Inverse laminoplasty for the treatment of lumbar spinal stenosis.
METHODS
Fifteen patients with lumbar spinal stenosis were treated by a new technique, inverse laminoplasty, and the results were evaluated clinically and radiologically.


OBJECTIVE
To present the advantages of inverse laminoplasty over laminectomy for the treatment of lumbar spinal stenosis.


BACKGROUND
Laminectomy has been used widely in the treatment of lumbar spinal stenosis. Destruction of the spinal bony structure, instability, and peridural scar formation are the main problems with this procedure. To overcome these disadvantages, a practical technique is presented here.


METHODS
In a prospective study, 15 patients who underwent surgery with the inverse laminoplasty technique were evaluated clinically and radiologically. The Oswestry Disability Index was used for clinical assessment. L4-L5 spinal stenosis was detected in all patients. As the operative technique, the L4 lamina was elevated en bloc using a high-speed drill and rongeur. After removal of the ligamentum flavum, the roof of the foramina, and/or disc, the lamina was rotated 180 degrees, rested on facets, and reattached by use of a titanium miniplate.


RESULTS
All patients improved clinically and neurologically after this procedure. The mean Oswestry Disability Score was 38.33 preoperatively and 7.0 postoperatively. The mean follow-up time was 17.3 months. Spinal canal diameters were calculated by preoperative and postoperative computed tomography, and the mean enlargement was 77.8%. No complications were observed.


CONCLUSIONS
With this technique, the important integrity of the spinal osseous structures is preserved, and a significant enlargement of the spinal canal area is achieved. This technique prevents peridural scar formation after laminectomy caused by a mechanical barrier effect. Long-term follow-up is needed to evaluate spinal stability in these patients.
Department of Neurosurgery, Dokuz Eylül University Medical Faculty, Izmur, Turkey. kyucesoy@hotmail.com
Kemal
K
Yücesoy
Ercan
E
Ozer
D000293:Adolescent; D000328:Adult; D001860:Bone Plates; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007796:Laminectomy / Q000009:adverse effects / Q000379:methods; D008159:Lumbar Vertebrae / Q000601:surgery*; D008161:Lumbosacral Region; D008297:Male; D008488:Medical Illustration; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D019637:Orthopedic Procedures / Q000379:methods*; D011446:Prospective Studies; D013115:Spinal Canal / Q000000981:diagnostic imaging / Q000601:surgery; D013130:Spinal Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D014025:Titanium; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D014025:Titanium