title: Midterm outcome after unilateral approach for bilateral decompression of lumbar spinal stenosis: 5-year prospective study.
abstract: The aim of our study is to evaluate the results and effectiveness of bilateral decompression via a unilateral approach in the treatment of degenerative lumbar spinal stenosis. We have conducted a prospective study to compare the midterm outcome of unilateral laminotomy with unilateral laminectomy. One hundred patients with 269 levels of lumbar stenosis without instability were randomized to two treatment groups: unilateral laminectomy (Group 1), and laminotomy (Group 2). Clinical outcomes were assessed with the Oswestry Disability Index (ODI) and Short Form-36 Health Survey (SF-36). Spinal canal size was measured pre- and postoperatively. The spinal canal was increased to 4-6.1-fold (mean 5.1 +/- SD 0.8-fold) the preoperative size in Group 1, and 3.3-5.9-fold (mean 4.7 +/- SD 1.1-fold) the preoperative size in Group 2. The mean follow-up time was 5.4 years (range 4-7 years). The ODI scores decreased significantly in both early and late follow-up evaluations and the SF-36 scores demonstrated significant improvement in late follow-up results in our series. Analysis of clinical outcome showed no statistical differences between two groups. For degenerative lumbar spinal stenosis unilateral approaches allowed sufficient and safe decompression of the neural structures and adequate preservation of vertebral stability, resulted in a highly significant reduction of symptoms and disability, and improved health-related quality of life.
authors: Department of Neurosurgery, Sişli Etfal State Hospital, 34303, Istanbul, Turkey. anhcavusoglu@yahoo.com
authors: Halit
authors: H
authors: Cavuşoğlu
authors: Ramazan Alper
authors: RA
authors: Kaya
authors: Osman Nuri
authors: ON
authors: Türkmenoglu
authors: Cengiz
authors: C
authors: Tuncer
authors: Ibrahim
authors: I
authors: Colak
authors: Yunus
authors: Y
authors: Aydin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical / Q000379:methods* / Q000706:statistics & numerical data; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D008137:Longitudinal Studies; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods* / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D011446:Prospective Studies; D011788:Quality of Life; D011859:Radiography; D013130:Spinal Stenosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
references: N Engl J Med. 2004 Feb 12;350(7):643-4
references: 14960739
references: Spine J. 2003 Nov-Dec;3(6):471-8
references: 14609692
references: Spine (Phila Pa 1976). 2004 Mar 1;29(5):581-5; discussion 585
references: 15129077
references: Arch Phys Med Rehabil. 1975 Feb;56(2):80-3
references: 1124981
references: Spine (Phila Pa 1976). 1980 May-Jun;5(3):245-53
references: 7394664
references: Neurosurgery. 1982 Oct;11(4):546-9
references: 7145072
references: Morphol Med. 1982 Feb;2(1):53-8
references: 7177139
references: Spine (Phila Pa 1976). 1983 Apr;8(3):327-30
references: 6623200
references: Spine (Phila Pa 1976). 1985 Jul-Aug;10(6):516-23
references: 4081866
references: Spine (Phila Pa 1976). 1986 Mar;11(2):107-10
references: 3704799
references: Clin Orthop Relat Res. 1988 Feb;227:143-51
references: 2962798
references: Neurosurgery. 1988 Nov;23(5):628-33
references: 3200393
references: Spine (Phila Pa 1976). 1989 Jan;14(1):33-6
references: 2913665
references: Neurosurgery. 1990 Mar;26(3):429-32; discussion 433
references: 2138716
references: J Biomed Eng. 1990 Jul;12(4):340-4
references: 2395361
references: J Bone Joint Surg Am. 1991 Jul;73(6):809-16
references: 2071616
references: J Clin Neurosci. 2005 Feb;12(2):169-71
references: 15749421
references: Qual Life Res. 2005 Feb;14(1):259-64
references: 15789959
references: J Neurosurg Spine. 2005 Aug;3(2):129-41
references: 16370302
references: J Bone Joint Surg Am. 1991 Sep;73(8):1184-91
references: 1890119
references: Spine (Phila Pa 1976). 1992 Jan;17(1):1-8
references: 1531550
references: J Spinal Disord. 1991 Mar;4(1):26-33
references: 1807528
references: J Neurosurg. 1993 May;78(5):695-701
references: 8468598
references: Spine (Phila Pa 1976). 1993 Apr;18(5):575-81
references: 8484148
references: J Bone Joint Surg Br. 1993 May;75(3):386-92
references: 8496205
references: J Neurosurg. 1994 Nov;81(5):699-706
references: 7755690
references: J Neurosurg. 1994 Nov;81(5):707-15
references: 7931616
references: J Bone Joint Surg Am. 1995 Jul;77(7):1036-41
references: 7608225
references: J Neurosurg. 1996 Feb;84(2):166-73
references: 8592217
references: Eur Spine J. 1996;5(3):193-7
references: 8831123
references: J Neurosurg. 1996 Nov;85(5):793-802
references: 8893716
references: Acta Neurochir (Wien). 1997;139(5):392-6
references: 9204106
references: Acta Neurochir (Wien). 1997;139(5):397-403
references: 9204107
references: Neurosurgery. 1997 Sep;41(3):567-74; discussion 574-5
references: 9310973
references: Spine (Phila Pa 1976). 1997 Oct 1;22(19):2278-82
references: 9346149
references: J Spinal Disord. 1998 Apr;11(2):116-22; discussion 123
references: 9588467
references: J Neurosurg. 1998 Jul;89(1):1-7
references: 9647165
references: Surg Neurol. 1998 Jul;50(1):3-10
references: 9657486
references: Acta Neurochir (Wien). 1998;140(7):637-41
references: 9781274
references: J Spinal Disord. 1998 Oct;11(5):389-94
references: 9811098
references: J Bone Joint Surg Am. 1998 Dec;80(12):1728-32
references: 9875930
references: Br J Neurosurg. 1998 Dec;12(6):556-8
references: 10070466
references: J Spinal Disord. 1999 Feb;12(1):40-4
references: 10078948
references: Spine (Phila Pa 1976). 1999 May 15;24(10):1010-4
references: 10332794
references: Spine (Phila Pa 1976). 1999 Nov 1;24(21):2268-72
references: 10562995
references: Spine (Phila Pa 1976). 2000 Apr 1;25(7):865-70
references: 10751299
references: Spine (Phila Pa 1976). 2000 Oct 15;25(20):2663-7
references: 11034653
references: Spine (Phila Pa 1976). 2002 Feb 15;27(4):432-8
references: 11840112
references: J Spinal Disord Tech. 2002 Feb;15(1):39-46
references: 11891449
references: Neurosurgery. 2002 Nov;51(5 Suppl):S146-54
references: 12234442
references: J Neurosurg. 2002 Sep;97(2 Suppl):213-7
references: 12296681
references: Orthop Clin North Am. 2003 Apr;34(2):281-95
references: 12914268
references: Spine (Phila Pa 1976). 2003 Oct 1;28(19):E385-90
references: 14520050
references: N Engl J Med. 2004 Feb 12;350(7):722-6
references: 14960750