Outcomes after decompressive laminectomy for lumbar spinal stenosis: comparison between minimally invasive unilateral laminectomy for bilateral decompression versus open laminectomy.

Document Type : Original Article

Authors

1 Department of Neurosurgery, Beni-Suef University, Egypt

2 Department of Orthoptic surgery, Beni-Suef University, Egypt

3 Department of Neurosurgery, Cairo University Egypt

Abstract

Background:  Lumbar spinal stenosis (LSS) is typically caused by degenerative facet joint , ligament hypertrophy, and broad-based disc bulging, leading to lateral recess and lumber  canal compression, resulting in walking debility and also leg pain. LSS is a progressive degenerative disease that most commonly affects elderly patients over 60 years old and can significantly impact the daily activities and quality of life leading to progressive disability. Aim: comparing the outcomes following minimally invasive unilateral laminectomy for bilateral decompression (ULBD) to standard open laminectomy for lumbar spinal stenosis. Patients & Methods: Randomized controlled prospective clinical trial- single-blinded study for 30 patients with lumbar canal stenosis who were randomly allocated to one of the two interventional groups; group (A) 15 patients underwent conventional Laminectomy, group (B) 15 patients underwent microsurgical decompression from March 2019 till March 2021 in a bani-siuf university and cairo university   department of neurosurgery. Results: There was no statistically significant difference between both groups regarding the motor power, sensory nerve affection, straight leg raising, and stenotic level (p-value >0.05). Four patients (26.6%) in group A presented with motor affection (ankle dorsiflexion grade 2_3) versus one patient in group B presented motor affection (ankle dorsiflexion grade 4). Five patients (16.7%) presented with sensory affection. SLR was affected in 6 patients (20%). L4-5 was the more level affected  (58%)  then  L3-4 (26%) and L5-S1 (16%). 7 patients (23.3%) need  discectomy. Conclusion: This study demonstrated the possibility of decompressing the lumber canal by the use of a unilateral approach. Surgical  experience is mandatory to adequately decompress the neural structures. ULBD is effective as laminectomy in the treatment of  LSS with the benefit of respecting the integrity of the neural elements with a little amount of blood loss.

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Egyptian Journal of Medical Research
Volume 4, Issue 1
January 2023
Pages 130-145

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