A Prospective Comparative Study of 2 Minimally Invasive Decompression Procedures for Lumbar Spinal Canal Stenosis

Abstract

3.

Effectiveness of posterior decompression techniques compared with conventional laminectomy for lumbar stenosis

“…Moreover, the duration of hospital stay was significantly shorter in the unilateral laminotomy group. We excluded eight studies because the control group did not meet the criteria of this review [6,[41][42][43][44][45][46][47]. We excluded three studies because the design precluded a reliable comparison of decompression techniques [48][49][50].…”

Technical Nuances of Minimal Invasive Interlaminar Decompression in Lumbar Spinal Stenosis: The Role of Minimal Invasive Bilateral Approach

“…It has been reported the usefulness of both procedures to treat patients with single level spinal stenosis [11]. In a recent prospective study, in patients with multilevel decompression, UBLD was found superior to MILD in term of low back pain and lumbar function (increased sagittal translation and lumbar lordosis in MILD compared to UBLD, probably due to the removal of half of the spinous processes in the MILD) [10]. Nonetheless, Mobbs et al [12] reported that UBLD can have some disadvantages such as the difficulty of manipulating instruments through a small portal (resulting in a more significant dural sac retraction and a higher possibility of dural tears) and the higher recurrence and reoperation rates due to minimal exposure, leading to inadequate decompression [12].…”

“…There is evidence that fusion may increase the biomechanical stress imposed on the adjacent segments, leading to overload disease [18] and requiring secondary spine surgery for lumbar adjacent instability [19]. To overcome these problems, minimal invasive procedures have been reported in the literature [10]- [14]. The most common minimal invasive approaches are: the muscle-preserving interlaminar decompression (MILD), introduced by Hatta et al [8] and the unilateral approach for bilateral decompression (ULBD), reported by Spetzger et al [9].…”

“…Nonetheless, this procedure can be associated to iatrogenic instability requiring reoperation to perform lumbar fusion by instrumentation [7]. Minimal invasive procedures such as the muscle-preserving interlaminar decompression (MILD) [8] and the unilateral approach for bilateral decompression (ULBD) [9] have been reported in the literature [10]- [12] as alternative techniques for lumbar spinal stenosis decompression. These techniques are both efficacious to treat patients with single level spinal stenosis [11].…”

“…Nonetheless, both the minimal invasive approaches have some limitations. MILD has been found to increase sagittal translation and lumbar lordosis in multilevel decompression, probably due to the removal of half of the spinous processes [10] and ULBD can show some disadvantages such as the difficulty of manipulating instruments through a small portal and the inadequate decompression due to a minimal exposure [12]. Here we report the results of a series of patients operated at one or multilevel lumbar spinal stenosis (with and without spondylolisthesis), using the minimal invasive bilateral interlaminar decompression [14], in which the access was bilateral but the supraspinous and interspinous ligaments and the spinous processes were preserved.…”