Assessment of Clinical Outcome of Bilateral Decompression through Unilateral Approach in Lumbar Canal Stenosis

Abouelmaaty, Emad; Molla, Shafik El

doi:10.21608/esj.2017.5522

Cited by 4 publications

(5 citation statements)

References 11 publications

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“…18 The microscopic unilateral laminectomy aims to preserve stability by preserving midline structures like spinous process, intraspinous and supra spinous ligaments and facet joint besides Dural and foraminal decompression. 1 The purpose of this study is to evaluate the surgical outcome of patients having lumbar spinal stenosis who underwent unilateral approach for bilateral decompression surgery, and to compare outcomes between this approach and the bilateral conventional approach for bilateral neural decompression.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Using Unilateral Approach for Bilateral Neural Decompression in Lumbar Spinal Stenosis

Abbas

Elwany

Farag

2017

Egyptian Spine Journal

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Background Data: Lumbar spinal stenosis refers to the anatomical narrowing of the lumbar spinal canal, and is associated with a spectrum of clinical symptoms. The annual incidence of lumbar spinal stenosis is reported to be five cases per 100,000 individuals. Purpose: The purpose of this study is to evaluate the surgical outcome of patients having lumbar spinal stenosis and underwent unilateral approach for bilateral spinal decompression surgery, and to compare outcomes with the conventional laminectomy approach. Study Design: This is a prospective randomized controlled study. Patients and Methods: This study included 21 patients with clinically manifest discoligamentous lumbar spinal stenosis without radiological instability. Eleven patients had bilateral neural decompression through a unilateral microscopic approach (unilateral laminectomy) (Group-I) and the other 10 patients had conventional laminectomy (Group-II).Clinical assessment was done using Visual Analogue Scale (VAS) and ODI. The patients were followed-up for 12 months postoperatively. Results: Thirteen patients were females and 8 were males. The mean age of unilateral approach group was 47.2 years, and 49.5 years for the conventional group. Reported duration of surgery was 100 minutes in group-I and 85 minutes group-II. Reported intraoperative blood loss was 84.7 cc in group-I, and 127 cc in group-II. Clinical improvement was achieved in both groups without significant difference in between regarding VAS and ODI. In group we reported unintended durotomy occurred in two patients, CSF leak in one patient, and hematoma in another patient. In group-I we had one patient of unintended durotomy, one patient had CSF leak, and one patient developed spondylolisthesis. Conclusion: Unilateral microscopic laminoforaminotomy with cross over the top technique, for bilateral neural decompression in lumbar spinal stenosis has equal efficacy and safety with minimal effect on stability and slight better postoperative back pain in comparison to conventional approach. (2017ESJ140)

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Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Using Unilateral Approach for Bilateral Neural Decompression in Lumbar Spinal Stenosis

Abbas

Elwany

Farag

2017

Egyptian Spine Journal

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“…Global sagittal balance, spinopelvic morphology, and sagittal alignment should be considered as important factors in surgical planning. The spinopelvic morphology affects the lumbosacral configuration and consequently, the mechanical forces at the lumbosacral junction [15][16][17][18][19][20][21][22]. In their study, most of the patients had neurologic claudication and the prevalence of sagittal imbalance in patients with lumbar canal stenosis was 31.2% which was significantly higher compared to controls [15][16][17][18][19][20][21][22].…”

Section: Discussionmentioning

confidence: 91%

“…The spinopelvic morphology affects the lumbosacral configuration and consequently, the mechanical forces at the lumbosacral junction [15][16][17][18][19][20][21][22]. In their study, most of the patients had neurologic claudication and the prevalence of sagittal imbalance in patients with lumbar canal stenosis was 31.2% which was significantly higher compared to controls [15][16][17][18][19][20][21][22]. Over the last few years, Different surgical procedures have been described for lumbar spine decompression.…”

Section: Discussionmentioning

confidence: 98%

“…North American Spine Society (NASS) guidelines suggest the use of decompressive surgery as a means of improving outcomes not only in patients with severe symptoms of LSS but in those with moderate symptoms as well [17]. Ramhmdani et al reported that of 105 patients with decompression in the form of laminectomies across 1-4 levels, 10 patients (9.5%; 5 male and 5 female with an average age of 63.0±11.2 years) complicated with iatrogenic spondylolisthesis at the same operated levels that required another surgery [18].…”

Section: Discussionmentioning

confidence: 99%

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Spinopelvic Parameters Following Central Decompressive Laminoplasty in Patients with Degenerative Lumbar Spinal Canal Stenosis

Saleh

2023

RISM

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Background data: Central Decompressive Laminoplasty (CDL) is a minimally invasive lumbar surgery that provides a wide decompression of neural components while maintaining the spine's stability and minimal resection of critical osteoligamentous structures. Purpose:The present study aims to assess the outcome and long-term results of CDL in the treatment of patients with degenerative lumbar canal stenosis regarding post-operative spinopelvic parameters, symptom relief, postoperative back pain, and wound complications. Study design: Patient Sample, Outcome Measures: A retrospective study was conducted over 30 patients and carried out at Zagazig university Hospital, Spine units, Orthopedic department, from October 2019 to May 2021.Patients and methods: Pre-operative radiological assessment was done using standing lumbosacral X-rays (anteroposterior, lateral, flexion and extension views), MRI, and/or CT, with obtaining following parameters using the Surgimap computer program; Spino-pelvic parameters using X-ray, AP Dural sac diameter (mm), Dural Sac Cross-Sectional Area (DSCSA) (mm2). Clinical evaluation was done with (VAS), and the Oswestry Disability Index (ODI). Result:The study showed no significant change in spinal stability, the mean pre-operative PT, PI, SS and LL were 20.81±6.58°, 49.31±12.54°, 29.37±4.32° and 35.44±12.36° respectively, while the post-operative PT, PI, SS, and LL were 21.10±5.79°, 51.30±11.69°, 30.86±5.81° and 37.69±9.82° respectively. The study showed improvement of VAS from 8.16±0.71 to 1.20±0.41 showing 84.5% improvement, while VAS of low back pain improved from 4.33±1.07 to 1.75±0.62 showing 59.5% improvement. The mean anteroposterior thecal diameter improved from 6.54±1.2mm to 12.79±1.6mm with 95.6% improvement. Conclusion:CDL is a safe, effective, less invasive, and easily applied surgical decompressive technique for treating degenerative LSS. The technique does not affect the spinopelvic parameters negatively.

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“…Last but not least, disc degradation and the apparent instability of spondylolisthesis may be brought on by laxity of ligaments and capsules even while these reactive processes fail to stabilize the segment (1,2) The location of the spine has an impact on the nerve root compression caused by these pathoanatomical modifications. The neural foramina, central canal, or lateral recess are three separate anatomic sites where narrowing can be precisely defined (3)(4)(5)(6)(7) .…”

Section: Introductionmentioning

confidence: 99%

Outcome of Microscopic Unilateral Laminotomy for Bilateral Decompression of Acquired Lumbar Spinal Stenosis

Youssef¹,

Ismaeil²,

Elawamry³

et al. 2023

The Egyptian Journal of Hospital Medicine

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Background: Degenerative lumbar spinal stenosis (LSS) remains one of the most common indications for lumbar spine surgery in elderly patients. Aim of the study: to assess the results of a minimally invasive bilateral decompression surgery with a unilateral laminectomy (ULBD). Patients and methods: an upcoming clinical trial investigation was conducted at the Neurosurgery Department of Zagazig University hospital during the period from November 2021 to August 2022. 24 patients were included in our study. Demographic, Clinical outcomes were assessed, both before and after surgery, The Visual Analogue Scale was used to rate leg and low back discomfort (VAS). Before and after surgery, disability was assessed using the Oswestry Disability Index (ODI) 3 months postoperatively. Pre-and postoperative measurements of the size of the spinal canal and the approximate cross-sectional area (CSA) of the dural sac were made. Results: VAS for low back pain (LBP) improved from 6.83 ± 2.65 to 1.79 ± 0.70, while VAS for leg pain improved from 6.54 ± 3.04 to 1.87 ± 0.59. ODI significantly decreased from 57 ± 6.75 % to 18.58 ± 5.01 %. A-P diameter increased from 9.12 ± 0.46 to 13.60 ± 0.61 mm, while. ADSCSA of the stenotic levels increased from 90.67 ± 4.32 to 167.37 ± 26.74 mm 2 . Conclusion: ULBD techniques is effective and safe procedure for LSS treatment, with good postoperative outcome.

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Assessment of Clinical Outcome of Bilateral Decompression through Unilateral Approach in Lumbar Canal Stenosis

Cited by 4 publications

References 11 publications

Efficacy and Safety of Using Unilateral Approach for Bilateral Neural Decompression in Lumbar Spinal Stenosis

Efficacy and Safety of Using Unilateral Approach for Bilateral Neural Decompression in Lumbar Spinal Stenosis

Spinopelvic Parameters Following Central Decompressive Laminoplasty in Patients with Degenerative Lumbar Spinal Canal Stenosis

Outcome of Microscopic Unilateral Laminotomy for Bilateral Decompression of Acquired Lumbar Spinal Stenosis

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