Treatment of lumbar spinal stenosis by extensive unilateral decompression and contralateral autologous bone fusion: operative technique and results

Abstract

A new surgical technique for the treatment of lumbar spinal stenosis features extensive unilateral decompression with undercutting of the spinous process and, to preserve stability, uses contralateral autologous bone fusion of the spinous processes, laminae, and facets. The operation was performed in 29 patients over a 19-month period ending in December of 1991. All individuals had been unresponsive to conservative treatment and presented with low-back pain in addition to signs and symptoms consistent with neurogenic claudication or radiculopathy. Nine had undergone previous lumbar decompressive surgery. The minimum and mean postoperative follow-up times were 2 and 2 1/2 years, respectively. The mean patient age was 64 years; only two patients were younger than 50 years of age. Of the patients with neurogenic claudication, 69% reported complete pain relief at follow-up review. Of those with radicular symptoms, 41% had complete relief and 23% had mild residual pain that was rated 3 or less on a pain-functionality scale of 0 to 10. For the entire sample, this surgery decreased pain from 9.2 to 3.3 (p < 0.0001) on the scale. Sixty-nine percent of patients were satisfied with surgery. Low-back pain was significantly relieved in 62% of all patients (p < 0.0001). Low-back pain relief correlated negatively with number of levels decompressed (p < 0.05). To assess fusion, follow-up flexion/extension radiographs were obtained, and no motion was detected at the surgically treated levels in any patient. The results suggest that this decompression procedure safely and successfully treats not only the radicular symptoms caused by lateral stenosis but also the neurogenic claudication symptoms associated with central stenosis. In addition, the procedure, by using contralateral autologous bone fusion along the laminae and spinous processes, can preserve stability without instrumentation.

Lumbar spinal stenosis in elderly patients: is a unilateral microsurgical approach sufficient for decompression?

“…Less invasive procedures, such as unilateral partial hemilaminectomies with transmedian removal of the compressive elements, are being used more frequently for the decompression of lumbar spinal stenosis in elderly patients. 8 This procedure is of a shorter duration. Compared with laminectomy, a unilateral partial hemilaminectomy results in less injury to paraspinal structures and provides a sufficient decompression.…”

“…The surgical armamentarium includes procedures such as interspinous spacer implantation 2 and different kinds of unilateral and bilateral partial or full hemilaminectomies. 8 Nowadays, it is not very clear which of the techniques in practice is the most favorable. There are also results that did not confirm longterm effects of surgery when compared with conservative treatment only.…”

A less invasive surgical approach in the lumbar lateral recess stenosis: direct approach to the medial wall of the pedicle

“…Besides extensive procedures of laminectomy, bilateral multilevel fenestration and bilateral fenestration restricted to the clinically relevant level have been used [2,4,7,13,17,18,24,29,32,35,41,43]. Some fenestration studies are focused on the symptomatic stenotic side and if present, the contralateral asymptomatic but stenotic lateral recess is ignored [29,32].…”

Posterior lumbar interbody fusion in the treatment of symptomatic spinal stenosis

“…[9,18,21,26,30,49,50,52] Spinal fusion, PLIF in particular, is technically more demanding to perform than decompressive surgery. Potential long-term consequences of segmental fusion, notably accelerated adjacent-level degeneration, must be further investigated and characterized.…”

“…Several recent, well-designed studies underscore the need for more effective treatments and outcome measures. [18,39,40,51,[68][69][70] Katz and associates [39] prospectively studied 194 patients treated with decompressive laminectomy for degenerative lumbar stenosis and reported that 22% of patients were somewhat or very dissatisfied with the results of surgery 6 months postoperatively. McCullen, et al, [50] reviewing 118 patients who underwent lumbar decompression for acquired spinal stenosis, reported 50% good, 27% fair, and 23% poor outcomes with an overall reoperation rate of 9%.…”