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Published November 12, 2022 | Version v1
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Comparative study between microscopic bilateral decompression via unilateral approach and standard total laminectomy for treatment of degenerative lumbar canal stenosis

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Abstract

Background: The better patient outcomes is driving to the development of minimally invasive spine surgical techniques. There are several evidences on the use of microscopic decompressive surgery for degenerative lumbar canal stenosis; however, few of these studies compared their outcomes with the classic laminectomy and laminotomy techniques.

Objectives: The aim of our study was to compare outcomes following microsurgical bilateral decompression via unilateral laminotomy approach for bilateral decompression (ULBD) of the lumbar spinal canal to the standard open laminectomy for cases with single and multiple degenerative lumbar canal stenosis.

Material and methods: Cases were divided in two groups. Group (A) cases were operated by  microscopic decomressive  laminotomy via unilateral approach and bilateral decompression; Group (B) cases were operated by standard classical decompressive laminectomy technique. Results from both groups were compared regarding duration of surgery, blood loss, perioperative complication, and postoperative outcome and patient satisfaction.

RESULTS: Statistical  difference  noted  between the improvement rate  of the two groups .Group A had higher rate of improvement than Group B. Unilateral laminotomy for bilateral micro-decompression : single and multiple levels had 88% improved VAS, 0.8% instability compared to Clinical results of decompressive laminectomy. Postoperative clinical improvement in (Group A) as regard back VAS, leg VAS, modified ODI and PSI  could lead to a significant improvement of symptoms during the  follow-up period. The pre- and postoperative JOA scores of the multiple level cases were significantly lower than those of the single level cases; however, there was no significant difference in the recovery rate (RR) between the groups. There is statistically significant difference between the mean VAS score for leg pain pre-operatively and post-operatively, at 3rd month ,6 th month and 12 th  months  follow up. Patient satisfaction varies from 57% to 81% with regard to excellent to good results. surgery met their expectations and patients were satisfied from the outcome.

CONCLUSIONS: Comparing ULBD with classic laminectomy showed the efficacy of the minimally invasive technique in obtaining good surgical outcome and patient satisfaction. Unilateral  laminotomy  with  bilateral  micro-decompression technique preserves  posterior midline  structures with  sparing  of  spinous  process, opposite  side  lamina , paraspinal muscles and provides  an  adequate and safe  bilateral  decompression at multiple levels. This  procedure  has  smaller  incision, minimal perioperative  blood  loss, postoperative  posterior  scarring  and back  pain,  less  length of  hospital  stay and it promotes  early mobilization  with early  return  to normal  routine  life than classic laminectomy technique.

 

 

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