J Korean Neurosurg Soc.  2013 Sep;54(3):194-200. 10.3340/jkns.2013.54.3.194.

Minimum 3-Year Outcomes in Patients with Lumbar Spinal Stenosis after Bilateral Microdecompression by Unilateral or Bilateral Laminotomy

• Yang SM
• Park HK
• Chang JC
• Kim RS
• Park SQ
• Cho SJ

• KMID: 2190897
• DOI: http://doi.org/10.3340/jkns.2013.54.3.194

Abstract

OBJECTIVE
Lumbar spine stenosis (LSS) can result in symptomatic compression of the neural elements, requiring surgical treatment if conservative management fails. Minimally invasive surgery has come to be more commonly used for the treatment of LSS. The current study describes outcomes of bilateral microdecompression by unilateral or bilateral laminotomy (BML) for degenerative LSS after a minimum follow-up period of 3 years and investigates factors that result in a poor outcome.
METHODS
Twenty-one patients who were followed-up for at least 3 years were included in this study. For clinical evaluation, the Japanese Orthopedic Association (JOA) scoring system for low back pain was used. The modified grading system of Finneson and Cooper was used for outcome assessment. Radiographic evaluation was also performed for spondylolisthesis, sagittal rotation angle, and disc height.
RESULTS
Twenty-one patients (10 men, 11 women) aged 53-82 years (64.1+/-8.9 years) were followed-up for a minimum of 3 years (36-69 months). During follow-up, two patients underwent reoperation. Average preoperative JOA score and clinical symptoms, except persistent low back pain, improved significantly at the latest follow-up. There were no significant differences in radiological findings preoperatively and postoperatively. Thirteen patients (61.9%) had excellent to fair outcomes.
CONCLUSION
BML resulted in a favorable and persistent outcome for patients with degenerative LSS without radiological instability over a mid-term follow-up period. Persistent low back pain unrelated to postoperative instability adversely affects mid-term outcomes.

Keyword

Minimally invasive; Lumbar stenosis; Laminotomy; Midterm; Outcomes

MeSH Terms

Asian Continental Ancestry Group
Constriction, Pathologic
Follow-Up Studies
Humans
Laminectomy*
Low Back Pain
Male
Orthopedics
Reoperation
Spinal Stenosis*
Spine
Spondylolisthesis

Figure

• 

  Fig. 1 At the L4/5 level, preoperative axial T2-weighted (A) and CT (B) images show spinal stenosis. Postoperative axial T2-weighted (C) and CT (D) images show the spinal canal decompressed by bilateral laminotomy.

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  Fig. 2 Average preoperative and postoperative JOA scores. JOA scores improved 1 year after the operation and slightly decreased at the last follow-up (>3 years). JOA : Japanese Orthopedic Association.

Reference

1. Aryanpur J, Ducker T. Multilevel lumbar laminotomies: an alternative to laminectomy in the treatment of lumbar stenosis. Neurosurgery. 1990; 26:429–432. discussion 433. PMID: 2138716.

2. Atlas SJ, Keller RB, Wu YA, Deyo RA, Singer DE. Long-term outcomes of surgical and nonsurgical management of lumbar spinal stenosis : 8 to 10 year results from the maine lumbar spine study. Spine (Phila Pa 1976). 2005; 30:936–943. PMID: 15834339.

3. Cavuşoğlu H, Kaya RA, Türkmenoglu ON, Tuncer C, Colak I, Aydin Y. Midterm outcome after unilateral approach for bilateral decompression of lumbar spinal stenosis : 5-year prospective study. Eur Spine J. 2007; 16:2133–2142. PMID: 17712577.

4. Costa F, Sassi M, Cardia A, Ortolina A, De Santis A, Luccarell G, et al. Degenerative lumbar spinal stenosis : analysis of results in a series of 374 patients treated with unilateral laminotomy for bilateral microdecompression. J Neurosurg Spine. 2007; 7:579–586. PMID: 18074681.

5. Finneson BE, Cooper VR. A lumbar disc surgery predictive score card. A retrospective evaluation. Spine (Phila Pa 1976). 1979; 4:141–144. PMID: 162549.

6. Fischgrund JS, Mackay M, Herkowitz HN, Brower R, Montgomery DM, Kurz LT. 1997 Volvo Award winner in clinical studies. Degenerative lumbar spondylolisthesis with spinal stenosis : a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation. Spine (Phila Pa 1976). 1997; 22:2807–2812. PMID: 9431616.

7. Getty CJ, Johnson JR, Kirwan EO, Sullivan MF. Partial undercutting facetectomy for bony entrapment of the lumbar nerve root. J Bone Joint Surg Br. 1981; 63-B:330–335. PMID: 7263743.

8. Herkowitz HN, Kurz LT. Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis. J Bone Joint Surg Am. 1991; 73:802–808. PMID: 2071615.

9. Iguchi T, Kurihara A, Nakayama J, Sato K, Kurosaka M, Yamasaki K. Minimum 10-year outcome of decompressive laminectomy for degenerative lumbar spinal stenosis. Spine (Phila Pa 1976). 2000; 25:1754–1759. PMID: 10888941.

10. Inoue H, Ohmori K, Miyasaka K, Hosoe H. Radiographic evaluation of the lumbosacral disc height. Skeletal Radiol. 1999; 28:638–643. PMID: 10591927.

11. Johnsson KE, Willner S, Johnsson K. Postoperative instability after decompression for lumbar spinal stenosis. Spine (Phila Pa 1976). 1986; 11:107–110. PMID: 3704799.

12. Jolles BM, Porchet F, Theumann N. Surgical treatment of lumbar spinal stenosis. Five-year follow-up. J Bone Joint Surg Br. 2001; 83:949–953. PMID: 11603533.

13. Katz JN, Lipson SJ, Chang LC, Levine SA, Fossel AH, Liang MH. Seven- to 10-year outcome of decompressive surgery for degenerative lumbar spinal stenosis. Spine (Phila Pa 1976). 1996; 21:92–98. PMID: 9122770.

14. Kleeman TJ, Hiscoe AC, Berg EE. Patient outcomes after minimally destabilizing lumbar stenosis decompression : the "Port-Hole" technique. Spine (Phila Pa 1976). 2000; 25:865–870. PMID: 10751299.

15. Mackay DC, Wheelwright EF. Unilateral fenestration in the treatment of lumbar spinal stenosis. Br J Neurosurg. 1998; 12:556–558. PMID: 10070466.

16. Mardjetko SM, Connolly PJ, Shott S. Degenerative lumbar spondylolis-thesis. A meta-analysis of literature 1970-1993. Spine (Phila Pa 1976). 1994; 19:2256S–2265S. PMID: 7817240.

17. Mayer HM, List J, Korge A, Wiechert K. [Microsurgery of acquired degenerative lumbar spinal stenosis. Bilateral over-the-top decompression through unilateral approach]. Orthopade. 2003; 32:889–895. PMID: 14579021.

18. McCulloch JA. Microdecompression and uninstrumented single-level fusion for spinal canal stenosis with degenerative spondylolisthesis. Spine (Phila Pa 1976). 1998; 23:2243–2252. PMID: 9802169.

19. Müslüman AM, Cansever T, Yılmaz A, Cavuşoğlu H, Yüce İ, Aydın Y. Midterm outcome after a microsurgical unilateral approach for bilateral decompression of lumbar degenerative spondylolisthesis. J Neurosurg Spine. 2012; 16:68–76. PMID: 21961964.

20. Nakai O, Ookawa A, Yamaura I. Long-term roentgenographic and functional changes in patients who were treated with wide fenestration for central lumbar stenosis. J Bone Joint Surg Am. 1991; 73:1184–1191. PMID: 1890119.

21. Nakanishi K, Tanaka N, Fujimoto Y, Okuda T, Kamei N, Nakamae T, et al. Medium-term Clinical Results of Microsurgical Lumbar Flavectomy That Preserves Facet Joints in Cases of Lumbar Degenerative Spondylolisthesis : Comparison of Bilateral Laminotomy With Bilateral Decompression by a Unilateral Approach. J Spinal Disord Tech. 2013; 26:351–358. PMID: 22331069.

22. Oertel MF, Ryang YM, Korinth MC, Gilsbach JM, Rohde V. Long-term results of microsurgical treatment of lumbar spinal stenosis by unilateral laminotomy for bilateral decompression. Neurosurgery. 2006; 59:1264–1269. discussion 1269-1270. PMID: 17277689.

23. Palmer S, Turner R, Palmer R. Bilateral decompression of lumbar spinal stenosis involving a unilateral approach with microscope and tubular retractor system. J Neurosurg. 2002; 97(2 Suppl):213–217. PMID: 12296681.

24. Papavero L, Thiel M, Fritzsche E, Kunze C, Westphal M, Kothe R. Lumbar spinal stenosis : prognostic factors for bilateral microsurgical decompression using a unilateral approach. Neurosurgery. 2009; 65(6 Suppl):182–187. discussion 187. PMID: 19934993.

25. Poletti CE. Central lumbar stenosis caused by ligamentum flavum : unilateral laminotomy for bilateral ligamentectomy : preliminary report of two cases. Neurosurgery. 1995; 37:343–347. PMID: 7477792.

26. Postacchini F, Cinotti G, Perugia D, Gumina S. The surgical treatment of central lumbar stenosis. Multiple laminotomy compared with total laminectomy. J Bone Joint Surg Br. 1993; 75:386–392. PMID: 8496205.

27. Rompe JD, Eysel P, Zöllner J, Nafe B, Heine J. Degenerative lumbar spinal stenosis. Long-term results after undercutting decompression compared with decompressive laminectomy alone or with instrumented fusion. Neurosurg Rev. 1999; 22:102–106. PMID: 10547007.

28. Sanderson PL, Wood PL. Surgery for lumbar spinal stenosis in old people. J Bone Joint Surg Br. 1993; 75:393–397. PMID: 8496206.

29. Spetzger U, Bertalanffy H, Naujokat C, von Keyserlingk DG, Gilsbach JM. Unilateral laminotomy for bilateral decompression of lumbar spinal stenosis Part I : anatomical and surgical considerations. Acta Neurochir (Wien). 1997; 139:392–396. PMID: 9204106.

30. Spetzger U, Bertalanffy H, Reinges MH, Gilsbach JM. Unilateral laminotomy for bilateral decompression of lumbar spinal stenosis. Part II : clinical experiences. Acta Neurochir (Wien). 1997; 139:397–403. PMID: 9204107.

31. Thomas NW, Rea GL, Pikul BK, Mervis LJ, Irsik R, McGregor JM. Quantitative outcome and radiographic comparisons between laminectomy and laminotomy in the treatment of acquired lumbar stenosis. Neurosurgery. 1997; 41:discussion 574-575. 567–574. PMID: 9310973.

32. Thomé C, Zevgaridis D, Leheta O, Bäzner H, Pöckler-Schöniger C, Wöhrle J, et al. Outcome after less-invasive decompression of lumbar spinal stenosis : a randomized comparison of unilateral laminotomy, bilateral laminotomy, and laminectomy. J Neurosurg Spine. 2005; 3:129–141. PMID: 16370302.

33. Toyoda H, Nakamura H, Konishi S, Dohzono S, Kato M, Matsuda H. Clinical outcome of microsurgical bilateral decompression via unilateral approach for lumbar canal stenosis : minimum five-year follow-up. Spine (Phila Pa 1976). 2011; 36:410–415. PMID: 20847714.

34. Tsai RY, Yang RS, Bray RS Jr. Microscopic laminotomies for degenerative lumbar spinal stenosis. J Spinal Disord. 1998; 11:389–394. PMID: 9811098.

35. Weiner BK, Walker M, Brower RS, McCulloch JA. Microdecompression for lumbar spinal canal stenosis. Spine (Phila Pa 1976). 1999; 24:2268–2272. PMID: 10562995.

36. Weinstein JN, Lurie JD, Tosteson TD, Hanscom B, Tosteson AN, Blood EA, et al. Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. N Engl J Med. 2007; 356:2257–2270. PMID: 17538085.

37. Young S, Veerapen R, O'Laoire SA. Relief of lumbar canal stenosis using multilevel subarticular fenestrations as an alternative to wide laminectomy : preliminary report. Neurosurgery. 1988; 23:628–633. PMID: 3200393.