression via Unilateral Approach in Single and Multiple Level Lumbar Canal Stenosis: A Series of 583 Cases

Microendoscopic bilateral Decompression via Unilateral Approach in Single and Multiple Level Lumbar Canal Stenosis: A Series of 583 Cases

Outpatient minimally invasive spine surgery using endoscopy for the treatment of lumbar spinal stenosis among obese patients

Early results of stand-alone anterior lumbar interbody fusion in iatrogenic spondylolisthesis patients

Contact Info

Product

Resources

About