Effectiveness of Unilateral Approach for Bilateral Decompression in Lumber Spinal Stenosis

Authors

  • Dr. Ikram Alam Lady Reading Hospital, Peshawar
  • Dr. Wefaq Ullah Lady Reading Hospital, Peshawar
  • Dr. Muhammad Idris Khan Lady Reading Hospital, Peshawar
  • Dr. Mumtaz Ali Lady Reading Hospital, Peshawar

Keywords:

Bilateral decompression, Lumbar spinal stenosis, Unilateral approach, Efficacy

Abstract

Background: Lumbar spinal stenosis is defined as “buttock or lower extremity pain, which may occur with or without low back pain, associated with diminished space available for the neural and vascular elements in the lumbar spine. Patients complain of neurogenic claudication that is compatible with a narrowing of the lumbar spinal canal. Conventional laminectomy is frequently associated with surgical failures, generally related to postoperative iatrogenic spinal instability. Other operative options that are less invasive, such as the bilateral laminotomy and, in particular, the unilateral laminotomy for bilateral decompression (ULBD), have been introduced during the past years.

Objectives: The objective of this study is to determine the effectiveness of unilateral approach for bilateral decompression in Lumbar spinal stenosis.

Methods: It was a Descriptive case series study conducted in the admitted patients of Lumbar spinal stenosis in the Department of Neurosurgery, Lady Reading Hospital, Peshawar, in six months duration. Total of 171 patients were enrolled in the study. Bilateral decompression through a unilateral approach was performed under general anesthesia by single expert neurosurgeon having a minimum of 5 years of experience. All the patients were followed up till 24 hours post operatively for the determination of effectiveness in terms of improvement in at least one grade of pain on visual analogue scale from baseline.

Results: In this study, 171 patients with Lumbar spinal stenosis were observed. Male to female ratio was 1.41:1. The study included age ranged from 40 to 78 years. Average age was 59.29 years ± 11.41 SD. Efficacy of unilateral approach for bilateral decompression in Lumbar spinal stenosis was found in 136 (79.53%).

Conclusion: Unilateral approach for bilateral decompression is the better option for the patients presenting with Lumbar spinal stenosis.

Author Biographies

Dr. Ikram Alam, Lady Reading Hospital, Peshawar

Department of Neurosurgery

Dr. Wefaq Ullah, Lady Reading Hospital, Peshawar

Department of Neurosurgery

Dr. Muhammad Idris Khan, Lady Reading Hospital, Peshawar

Department of Neurosurgery

Dr. Mumtaz Ali, Lady Reading Hospital, Peshawar

Department of Neurosurgery

References

1. Steurer J, Nydegger A, Held U, Brunner F, Hodler J, Porchet F et al. Lumb Sten: The lumbar spinal stenosis outcome study. BMC Musculoskeletal Disorders, 2010; 11: 254.
2. Hwang S, Rhim S, Roh S, Jeon S, Hyun S. Outcomes of Unilateral Approach for Bilateral Decompression of Lumbar Spinal Stenosis: Comparison between Younger and Geriatric Patients. Kor J Spine, 2008; 5 (2): 51-7.
3. Kalichman L, Cole R, Kim DH, Li L, Suri P, Guermazi A et al. Spinal stenosis prevalence and association with symptoms. The Framingham Study. Spine J. 2009; 9 (7): 545-50.
4. Costa F, Sassi M, Cardia A, Ortolina A, De Santis A, Luccarell G et al. J Neurosurg Spine, 2007; 7: 579–86.
5. Cavusoglu H, Turkmenoglu O, Kaya RA, Tuneer C, Colak I, Sahin Y et al. Efficacy of Unilateral Laminectomy for Bilateral Decompression in Lumbar Spinal Stenosis. Turkish Neurosurgery, 2007; 17 (2): 100-108.
6. Rahman M, Summers LE, Richter B, Mimran RI, Jacob RP. Comparison of Techniques for Decompressive Lumbar Laminectomy: the Minimally Invasive versus the “Classic” Open Approach. Minim Invasive Neurosurg. 2008; 51 (2): 100-105.
7. Oertel MF, Ryang YM, Korinth MC, Gilsbach JM, Rohde V. Long-term results of microsurgical treatment of lumbarspinal stenosis by unilateral laminotomy for bilateral decompression. Neurosurgery, 2007; 59 (6): 1264-9.
8. Airaksinen O, Herno A, Kaukanen E, Saari T, Sihvonen T, Suomalainen O. Density of lumbar muscles 4 years after decompressive spinal surgery. Eur Spine J. 1996; 5 (3): 193–7.
9. Weiner BK, Walker M, Brower RS, McCulloch JA. Microdecompression for lumbar spinal canal stenosis. Spine, 1999; 24 (21): 2268–72.
10. Fox MW, Onofrio BM, Hanssen AD. Clinical outcomes and radiological instability following decompressive lumbar laminectomy for degenerative spinal stenosis: a comparison of patients undergoing concomitant arthrodesis versus decompression alone. J Neurosurg. 1996; 85 (5): 793–802.
11. Johnsson KE, Willner S, Johnsson K. Postoperative instability after decompression for lumbar spinal stenosis. Spine, 1986; 11 (2): 107–10.
12. Kleeman TJ, Hiscoe AC, Berg EE. Patient outcomes after minimally destabilizing lumbar stenosis decompression: the „„Port – Hole?? technique. Spine, 2000; 25 (7): 865–70.
13. Nakai O, Ookawa A, Yamaura I. Long-term roentgenographic and functional changes in patients who were treated with wide fenestration for central lumbar stenosis. J Bone Joint Surg Am. 1991; 73 (8): 1184–91.
14. Tuite GF, Doran SE, Stern JD, McGillicuddy JE, Papadopoulos SM, Lundquist CA et al. Outcome after laminectomy for lumbar spinal stenosis. Part II: Radiographic changes and clinical correlations. J Neurosurg. 1994; 81 (5): 707–15.
15. Weiner BK, Walker M, Brower RS, McCulloch JA. Microdecompression for lumbar spinal canal stenosis. Spine, 1999; 24 (21): 2268–72.
16. Deyo RA, Nachemson A, Mirza SK. Spinal – fusion surgery – the case for restraint. N Engl J Med. 2004; 350 (7): 722–6.
17. Lipson SJ. Spinal – fusion surgery-advances and concerns. N Engl J Med. 2004; 350 (7): 643–4.
18. Turner JA, Ersek M, Herron L, Deyo R. Surgery for lumbar spinal stenosis. Attempted meta-analysis of the literature. Spine, 1992; 17 (1): 1–8.
19. Fredman B, Arinzon Z, Zohar E, Shabat S, Jedeikin R, Fidelman ZG, et al. Observations on the safety and efficacy of surgical decompression for lumbar spinal stenosis in geriatric patients. Eur Spine. J. 2002; 11: 571-4.
20. Herno A, Airaksinen O, Saari T, Luukkonen M. Lumbar spinal stenosis : a matched-pair study of operated and non-operated patients. Br J Neurosurg. 1996; 10: 461-5.
21. Katz JN, Lipson SJ, Brick GW, Grobler LJ, Weinstein JN, Fossel AH, et al. Clinical correlates of patient satisfaction after laminectomy for degenerative lumbar spinal stenosis. Spine, 1995; 20: 1155-60.
22. Shabat S, Leitner Y, Nyska M, Berner Y, Fredman B, Gepstein R. Surgical treatment of lumbar spinal stenosis in patients aged 65 years and older. Arch Gerontol Geriatr. 2002; 35: 143-52.
23. Mariconda M, Zanforlino G, Celestino GA, Brancaleone S, Fava R, Minano C. Factors influencing the outcome of degenerative lumbar spinal stenosis. J Spinal Disord. 2000; 13: 131-7.
24. Okuyama K, Abe E, Suzuki T, Tamura Y, Chiba M, Sato K. Influence of bone mineral density on pedicle screw fixation: a study of pedicle screw fixation augmenting posterior lumbar interbody fusion in elderly patients. Spine J. 2001; 1: 402-7.
25. Iwamoto J, Takeda T. Effect of surgical treatment on physical activity and bone resorption in patients with neurogenic intermittent claudication. J Orthop Sci. 2001; 7: 84-90.
26. Turner JA, Ersek M, Herron L, Deyo R. Surgery for lumbar spinal stenosis. Attempted meta-analysis of the literature. Spine, 1992; 17 (1): 1–8.
27. Fox MW, Onofrio BM, Hanssen AD. Clinical outcomes and radiological instability following decompressive lumbar laminectomy for degenerative spinal stenosis: a comparison of patients undergoing concomitant arthrodesis versus decompression alone. J Neurosurg. 1996; 85 (5): 793–802.
28. Johnsson KE, Willner S, Johnsson K. Postoperative instability after decompression for lumbar spinal stenosis. Spine, 1986; 11 (2): 107–10.
29. Mullin BB, Rea GL, Irsik R, Catton M, Miner ME. The effect of postlaminectomy spinal instability on the outcome of lumbar spinal stenosis patients. J Spinal Disord. 1996; 9 (2): 107–16.
30. Tuite GF, Doran SE, Stern JD, McGillicuddy JE, Papadopoulos SM, Lundquist CA, et al. Outcome after laminectomy for lumbar spinal stenosis. Part II: Radiographic changes and clinical correlations. J Neurosurg. 1994; 81 (5): 707–15.
31. Detwiler PW, Spetzler CB, Taylor SB, Crawford NR, Porter RW, Sonntag VK. Biomechanical comparison of facet – sparing laminectomy and Christmas tree laminectomy. J Neurosurg. 2003; 99 (2): 214–20.
32. Quint U, Wilke HJ, Loer F, Claes L. Laminectomy and functional impairment of the lumbar spine: the importance of muscle forces in flexible and rigid instrumented stabilization – a biomechanical study in vitro. Eur Spine J. 1998; 7 (3): 229–38.
33. Katz JN, Lipson SJ, Lew RA, Grobler LJ, Weinstein JN, Brick GW, et al. Lumbar laminectomy alone or with instrumented or noninstrumented arthrodesis in degenerative lumbar spinal stenosis. Patient selection, costs, and surgical outcomes. Spine, 1997; 22 (10): 1123–31.
34. Korovessis P, Papazisis Z, Koureas G, Lambiris E. Rigid, semirigid versus dynamic instrumentation for degenerative lumbar spinal stenosis: a correlative radiological and clinical analysis of short-term results. Spine, 2004; 29 (7): 735–42.
35. Weiner BK, Walker M, Brower RS, McCulloch JA. Microdecompression for lumbar spinal canal stenosis. Spine, 1999; 24 (21): 2268–72.
36. Mariconda M, Fava R, Gatto A, Longo C, Milano C. Unilateral laminectomy for bilateral decompression of lumbar spinal stenosis: a prospective comparative study with conservatively treated patients. J Spinal Disord Tech. 2002; 15 (1): 39–46.
37. Spetzger U, Bertalanffy H, Reinges MH, Gilsbach JM. Unilateral laminotomy for bilateral decompression of lumbar spinal stenosis. Part II: Clinical experiences. Acta Neurochir. 1997; 139 (5): 397–403.
38. Thome C, Zevgaridis D, Leheta O, Bazner H, PocklerSchoniger C, Wohrle J, et al. Outcome after less – invasive decompression of lumbar spinal stenosis: a randomized comparison of unilateral laminotomy, bilateral laminotomy, and laminectomy. J Neurosurg Spine, 2005; 3 (2): 129–41.
39. Ji YC, Kim YB, Hwang SN, Park SW, Kwon JT, Min BK. Efficacy of Unilateral Laminectomy for Bilateral Decompression in Elderly Lumbar Spinal Stenosis. J orean Neurosurg Soc. 2005; 37: 410-5.
40. Okuyama K, Abe E, Suzuki T, Tamura Y, Chiba M, Sato K. Influence of bone mineral density on pedicle screw fixation: a study of pedicle screw fixation augmenting posterior lumbar interbody fusion in elderly patients. Spine J. 2001; 1 (6): 402-7.
41. Hurri H, Slatis P, Soini J, Tallroth K, Alaranta H, Laine T, et al. Lumbar spinal stenosis: assessment of longterm outcome 12 years after operative and conservative management. J Spin Disor. 1998; 11 (2): 110–5.
42. Mayer TG, Vanharanta H, Gatchel RJ, Mooney V, Barnes D, Judge L, et al. Comparison of CT scan muscle measurements and isokinetic trunk strength in postoperative patients. Spine, 1989; 14 (1): 33–6.
43. See DH, Kraft GH. Electromyography in paraspinal muscles following surgery for root compression. Arch Phys Med Rehabil. 1975; 56 (2): 80–3.
44. Sihvonen T, Herno A, Paljarva L, Airaksinen O, Patanen J, Tapaninaho A. Local denervation atrophy of paraspinal muscles in postoperative failed back syndrome. Spine, 1993; 18 (5): 575–81.
45. Markwalder TM. Surgical management of neurogenic claudication in 100 patients with lumbar spinal stenosis due to degenerative spondylolisthesis. Acta Neurochir. 1993; 120: 136-42.
46. Pappas CTE, Sonntag VKH. Lumbar stenosis in the elderly. Neurosurg Quart. 1994: 102-12.
47. diPiero CG, Helm GA, Shaffrey CI, Chadduck JB, Henson SL, Malik JM et al. treatment of lumbar spinal stenosis by extensive unilateral decompression and contralateral autologous bone fusion: operative technique and results. J Neurosurg. 1996; 84: 166-73.
48. Verbiest H. Results of surgical treatment of idiopathic development stenosis of the lumbar vertebral canal. A review of twenty – seven years experience. J Bone Joint Surg. 1977; 59: 181-8.
49. Ganz JC. Lumbar spinal stenosis: postoperative results in terms of preoperative posture-related pain. J Neurosurg. 1990; 72: 71-4.
50. Hall S, Bartleson JD, Onofrio BM. Lumbar spinal stenosis. Clinical features, diagnostic procedures and results of surgical treatment in 68 patients. Ann Internet Med. 1985; 103: 271-5.
51. Herno A, Airaksinen O, Saari T. Long term results of surgical treatment of lumbar stenosis. Spine, 1993; 18: 1471-4.
52. Herron LD, Mangelsdorf C. Lumbar spinal stenosis: results of surgical treatment. J Spinal Disord. 1991; 4: 26-33.
53. Caputy AJ, Luessenhop AJ. Long term evaluation of decompresssive surgery for degenerative lumbar stenosis. J Neurosurg. 1992; 77: 669-76.
54. Nachemson AL. Instability of the lumbar spine. Pathology, treatment and clinical evaluation Neurosurg Clin N Am. 1991; 2 (4): 785-90.
55. verbiest H. Lumbar spine stenosis. In: Youmans JR eds. Neurological surgery. Saudes, Philadelphia. 1990: 2805-55.

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2015-12-25

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