J Korean Soc Spine Surg.  2005 Dec;12(4):324-330.

Comparison of the Results of the Decompression Methods for Degenerative Lumbar Spinal Stenosis: Comparison of Posterior Element Saving Procedures

• You JW
• Sohn HM
• Lee JY
• Yang KH

Abstract

STUDY DESIGN: This is a prospective study.
OBJECTIVES
We wanted to analyze the radiographic and clinical results of the three posterior element saving decompression techniques for treating lumbar degenerative spinal stenosis. SUMMARY OF THE LITERATURE REVIEW: Minimal invasive decompression reduces patient morbidity and the hospital stay.
MATERIALS AND METHODS
We evaluated 30 patients, who were treated with posterior element saving microscopic decompression for their lumbar spinal stenosis (without instability), during the period from March, 2002 and February, 2004. The procedures were bilateral laminotomy (10 cases), spinous process osteotomy (8 cases) and laminoplasty (12 cases). We evaluated the estimated blood loss, the amount of transfusion, the complications and the radiographic instability at the last follow-up. The clinical results were evaluated with using the Oswestry disability index (ODI) and the visual analogue scale (VAS) for buttock and leg pain both preoperatively and at postoperative 1, 3, 6 and 12 months, respectively.
RESULTS
There was no radiographic instability noted for any of the patients at the last follow up. The mean ODI and VAS scores were substantially improved at postoperative 1 month and then they were marginally improved afterwards. However, there were no statistically significant differences among three procedures (p>0.05). The mean blood loss and the amount of transfusion for each spinal level were 290 ml and 0.5 U for bilateral laminotomy, 370 ml and 0.9 U for spinous process osteotomy and 180 ml and 0.1 U for laminoplasty, respectively.
CONCLUSION
There were no significant differences in the radiograhic and clinical results among bilateral laminotomy, spinous process osteotomy and laminoplasty. Yet in terms of blood loss and transfusion, laminoplasty was better than the other techniques. We believe that laminoplasty is a useful and safe technique for treating degenerative lumbar spinal stenosis.

Keyword

Lumbar spinal stenosis; Bilateral laminotomy; Spinous process osteotomy; Laminoplasty

MeSH Terms

Buttocks
Decompression*
Follow-Up Studies
Humans
Laminectomy
Leg
Length of Stay
Osteotomy
Prospective Studies
Spinal Stenosis*

Figure

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  Fig. 1. Preoperative MRI image(A) and postoperativeCT image (B) of bilateral laminotomy patient.

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  Fig. 2. Preoperative MRI image (A) and postoperative CT image (B) of spinous process osteotomy patient.

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  Fig. 3. Preoperative MRI image (A) and postoperative CT image (B) of laminoplasty patient.

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  Fig. 4. The serial changes of Oswestry disability index.

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  Fig. 5. The serial changes of visual analogue scale for buttock and leg pain.

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