Unilateral tubular approach for bilateral laminotomy: effect on ipsilateral and contralateral buttock and leg pain

Alimi, Marjan; Hofstetter, Christoph P.; Torres-Campa, Jose M.; Navarro-Ramírez, Rodrigo; Cong, Guang‐Ting; Njoku, Innocent; Härtl, Roger

doi:10.1007/s00586-016-4594-1

Cited by 38 publications

(29 citation statements)

References 43 publications

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“…Surgical procedures aim to decompress the nerve root emerging from the thecal sac along its course in the lateral recess. A multitude of surgical procedures for surgical decompression of symptomatic lateral recess stenosis have been described ranging from standard open laminectomies to minimally invasive decompressive techniques (14)(15)(16)(17)(18)(19)(20)(21)(22). In the current study we describe the surgical technique of endoscopic interlaminar lateral recess decompression in a small cohort of patients with unilateral symptomatic lateral recess stenosis with well-defined radiographic criteria.…”

Section: Introductionmentioning

confidence: 99%

Interlaminar endoscopic lateral recess decompression—surgical technique and early clinical results

Birjandian¹,

Emerson²,

Telfeian³

et al. 2017

J. Spine Surg.

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Background: Lateral recess stenosis is a common pathology causing de-novo or residual radicular pain following lumbar spine surgery. Diagnostic criteria and treatment strategies for symptomatic lateral recess stenosis are not well established. Methods:We identified ten patients in our prospective patient database (n=146) who underwent endoscopic interlaminar decompression for unilateral symptomatic lateral recess stenosis. Lateral recess height and angle were measured on axial T2-weighted MRI. Values from the symptomatic side were compared to the contralateral side which served as asymptomatic control. Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) for back and leg pain were collected preoperatively, postoperatively and at last follow-up.Results: Preoperative MRI revealed that both lateral recess angle and height were significantly smaller on the symptomatic compared to the asymptomatic side (angle: 19.3˚ vs. 35.7˚; height: 2.9 vs. 5.7 mm; P<0.01).All patients tolerated endoscopic interlaminar decompression well and half of the patients were discharged on the day of surgery. At last follow-up (12.6±1.7 months), 8 out of 10 patients experienced a minimally clinically important improvement of their VAS for ipsilateral leg pain, which improved from 7.2±0.5 preoperatively to 2.5±0.8 postoperatively (P=0.001). The back pain VAS also improved (preoperatively 5.1±1.1 vs. postoperatively 1.7±0.9, P<0.05). The ODI improved from 50±5.8 preoperatively to 22.2±5.1 at last follow-up (P=0.001). One patient experienced persistent leg pain.Conclusions: Lateral recess height and angle correlate with symptomatic lateral recess stenosis which is effectively treated utilizing interlaminar endoscopic lateral recess decompression.

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Section: Introductionmentioning

confidence: 99%

Interlaminar endoscopic lateral recess decompression—surgical technique and early clinical results

Birjandian¹,

Emerson²,

Telfeian³

et al. 2017

J. Spine Surg.

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“…11,30,31 Patients suffering from LCS receive conservative treatment as a primary line of management for symptomatic relief, however; treatment failure or progression of neurological symptoms designate necessity for surgical resolution. 4,50 On a traditional basis, open decompressive laminectomy has been exceedingly utilized in management of LCS refractory to medical treatment with variable success rate ranging between 62-70%. 35,50,54 Nonetheless, post-procedural delayed spinal instability with concomitant rise in fusion procedures attributable to loss of native support taken over by posterior osseoligamentous structures was a major concern.…”

Section: Introductionmentioning

confidence: 99%

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

Kabil

Ebrahim

2017

Egyptian Spine Journal

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Background Data: Traditionally, lumbar canal stenosis (LCS) has been treated with conventional laminectomy involving wide resection of posterior supporting structures of the lumbar spine such as the supraspinous and inter-spinous ligamentum complex, the spinous process as well as wide areas of the lamina. In addition, this required a large incision of the skin and underlying musculoligamentous complex (posterior tension band). Purpose: The current study focuses on the clinical outcome and utility of minimally invasive microendoscopic decompression from a unilateral approach in surgical management of patients with single and multiple level lumbar canal stenosis. The objective is to describe the indications, significance and applications of endoscopic spine surgery in patients with single and multiple level LCS. Additionally, to highlight important anatomical perspectives of the technique and share surgical experience and results. Study Design: A retrospective clinical case study. Patients and Methods: From May 2008 to January 2016, 583 consecutive patients were treated for LCS and included in this study. Patients' main complaint was bilateral neurogenic claudication in addition to back pain and sciatic neuralgia. Single level decompression was performed in 468 (80%) patients and multiple level decompressions in 115 (20%) patients. Magnetic resonance imaging (MRI), computed tomography (CT) scan and plain X-rays were performed for all patients to confirm evidence of central stenosis and then repeated postoperatively. All patients were followed up for at least 3 months and their data collected. Clinical and functional outcomes were assessed using Visual Analogue Scale (VAS) and the Japanese Orthopedic Association Score (JOA) score for lumbar disease. Results: Compared to preoperative complaint, there was an improvement of back pain in 77.9% of patients and in radiating leg pain in 86.3%. With regards to functional outcomes, median preoperative JOA score was 14.93 ± 0.48 and improved postoperatively to 27.17 ± 1.45 (p < 0.001). The mean operating time per level was 78 minutes, and the mean intraoperative blood loss per level was 18 ml. Complications mainly included dural tears in 27 (4.6%) patients, transient postoperative dysesthesia in 46/583 (7.9%) patients and excess bony work in the form of unintended medial facetectomy in 38/583 (6.5%) patients and fracture of the spinous process in 3 (0.5%) patients.

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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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Unilateral tubular approach for bilateral laminotomy: effect on ipsilateral and contralateral buttock and leg pain

Abstract: MIS tubular laminotomy through a unilateral approach results in clinically effective bilateral decompression of LSS and lateral recesses, regardless of the approach side.

Cited by 38 publications

References 43 publications

Interlaminar endoscopic lateral recess decompression—surgical technique and early clinical results

Interlaminar endoscopic lateral recess decompression—surgical technique and early clinical results

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

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

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