Outcomes after decompressive laminectomy for lumbar spinal stenosis: comparison between minimally invasive unilateral laminectomy for bilateral decompression and open laminectomy

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The development of minimally invasive surgical techniques is driven by the quest for better patient outcomes. There is some evidence for the use of minimally invasive surgery for degenerative lumbar spine stenosis (LSS), but there are currently no studies comparing outcomes with matched controls. The object of this study was to compare outcomes following minimally invasive unilateral laminectomy for bilateral decompression (ULBD) to a standard “open” laminectomy for LSS.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The authors conducted a prospective, 1:1 randomized trial comparing ULBD to open laminectomy for degenerative LSS. The study enrolled 79 patients between 2007 and 2009, and adequate data for analysis were available in 54 patients (27 in each arm of the study). Patient demographic characteristics and clinical characteristics were recorded and clinical outcomes were obtained using pre- and postoperative Oswestry Disability Index (ODI) scores, visual analog scale (VAS) scores for leg pain, patient satisfaction index scores, and postoperative 12-Item Short Form Health Survey (SF-12) scores.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Significant improvements were observed in ODI and VAS scores for both open and ULBD interventions (p &lt; 0.001 for both groups using either score). In addition, the ULBD-treated patients had a significantly better mean improvement in the VAS scores (p = 0.013) but not the ODI scores (p = 0.055) compared with patients in the open-surgery group. ULBD-treated patients had a significantly shorter length of postoperative hospital stay (55.1 vs 100.8 hours, p = 0.0041) and time to mobilization (15.6 vs 33.3 hours, p &lt; 0.001) and were more likely to not use opioids for postoperative pain (51.9% vs 15.4%, p = 0.046).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Based on short-term follow-up, microscopic ULBD is as effective as open decompression in improving function (ODI score), with the additional benefits of a significantly greater decrease in pain (VAS score), postoperative recovery time, time to mobilization, and opioid use.</jats:p></jats:sec>

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

“…Contrariwise, the imperative wide exposure and surgical resection is accompanied with disruption of posterior ligamentous complex increasing postprocedural spinal instability and concomitant fusion procedures which multiply incidence of rehospitalization and major complication by two and three folds respectively. 32 Johnsson et al, 23 found 40% of postoperative slippage following laminectomies. Moreover; expansive laminectomy and multifidus denervation posterior to injury of medial branch of dorsal ramus is the proposed theory for failed back spinal surgery syndrome cause of post-operative muscular atrophy evident on electromyogram and CT. 39,46 Additionally, as a major procedure, open laminectomy is coupled with intraoperative great blood loss, lengthy procedural time and postoperative significant pain and prolonged hospital stays.…”

“…51 Knowing that neural compromise usually takes place at the level of inter-laminar window; less invasive spine surgeries in form of laminotomy procedure has been developed as an alternate to laminectomy with advantage of preserving the posterior column function. 26,32 McCulloch's and Young 28 introduced unilateral microscopic hemilaminotomy procedure as one step ahead toward reducing tissue trauma and minimizing risk of iatrogenic post-operative instability to the lowest extent.…”

Perioperative outcomes in minimally invasive lumbar spine surgery: A systematic review

“…Watanabe et al [16] examined the visual analog scale (VAS) score for postoperative wound pain on postoperative day 7 and found a VAS of 16 (± 17) for MIS patients and a VAS of 34 (± 31) for open laminectomies, a statistically significant difference (P = 0.04). Mobbs et al [17] examined postoperative narcotic use during hospital stay and found an intravenous morphine equivalent of 9.3 mg in MIS patients and 42.8 mg in open patients, a difference of unknown statistical significance (P value not stated). Komp et al [21] reported that "no operation related pain medication was required" in their MIS case series.…”

“…Laminectomy: Unilateral laminectomy for bilateral decompression LSS, no spondylolisthesis > 1 74 -Nomura et al [22] 2012 Laminectomy: Unilateral laminectomy for bilateral decompression: Paramedian approach LSS, no discectomy 70 -Tomasino et al [23] 2009 Laminectomy: Unilateral laminectomy for bilateral decompression LSS, herniation in obese 28 -Wada et al [24] [14] 259 ± 122 193 ± 68 154 ± 135 132 ± 128 --4.0 ± 2.9 7.2 ± 1.6 Usman et al [15] 69 ± 0.1 65 ± 0.1 ----4.7 ± 0.5 3.5 ± 0.5 Mobbs et al [17] - [18] 110 ± 10 157 ± 7 52 ± 14 246 ± 32 5% 8% 2.1 ± 0.7 4.1 ± 0.4 Nomura et al [19] 187 ± 68 -90 ± 94 -2% ---Parikh et al [20] 118 ± 40 -41 ± 90 -11% -1.2 1.3 Komp et al [21] …”

“…Identified pertinent studies are shown in Table 1, including three randomized controlled trials (RCTs) (Cho et al [14] , Usman et al [15] and Watanabe et al [16] ), one incompletely randomized trial (Mobbs et al [17] ; randomized by consecutive, odd/even patient order [18] ), and one cohort comparison study [12] . In Table 2 Three studies specifically examined rates of post operative pain in these patient groups.…”