Unilateral tubular approach for bilateral laminotomy: effect on ipsilateral and contralateral buttock and leg pain.
Tubular laminotomy is an effective procedure for treatment of lumbar spinal stenosis (LSS) and lateral recesses stenosis. Most surgeons familiar with the procedure agree that the tubular approach appears to afford a more complete decompression of the contralateral thecal sac and nerve root, as compared to the ipsilateral approach. With this study we sought to answer the question whether this is reflected in clinically significant differences between the ipsilateral and contralateral side pain improvements.



In a retrospective case study, patients with LSS and lateral recesses stenosis who started out with VAS scores that were similar on the right and left side were included. All patients underwent a tubular (MIS) "over the top" laminotomy from a unilateral approach and through one incision. Surgeries were performed by a single surgeon in a single center. At the last follow-up, the extent of VAS score improvement on the approach (ipsilateral) side was compared to that of the contralateral side.



Thirty-three patients were included in. At the latest follow-up of 25.8 ± 3.4 months, there were statistically significant improvements in ODI and back VAS scores (p = 0.002 and p < 0.0001, respectively). In addition, buttock VAS scores were significantly improved both on the ipsilateral and the contralateral side (p < 0.001, and p = 0.001, respectively). Similarly, leg VAS scores were improved significantly on both sides (p < 0.001, and p = 0.001, respectively). There were no statistically significant differences between the extent of pain improvement on the ipsilateral and the contralateral side.



MIS tubular laminotomy through a unilateral approach results in clinically effective bilateral decompression of LSS and lateral recesses, regardless of the approach side.
Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, Weill Cornell Brain and Spine Center, 525 East 68th Street, Box 99, New York, NY, 10065, USA.
Marjan
M
Alimi
Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, Weill Cornell Brain and Spine Center, 525 East 68th Street, Box 99, New York, NY, 10065, USA.
Christoph P
CP
Hofstetter
Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, Weill Cornell Brain and Spine Center, 525 East 68th Street, Box 99, New York, NY, 10065, USA.
Jose M
JM
Torres-Campa
Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, Weill Cornell Brain and Spine Center, 525 East 68th Street, Box 99, New York, NY, 10065, USA.
Rodrigo
R
Navarro-Ramirez
Weill Cornell Medical College, New York, NY, USA.
Guang-Ting
GT
Cong
Weill Cornell Medical College, New York, NY, USA.
Innocent
I
Njoku
Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, Weill Cornell Brain and Spine Center, 525 East 68th Street, Box 99, New York, NY, 10065, USA. roger@hartlmd.net.
Roger
R
Härtl
D000368:Aged; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007796:Laminectomy / Q000379:methods*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D010146:Pain / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D013130:Spinal Stenosis / Q000601:surgery*; D064232:Visual Analog Scale
Contralateral approach; Laminectomy; Laminotomy; Lumbar spinal stenosis; Minimally invasive