Wide Laminectomy, Segmental Bilateral Laminotomies, or Unilateral Hemi-Laminectomy for Lumbar Spinal Stenosis

Abstract

Study Design. Propensity-matched retrospective study of patients prospectively enrolled in Danespine.Objective. The aim of this study was to report 5-year patient reported outcome in lumbar spinal stenosis (LSS) patients who underwent wide laminectomy (WL), segmental bilateral laminotomies (SBL), or unilateral hemilaminectomy (UHL) with bilateral decompression. Summary of Background Data. The optimal procedure for LSS remains controversial. Studies have shown no difference in short term outcomes among micro-laminectomy, hemi-laminotomies, broad laminectomy, and laminectomy with instrumented fusion. Methods. Patients with spinal stenosis who were enrolled in DaneSpine at two spine centers from January 2010 until May 2014 and underwent WL0, SBL, or UHL with bilateral decompression were identified. Patients completed standard questionnaires preoperatively and 1, 2, and 5 years after surgery. Patients in the three cohorts were propensity-matched using age, sex, body mass index (BMI), smoking status, number of surgical levels, American Society of Anesthesiologists (ASA) score, and patient-reported outcome measures (PROMs). Results. Propensity matching produced 62 cases in each group. There were no differences in PROM among the three cohorts at five years follow up. Twelve patients were re-operated at the index level. The most frequent indication of reoperation was repeat decompression after SBL. Regression analysis revealed no statistical significant associations between the incidence of reoperation and age, sex, number of operated levels, ASA score, BMI, center, smoking status, or having a dural tear at index operation. Conclusion. This study revealed no significant difference PROMs, reoperation rates or time to reoperation at five years follow up between SBLs, UHL, or WL in patients operated for central LSS.

Patient Perceptions of Paramedian Minimally Invasive Spine Skin Incisions

“…The study found that 91% of patients reported being satisfied with their surgery, and 92% reported an improvement in their symptoms. In a more recent study by Bouknaitir et al, 2021, patient satisfaction was evaluated after lumbar decompression surgery using a validated questionnaire [16]. The study found that 87% of patients reported being satisfied with their surgery, and 85% would choose to have the same surgery again.…”

Multiple tophi deposits in the spine: A case report

“…This method was selected to preserve the patient’s unilateral pedicle and lamina and preserve some of the posterior column structures, thus re-establishing postoperative spinal stability and sagittal balance, reducing operative time, bleeding, and improving postoperative healing rates[ 18 ]. A 5-year retrospective study conducted at the New Zealand University Hospital showed no significant differences between reoperation rates and reoperation time between extensive laminectomy, unilateral hemi-laminectomy, and bilateral segmental laminectomy when treating lumbar spinal stenosis[ 19 ]. However, the authors concluded that the spine discipline is moving towards a minimally invasive path, where the same effect of minimizing operative time, the extent of surgery, and incision size was achieved as total laminectomy, with improved patients’ acceptance of surgical treatment.…”

Perioperative Complications of Anterior Decompression with Fusion in Degenerative Cervical Myelopathy—A Comparative Study between Ossification of Posterior Longitudinal Ligament and Cervical Spondylotic Myelopathy Using a Nationwide Inpatient Database

“…Propensity scores were calculated using logistic regression analysis with the known preoperative items as explanatory variables [ 18 , 19 , 20 ]. Explanatory variables for logistic regression included age, sex, BMI, smoking, admission type, emergency, hospital type, ADL score, and preoperative comorbidities.…”