Unilateral Laminotomy for Bilateral Microdecompression of Stenosis of the Lumbar Canal

Abstract

With the aging of the world population, the treatment of stenosis of the lumbar canal has become an important issue in addressing degenerative diseases of the spine. The prevalence of this disease tends to increase as the number of surgeries and the impact on health care costs. This paper aims to describe in detail the technique of unilateral laminotomy for bilateral microdecompression (ULBM) of stenosis of the lumbar canal (LSC) and current clinical results, including their advantages, disadvantages and common complications, based on the available literature. Important studies have shown evidence that surgical treatment for LSC is more effective than the conservative, but without evaluating ULBM. Several studies on ULBM have been conducted since the 90s, showing the results of this technique, however, most of these are case series, retrospective studies or cohorts without proper control group or with weak statistical analysis to prove some evidence. A double-blind randomized clinical trial was found, but with short follow-up. We conclude that studies are needed with more solid evidence to prove the effectiveness of ULBM despite the clinical results being similar to those of classical surgery found in the literature.

Retrospective Study to Compare the Effectiveness of Minimally Invasive Microscopic Unilateral Laminotomy with Microscopic Bilateral Laminotomy for Bilateral Decompression in the Early Postoperative Period in 142 Patients with Single-Level Lumbar Spinal Stenosis

“…Reported advantages of ULBD include shorter operating time, shorter postoperative hospital stay, earlier ambulation, lower risk of adjacent segment degeneration, and lower risk of muscle atrophy due to unilateral opening of paravertebral muscles compared to bilateral opening, causing less blood loss and reducing the time to initiate mobilization. Additionally, the ULBD approach has been reported to provide better visualization of the contralateral recess and to allow for bilateral discectomy if necessary [ 17 , 31 , 35 , 42 , 43 ]. While our study did not compare classical laminectomy and microscopic laminotomy, the collective results from our study and previous research suggest that ULBD and BLBD can achieve satisfactory success in patients with LSS requiring bilateral decompression, without exposing patients to the potential high complication risks of laminectomy.…”

“…ULBD may be more successful than BLBD in improving disability. However, some researchers assert that ULBD is technically more challenging, has a longer learning curve, presents a higher risk of dural sac lesions and liqueuric fistula due to instrument manipulation through a small portal, has a poorer view of the contralateral recess, and has higher rates of recurrence and reoperation due to inadequate decompression, compared with open surgery or the bilateral approach [ 15 – 17 ]. Our study also indicated that ULBD can pose a higher risk for wound infection than BLBD.…”

“…These claims have been substantiated by many studies showing that ULBD provides satisfactory symptomatic and functional improvement in the short, medium, and long term, with a low risk of complications in patients with LSS [ 12 – 14 ]. However, ULBT is described to be a difficult procedure, compared with bilateral laminotomy for bilateral decompression (BLBD), and has been demonstrated to prolong operating time, increase bleeding, and elevate risks for dural sac lesions [ 15 – 17 ]. Therefore, there is an ongoing debate regarding the utility of ULBD compared with that of BLBD; however, evidence is limited, indicating the need for comparative research focusing on these interventions.…”