title: Outcomes after decompressive laminectomy for lumbar spinal stenosis: comparison between minimally invasive unilateral laminectomy for bilateral decompression and open laminectomy: clinical article.
abstract: OBJECTIVE
  The development of minimally invasive surgical techniques is driven by the quest for better patient outcomes. There is some evidence for the use of minimally invasive surgery for degenerative lumbar spine stenosis (LSS), but there are currently no studies comparing outcomes with matched controls. The object of this study was to compare outcomes following minimally invasive unilateral laminectomy for bilateral decompression (ULBD) to a standard "open" laminectomy for LSS.
  
  
  METHODS
  The authors conducted a prospective, 1:1 randomized trial comparing ULBD to open laminectomy for degenerative LSS. The study enrolled 79 patients between 2007 and 2009, and adequate data for analysis were available in 54 patients (27 in each arm of the study). Patient demographic characteristics and clinical characteristics were recorded and clinical outcomes were obtained using pre- and postoperative Oswestry Disability Index (ODI) scores, visual analog scale (VAS) scores for leg pain, patient satisfaction index scores, and postoperative 12-Item Short Form Health Survey (SF-12) scores.
  
  
  RESULTS
  Significant improvements were observed in ODI and VAS scores for both open and ULBD interventions (p < 0.001 for both groups using either score). In addition, the ULBD-treated patients had a significantly better mean improvement in the VAS scores (p = 0.013) but not the ODI scores (p = 0.055) compared with patients in the open-surgery group. ULBD-treated patients had a significantly shorter length of postoperative hospital stay (55.1 vs. 100.8 hours, p = 0.0041) and time to mobilization (15.6 vs. 33.3 hours, p < 0.001) and were more likely to not use opioids for postoperative pain (51.9% vs. 15.4%, p = 0.046).
  
  
  CONCLUSIONS
  Based on short-term follow-up, microscopic ULBD is as effective as open decompression in improving function (ODI score), with the additional benefits of a significantly greater decrease in pain (VAS score), postoperative recovery time, time to mobilization, and opioid use.
authors.affiliation: Neurospine Clinic and.
authors.forename: Ralph Jasper
authors.initials: RJ
authors.lastname: Mobbs
authors.forename: Jane
authors.initials: J
authors.lastname: Li
authors.forename: Praveenan
authors.initials: P
authors.lastname: Sivabalan
authors.forename: Darryl
authors.initials: D
authors.lastname: Raley
authors.forename: Prashanth J
authors.initials: PJ
authors.lastname: Rao
mesh_terms: D000368:Aged; D015897:Comorbidity; D019299:Decompression, Surgical; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007796:Laminectomy / Q000379:methods*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D010147:Pain Measurement; D011446:Prospective Studies; D013130:Spinal Stenosis / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: IV = intravenous; LSS = lumbar spinal stenosis; MIS = minimally invasive surgery; ODI = Oswestry Disability Index; PSI = patient satisfaction index; SF-12 = 12-Item Short Form Health Survey; ULBD = unilateral laminectomy for bilateral decompression; VAS = visual analog scale; degenerative; laminectomy; lumbar; minimally invasive surgery; stenosis