Unilateral laminectomy for bilateral decompression improves low back pain while standing equally on both sides in patients with lumbar canal stenosis: analysis using a detailed visual analogue scale

Abstract

Background Unilateral laminectomy for bilateral decompression (ULBD) for lumbar spinal stenosis (LSS) is a less invasive technique compared to conventional laminectomy. Recently, several authors have reported favorable results of low back pain (LBP) in patients of LSS treated with ULBD. However, the detailed changes and localization of LBP before and after ULBD for LSS remain unclear. Furthermore, unsymmetrical invasion to para-spinal muscle and facet joint may result in the residual unsymmetrical symptoms. To clarify these points, we conducted an observational study and used detailed visual analog scale (VAS) scores to evaluate the characteristics and bilateral changes of LBP and lower extremity symptoms. Methods We included 50 patients with LSS treated with ULBD. A detailed visual analogue scale (VAS; 100 mm) score of LBP in three different postural positions: motion, standing, and sitting, and bilateral VAS score (approached side versus opposite side) of LBP, lower extremity pain (LEP), and lower extremity numbness (LEN) were measured. Oswestry Disability Index (ODI) was used to quantify the clinical improvement. Results Detailed LBP VAS score before surgery was 51.5 ± 32.5 in motion, 63.0 ± 30.1 while standing, and 37.8 ± 31.8 while sitting; and showed LBP while standing was significantly greater than LBP while sitting ( p < 0.01). After surgery, LBP while standing was significantly improved relative to that while sitting ( p < 0.05), and levels of LBP in the three postures became almost the same with ODI improvement. Bilateral VAS scores showed significant improvement equally on both sides ( p < 0.01). Conclusions ULBD improves LBP while standing equally on both sides in patients with LCS. The improvement of LBP by the ULBD surgery suggests radicular LBP improved because of decompression surgery. Furthermore, the symmetric improvement of LBP by the ULBD surgery suggests unsymmetrical invasion of the paraspinal muscles and facet joints is unrelated to residual LBP.

Characteristics of Relief and Residual Low Back Pain After Discectomy in Patients With Lumbar Disc Herniation: Analysis Using a Detailed Visual Analogue Scale

“…In our study, LBP during motion was signi cantly greater in patients with LDH before surgery, and the LBP in motion on the affected side was reduced by discectomy. This pattern of LBP relief suggests that radicular LBP is improved by nerve root decompression surgery, as mentioned in previous reports [1,6]. Despite this similarity regarding nerve root decompression, however, greater LBP during motion that occurred with LDH patients was different than the increased LBP while standing found in LSS patients.…”

“…To our knowledge, this study is the rst to evaluate the characteristics and location of LBP in patients with LDH treated with discectomy. According to the previous study analyzed detailed and bilateral VAS scores for LSS patients, LBP in patients with LSS before surgery was signi cantly greater while standing, but pain was reduced by decompression surgery, with LBP improving equally on the affected and opposite sides [6]. In our study, LBP during motion was signi cantly greater in patients with LDH before surgery, and the LBP in motion on the affected side was reduced by discectomy.…”

“…Based on past reports, a detailed VAS (100 mm) for LBP under 3 postural conditions: in-motion, standing, and sitting were administered (Fig. 1A) [5,6]. In addition, the location (left versus right side) of LBP, LEP, and LEN were administered and analysis were performed divided into the affected (approached) and opposite side ( Fig.…”

“…In addition, the location (left versus right side) of LBP, LEP, and LEN were administered and analysis were performed divided into the affected (approached) and opposite side ( Fig. 1B) [6]. In the patients with bilateral symptoms who underwent bilateral laminectomy and herniation extirpation, we established the affected side as the one that was more symptomatic and more extensively herniated on MRI.…”

“…Those studies were unable to discuss detailed changes in LBP and the characteristics of relief and residual LBP. On the other hand, recent reports have clari ed the characteristics of LBP using a detailed VAS for some lumbar degenerative disorders, including spondylolysis and lumbar spinal stenosis (LSS) [5,6,7]. Nevertheless, there are few reports of the detailed changes and location of LBP before and after discectomy for LDH.…”