The Outcome of Laminectomy versus Laminoforaminotomy in Terms of Claudication Distance in Lumbar Spinal Stenosis
Keywords:Claudication distance, Laminoforaminotomy, Laminectomy
Objectives: The study aimed to compare the surgical outcome of two different procedures for lumbar spinal stenosis. It helped us in the decision-making to go for less invasive procedures, as compared to conventional laminectomy in lumbar spinal stenosis patient patients.
Materials and Methods: An interventional randomized controlled trial was conducted in the department of neurosurgery, Shaheed Zulfiqar Ali Bhutto Medical University, PIMS Islamabad. A total of 158 adult patients aged between 35 to 55 years with an established diagnosis of lumbar stenosis and claudication distance of fewer than 100 meters were enrolled. Patients were randomly included into two equal groups via the computerized method. In Group A laminectomy was done and in Group Blaminoforaminotomy was adopted. The outcome was measured in terms of claudication distance at 4 weeks after the procedure, and compared in both groups.
Results: The mean age of the patients was 44.92 ± 6.28 years. Poor outcome was significantly lower in the Laminoforaminotomy group as compared to the Laminectomy group, at 4 weeks after the procedure. The frequency of claudication distance > 500m (good) at 4 weeks was found to be 62 (78.5%) in the Laminectomy group and it was found in 74 (93.7%) patients in the Laminoforaminotomy group (p = 0.022).
Conclusions: The study concluded that the laminoforaminotomy is superior to laminectomy, in terms of claudication distance at four weeks after the procedure.
Deer T, Sayed D, Michels J, Josephson Y, Li S, Calodney AK. A review of lumbar spinal stenosis with intermittent neurogenic claudication: disease and diagnosis. Pain medicine, 2019 Dec 1; 20 (Supplement_2): S32-44.
Lafian AM, Torralba KD. Lumbar spinal stenosis in older adults. Rheum Dis Clin. 2018; 44 (3): 501-512.
Pietrantonio A, Trungu S, Famà I, Forcato S, Miscusi M, Raco A. Long-term clinical outcomes after bilateral laminotomy or total laminectomy for lumbar spinal stenosis: a single-institution experience. Neurosurg Focus, 2019; 46 (5): E2.
Wessberg P, Frennered K. Central lumbar spinal stenosis: natural history of non-surgical patients. Eur Spine J. 2017; 26 (10): 2536-2542.
Balaara A, Xu XF, Huang YH, Dapeng L. Predictors of the outcome of lumbar disc herniation following classical surgery. Der Orthopäde. 2017; 46 (6): 530-7.
Khan OA, Khan MP, Azam M, Abideen Z, Uddin S. A Comparison of Bilateral Decompression via Unilateral Approach and Classic Laminectomy in Patients with Lumbar Spinal Stenosis in terms of postoperative back pain. Journal of Saidu Medical College, Swat, 2021 Mar 17; 11 (1): 45-9.
Phan K, Mobbs RJ. Minimally invasive versus open laminectomy for lumbar stenosis: a systematic review and meta-analysis. Spine, 2016; 41 (2): E91-100.
Bays A, Stieger A, Held U, Hofer LJ, Rasmussen-Barr E, Brunner F, Steurer J, Wertli MM. The influence of comorbidities on the treatment outcome in symptomatic lumbar spinal stenosis: A systematic review and meta-analysis. North American Spine Society Journal (NASSJ). 2021 Jun
; 6: 100072.
Ghori SA, Khan AA, Imran M, Ashraf J, Hareem A. Comparison of short-term surgical outcome of laminectomy and laminoforaminotomy by postoperative walking distance, in patients with neurogenic claudication due to single level lumbar stenosis. Pak J Surg. 2015; 31 (1): 54-61.
Overdevest GM, Jacobs W, Vleggeert?Lankamp C, Thomé C, Gunzburg R, Peul W. Effectiveness of posterior decompression techniques compared with conventional laminectomy for lumbar stenosis. Cochrane database of systematic reviews, 2015(3): 1-76.
Machado GC, Ferreira PH, Yoo RI, Harris IA, Pinheiro MB, Koes BW, van Tulder MW, Rzewuska M, Maher CG, Ferreira ML. Surgical options for lumbar spinal stenosis. Cochrane Database of Systematic Reviews, 2016 (11).
Pich J. Effectiveness of posterior decompression techniques compared with conventional laminectomy for lumbar stenosis. Orthopaedic Nursing. 2018;37(5):318-9.
Lee SY, Kim TH, Oh JK, Lee SJ, Park MS. Lumbar stenosis: a recent update by review of literature. Asian Spine J. 2015; 9 (5): 818-828.
Robaina-Padron FJ. Controversies about instrumented surgery and pain relief in degenerative lumbar spine pain. Results of scientific evidence. Neurocirugia (Asturias, Spain), 2007; 18 (5): 406-413.
Lai MK, Cheung PW, Cheung JP. A systematic review of developmental lumbar spinal stenosis. European Spine Journal, 2020 Sep; 29 (9): 2173-87.
Nerland US, Jakola AS, Solheim O, Weber C, Rao V, Lonne G, et al. Minimally invasive decompression versus open laminectomy for central stenosis of the lumbar spine: pragmatic comparative effectiveness study. BMJ. 2015; 35.
Copyright (c) 2023 Pakistan Journal Of Neurological Surgery
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.