Microsurgical unilateral laminotomy for decompression of lumbar spinal stenosis: long-term results and predictive factors

Schöller, Karsten; Steingrüber, Thomas; Stein, Marco; Vogt, Nina; Müller, Tilman; Pons-Kühnemann, Jörn; Uhl, Eberhard

doi:10.1007/s00701-016-2804-6

Cited by 35 publications

(34 citation statements)

References 57 publications

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“…As previously reported [20, 21], the rate of excellent outcomes for surgical treatment over long periods (many years), decreases by about 70%, and this data appears to be confirmed in the present series.…”

Section: Discussionsupporting

confidence: 92%

Assessing the real benefits of surgery for degenerative lumbar spinal stenosis without instability and spondylolisthesis: a single surgeon experience with a mean 8-year follow-up

Caruso

Pesce²,

Martines

et al. 2018

J Orthop Traumatol

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BackgroundThe degenerative lumbar spinal stenosis is one of the most commonly treated spinal disorders in older adults; despite its increasing frequency, it is not yet clear what the most effective therapy might be. The aim of this study is to investigate the very long term results of a homogenized cohort of patients suffering from lumbar spinal stenosis: the first subset of patients operated on with laminectomy and the second subset of patients was also advised to undergo laminectomy but never operated on.MethodsPatients from both subgroups were advised to undergo surgery, according to the same criteria, in the period between 2000 and 2010 and were re-evaluated in the period between January and December 2016.ResultsComparing the two subsets of patients, both suffering from clinically relevant LSS, the first subset returns a statistically significant clinical improvement at follow-up. The rate of excellent results decreases over years. Iatrogenic spinal instability incidence was found to be 3.8% in the present cohort.ConclusionsAlthough the improvement of the first postoperative years decreases over time and despite the lack of general consensus, the lack of established shared guidelines and the limitations of this research, the results support the utilisation of surgery for the management of this condition.Level of Evidence3.

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Section: Discussionsupporting

confidence: 92%

Assessing the real benefits of surgery for degenerative lumbar spinal stenosis without instability and spondylolisthesis: a single surgeon experience with a mean 8-year follow-up

Caruso

Pesce²,

Martines

et al. 2018

J Orthop Traumatol

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“…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…”

Section: █ Discussionmentioning

confidence: 99%

“…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).…”

Section: █ Introductionmentioning

confidence: 99%

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

Öğden

Yüksel²,

Bakar³

et al. 2018

Turkish Neurosurgery

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ligamentum flavum hypertrophy and central degenerative disc herniation. This is a clinical and radiological condition seen in more than 65% of females and 80% of males, with incidence directly related to age. In addition, degenerative spondylolisthesis, basically a facet joint lesion, develops as a consequence of degeneration of the lumbar vertebrae, resulting in hypertrophy and segmental instability in the facet joints. With age, the inferior and superior articular processes of the AIM: To investigate the mid-term efficacy of bilateral decompression with a unilateral approach (BDUA) on symptoms and quality of life of in patients with lumbar spinal stenosis (LSS), with low grade (with percentage slip <25%) degenerative spondylolisthesis or without spondylolisthesis. MATERIAL and METHODS:The study included patients who underwent BDUA due to one or two-level LSS related to degenerative spondylosis and/ or degenerative spondylolisthesis. Pre-and postoperative data of the Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), and walking distance were compared. RESULTS:Evaluation was made up of a total of 53 patients, comprising 32 males and 21 females with a mean age of 60.6 ± 9.0 years. Compared with the preoperative data, VAS, ODI and walking distance improved significantly in all patients at the 3-year follow-up examination. Furthermore, a significant improvement was determined in the clinical parameters of patients with degenerative spondylolisthesis, with no worsening of slip and no requirement for instrumentation. Moreover, when patients were separated into two groups according to age, as elderly (>60 years) and adult (<60 years), similar improvements were seen in both groups.CONCLUSION: BDUA could be quite effective in reducing pain, improving quality of life and walking distance with no worsening of the grade or degree of slipping.

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“…The microscopic decompression procedure has been previously described [6,7]. In brief, we made a 3-5cm midline incision after uoroscopic con rmation of surgical level.…”

Section: Unilateral Laminotomy For Bilateral Decompression Techniquementioning

confidence: 99%

Clinical and radiographic outcomes for microsurgical unilateral laminotomy for bilateral decompression of lumbar spinal stenosis for elderly patients-A retrospective cohort study

Lv¹

2020

Preprint

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BackgroundRecently, unilateral laminotomy for bilateral decompression (ULBD) has become a alternative to conventional decompression for symptomatic lumbar spinal stenosis (LSS),and this minimally invasive surgical technique has shown a satisfactory outcomes and low complications. However, the influence of old age on the risk of postoperative complications and clinical outcome is not well understood.OBJECTIVEThe purpose of this study was to evaluate clinical and radiographic outcomes and complication rates after ULBD in elderly patients.Study DesignSingle center retrospective observational study.SettingAll data was from the affiliated people's hospital of Jiangsu University.METHODSIn this study, 39 elderly patients were treated for lumbar spinal stenosis by ULBD between January 2016 and January 2018. Follow-up consisted of radiologic investigations, Visual Analog Scale, Oswestry Disability Index, and 36-Item Short-Form Health Survey at 6 and 12 months postoperatively. Preoperative comorbidity, postoperative complications and revision surgery rates were also analyzed.RESULTSThere were 12 female patients and 27 male patients with a mean age of 75.83 ± 9.16 years. 20 patients had one levels of spinal stenosis, 13 patients had two levels of stenosis, 6 patients had three levels of stenosis. Average follow-up time was 14.6 ± 7.8 months (range, 6–24 months), Total complications were 10.2%(4/39),and reoperation rate was 2.5%(1/39). Oswestry Disability Index scores decreased significantly (from 32.26 ± 6.82 to 11.44 ± 2.50 at 6 months and 10.56 ± 2.29 at 12 months), and 36-Item Short-Form Health Survey parameter scores demonstrated a significant improvement in the follow-up results.LimitationA multi-center study is recommended to confirm our findings and explore the factors related to clinical and radiographic outcomes.CONCLUSIONSULBD for lumbar spinal stenosis is a safe and effective treatment for elderly patients, improves these patients’ quality of life and does not pose an increased risk of complications.

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Microsurgical unilateral laminotomy for decompression of lumbar spinal stenosis: long-term results and predictive factors

Cited by 35 publications

References 57 publications

Assessing the real benefits of surgery for degenerative lumbar spinal stenosis without instability and spondylolisthesis: a single surgeon experience with a mean 8-year follow-up

Assessing the real benefits of surgery for degenerative lumbar spinal stenosis without instability and spondylolisthesis: a single surgeon experience with a mean 8-year follow-up

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

Clinical and radiographic outcomes for microsurgical unilateral laminotomy for bilateral decompression of lumbar spinal stenosis for elderly patients-A retrospective cohort study

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