Limited Unilateral Decompression and Pedicle Screw Fixation with Fusion for Lumbar Spinal Stenosis with Unilateral Radiculopathy: A Retrospective Analysis of 25 Cases

Abstract

ObjectiveLumbar spinal stenosis is conventionally treated with surgical decompression. However, bilateral decompression and laminectomy is more invasive and may not be necessary for lumbar stenosis patients with unilateral radiculopathy. We aimed to report the outcomes of unilateral laminectomy and bilateral pedicle screw fixation with fusion for patients with lumbar spinal stenosis and unilateral radiculopathy.MethodsPatients with lumbar spinal stenosis with unilateral lower extremity radiculopathy who received limited unilateral decompression and bilateral pedicle screw fixation were included and evaluated using visual analog scale (VAS) pain and the Oswestry Disability Index (ODI) scores preoperatively and at follow-up visits. Ligamentum flavum thickness of the involved segments was measured on axial magnetic resonance images.ResultsTwenty-five patients were included. The mean preoperative VAS score was 6.6±1.6 and 4.6±3.1 for leg and back pain, respectively. Ligamentum flavum thickness was comparable between the symptomatic and asymptomatic side (p=0.554). The mean follow-up duration was 29.2 months. The pain in the symptomatic side lower extremity (VAS score, 1.32±1.2) and the back (VAS score, 1.75±1.73) significantly improved (p=0.000 vs. baseline for both). The ODI improved significantly postoperatively (6.60±6.5; p=0.000 vs. baseline). Significant improvement in VAS pain and ODI scores were observed in patients receiving single or multi-segment decompression fusion with fixation (p<0.01).ConclusionLimited laminectomy and unilateral spinal decompression followed by bilateral pedicle screw fixation with fusion achieves satisfactory outcomes in patients with spinal stenosis and unilateral radiculopathy. This procedure is less damaging to structures that are important for maintaining posterior stability of the spine.

Clinical and Radiological Comparison between Ipsilateral and Contralateral Side Canal Decompression Using an Unilateral Laminotomy Approach

“…Laminectomy has been widely used in the treatment of lumbar spinal stenosis 15 18) . Destruction of the spinal bony and ligamentous structures with concomitant instability and peridural scar formation are the main problems with this procedure 5 19 20) . To overcome these significant disadvantages, many procedures have been proposed.…”

Comparative Cohort Study for Expansion of Lateral Recess and Facet Joint Injury after Biportal Endoscopic Ipsilateral Decompression and Contralateral Decompression

“…Given that a significant proportion of patients present only with unilateral radiculopathy, it is hypothesized that it may not be necessary to decompress the asymptomatic side [ 18 ]. In series of Zhang et al [ 18 ], the lamina, facet joint, and flavum of the asymptomatic side were left intact. Decompression up to the midline was carried out on the symptomatic side until the base of spinous process was reached [ 18 ].…”

“…In series of Zhang et al [ 18 ], the lamina, facet joint, and flavum of the asymptomatic side were left intact. Decompression up to the midline was carried out on the symptomatic side until the base of spinous process was reached [ 18 ]. In our series, the symptomatic side was first decompressed after unilateral laminotomy.…”

Comparing Mean Post-Operative Back Pain Score between Hemilaminectomy and Conventional Laminectomy in Patients of Lumbar Stenosis

“…More than eighty percent of the patients with this condition, improve successfully through decompression surgery. 14 But it should be done after the failure of the medical and physiotherapy conservative management. 2 Current prevailing approaches include laminectomy with or without fusion, laminotomy with medial facetectomy, laminoplasty, minimally invasive bilateral decompression, unilateral laminectomy with bilateral decompression, and placement of an interspinous device.…”