Long-term Clinical Outcomes After Bilateral Laminotomy or Total Laminectomy for Lumbar Spinal Stenosis

A Single-institution Experience

Andrea Pietrantonio, MD; Sokol Trungu, MD; Isabella Famà, MD; Stefano Forcato, MD; Massimo Miscusi, MD, PhD; Antonino Raco, MD, PhD

Disclosures

Neurosurg Focus. 2019;46(5):e2 

In This Article

Abstract and Introduction

Abstract

Objective: Lumbar spinal stenosis (LSS) is the most common spinal disease in the geriatric population, and is characterized by a compression of the lumbosacral neural roots from a narrowing of the lumbar spinal canal. LSS can result in symptomatic compression of the neural elements, requiring surgical treatment if conservative management fails. Different surgical techniques with or without fusion are currently treatment options. The purpose of this study was to provide a description of the long-term clinical outcomes of patients who underwent bilateral laminotomy compared with total laminectomy for LSS.

Methods: The authors retrospectively reviewed all the patients treated surgically by the senior author for LSS with total laminectomy and bilateral laminotomy with a minimum of 10 years of follow-up. Patients were divided into 2 treatment groups (total laminectomy, group 1; and bilateral laminotomy, group 2) according to the type of surgical decompression. Clinical outcomes measures included the visual analog scale (VAS), the 36-Item Short-Form Health Survey (SF-36) scores, and the Oswestry Disability Index (ODI). In addition, surgical parameters, reoperation rate, and complications were evaluated in both groups.

Results: Two hundred fourteen patients met the inclusion and exclusion criteria (105 and 109 patients in groups 1 and 2, respectively). The mean age at surgery was 69.5 years (range 58–77 years). Comparing pre- and postoperative values, both groups showed improvement in ODI and SF-36 scores; at final follow-up, a slightly better improvement was noted in the laminotomy group (mean ODI value 22.8, mean SF-36 value 70.2), considering the worse preoperative scores in this group (mean ODI value 70, mean SF-36 value 38.4) with respect to the laminectomy group (mean ODI 68.7 vs mean SF-36 value 36.3), but there were no statistically significant differences between the 2 groups. Significantly, in group 2 there was a lower incidence of reoperations (15.2% vs 3.7%, p = 0.0075).

Conclusions: Bilateral laminotomy allows adequate and safe decompression of the spinal canal in patients with LSS; this technique ensures a significant improvement in patients' symptoms, disability, and quality of life. Clinical outcomes are similar in both groups, but a lower incidence of complications and iatrogenic instability has been shown in the long term in the bilateral laminotomy group.

Introduction

LUMBAR spinal stenosis (LSS) is defined as a narrowing of the lumbar spinal canal, and is one of the most common spine diseases in the geriatric population. LSS can result in symptomatic compression of the neural elements, requiring surgical treatment if conservative management fails.

Total laminectomy (initially known as a Christmas Tree laminectomy and now outdated) is the classic operative technique and consists of the unroofing of the spinal canal by resecting the spinous process, the laminae, the articular processes, and the pars interarticularis bilaterally; less invasive surgical options have been developed during the past years, including bilateral laminotomy and unilateral laminotomy for bilateral decompression.[12,16,17,21] In elderly patients with comorbidities, indirect decompression has been shown to be another treatment option.[13] The main assumption that justifies the development of these techniques is the possibility to obtain an adequate decompression, minimizing the tissue trauma and preserving the spinal architecture. As a consequence, a better clinical outcome with minor long-term complications can be expected.

In the current study, we report the long-term clinical outcomes of patients who underwent bilateral laminotomy for degenerative LSS (DLSS); a comparison between this group and a group of patients treated with total laminectomy at our institution has been done and the results have been discussed and analyzed in detail.

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