Midterm outcome after unilateral approach for bilateral decompression of lumbar spinal stenosis: 5-year prospective study.
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.
Cavuşoğlu
Halit
H
Department of Neurosurgery, Sişli Etfal State Hospital, 34303, Istanbul, Turkey. anhcavusoglu@yahoo.com
Kaya
Ramazan Alper
RA
Türkmenoglu
Osman Nuri
ON
Tuncer
Cengiz
C
Colak
Ibrahim
I
Aydin
Yunus
Y
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
N Engl J Med. 2004 Feb 12;350(7):643-4
14960739
Spine J. 2003 Nov-Dec;3(6):471-8
14609692
Spine (Phila Pa 1976). 2004 Mar 1;29(5):581-5; discussion 585
15129077
Arch Phys Med Rehabil. 1975 Feb;56(2):80-3
1124981
Spine (Phila Pa 1976). 1980 May-Jun;5(3):245-53
7394664
Neurosurgery. 1982 Oct;11(4):546-9
7145072
Morphol Med. 1982 Feb;2(1):53-8
7177139
Spine (Phila Pa 1976). 1983 Apr;8(3):327-30
6623200
Spine (Phila Pa 1976). 1985 Jul-Aug;10(6):516-23
4081866
Spine (Phila Pa 1976). 1986 Mar;11(2):107-10
3704799
Clin Orthop Relat Res. 1988 Feb;227:143-51
2962798
Neurosurgery. 1988 Nov;23(5):628-33
3200393
Spine (Phila Pa 1976). 1989 Jan;14(1):33-6
2913665
Neurosurgery. 1990 Mar;26(3):429-32; discussion 433
2138716
J Biomed Eng. 1990 Jul;12(4):340-4
2395361
J Bone Joint Surg Am. 1991 Jul;73(6):809-16
2071616
J Clin Neurosci. 2005 Feb;12(2):169-71
15749421
Qual Life Res. 2005 Feb;14(1):259-64
15789959
J Neurosurg Spine. 2005 Aug;3(2):129-41
16370302
J Bone Joint Surg Am. 1991 Sep;73(8):1184-91
1890119
Spine (Phila Pa 1976). 1992 Jan;17(1):1-8
1531550
J Spinal Disord. 1991 Mar;4(1):26-33
1807528
J Neurosurg. 1993 May;78(5):695-701
8468598
Spine (Phila Pa 1976). 1993 Apr;18(5):575-81
8484148
J Bone Joint Surg Br. 1993 May;75(3):386-92
8496205
J Neurosurg. 1994 Nov;81(5):699-706
7755690
J Neurosurg. 1994 Nov;81(5):707-15
7931616
J Bone Joint Surg Am. 1995 Jul;77(7):1036-41
7608225
J Neurosurg. 1996 Feb;84(2):166-73
8592217
Eur Spine J. 1996;5(3):193-7
8831123
J Neurosurg. 1996 Nov;85(5):793-802
8893716
Acta Neurochir (Wien). 1997;139(5):392-6
9204106
Acta Neurochir (Wien). 1997;139(5):397-403
9204107
Neurosurgery. 1997 Sep;41(3):567-74; discussion 574-5
9310973
Spine (Phila Pa 1976). 1997 Oct 1;22(19):2278-82
9346149
J Spinal Disord. 1998 Apr;11(2):116-22; discussion 123
9588467
J Neurosurg. 1998 Jul;89(1):1-7
9647165
Surg Neurol. 1998 Jul;50(1):3-10
9657486
Acta Neurochir (Wien). 1998;140(7):637-41
9781274
J Spinal Disord. 1998 Oct;11(5):389-94
9811098
J Bone Joint Surg Am. 1998 Dec;80(12):1728-32
9875930
Br J Neurosurg. 1998 Dec;12(6):556-8
10070466
J Spinal Disord. 1999 Feb;12(1):40-4
10078948
Spine (Phila Pa 1976). 1999 May 15;24(10):1010-4
10332794
Spine (Phila Pa 1976). 1999 Nov 1;24(21):2268-72
10562995
Spine (Phila Pa 1976). 2000 Apr 1;25(7):865-70
10751299
Spine (Phila Pa 1976). 2000 Oct 15;25(20):2663-7
11034653
Spine (Phila Pa 1976). 2002 Feb 15;27(4):432-8
11840112
J Spinal Disord Tech. 2002 Feb;15(1):39-46
11891449
Neurosurgery. 2002 Nov;51(5 Suppl):S146-54
12234442
J Neurosurg. 2002 Sep;97(2 Suppl):213-7
12296681
Orthop Clin North Am. 2003 Apr;34(2):281-95
12914268
Spine (Phila Pa 1976). 2003 Oct 1;28(19):E385-90
14520050
N Engl J Med. 2004 Feb 12;350(7):722-6
14960750