Bilateral versus unilateral interlaminar approach for bilateral decompression in patients with single-level degenerative lumbar spinal stenosis: a multicenter retrospective study of 175 patients on postoperative pain, functional disability, and patient satisfaction

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>The bilateral and unilateral interlaminar techniques for bilateral decompression both demonstrate good results for the treatment of degenerative lumbar spinal stenosis (DLSS). Although there is some discussion about which approach is more effective, studies that directly compare these two popular techniques are rare. To address this shortcoming, this study compares postoperative functional disability, pain, and patient satisfaction among patients with single-level DLSS who underwent bilateral decompression using either a bilateral or unilateral approach.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>This retrospective study included patients who underwent operations between November 1, 2009, and October 1, 2011. These patients underwent single-level bilateral decompressive surgery using either the bilateral or unilateral interlaminar approach at one of 5 participating hospitals. Exclusion criteria included previous lumbar surgery, additional disc surgery, and spondylolisthesis requiring fusion surgery. Primary outcome measures included bodily pain (as reported using the visual analog scale [VAS]), the Roland-Morris Disability Questionnaire (RMDQ), and the Oswestry Disability Index (ODI). In addition, reductions in leg and back symptoms and the patient’s general evaluation of the procedure were queried. Finally, patient satisfaction and surgical parameters were evaluated. Questionnaires were sent to each patient’s home, and electronic patient files were used to collect the data.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>One hundred and seventy-five patients returned the questionnaire (74.4% response rate; 68 and 107 patients who underwent the bilateral or unilateral approach, respectively). Mean age at surgery was 68 years (range 34–89 years), and the mean follow-up period was 14.2 months (range 3.3–27.4 years). There were no significant differences in ODI (20.3 vs 22.6 for the bilateral and unilateral approaches, respectively), RMDQ (3.99 vs 4.8, respectively), or pain scores between treatment groups. Back symptoms were reduced in 74.8% (bilateral: 74.6% vs unilateral: 75%; not significant), and leg symptoms in 80.6% of the patients (bilateral: 73.1% vs unilateral: 85.4%; p = 0.048). In total, 72.1% (bilateral) and 80.0% (unilateral) of patients reported good overall treatment results (p = 0.226). Significantly more patients in the unilateral group reported a better overall satisfaction with the procedure (82.1% vs 69.1%; p = 0.047).</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>There were no differences in postoperative functional disability and pain between the surgical techniques. The significant differences in patient satisfaction and reduction in leg symptoms were unrelated to surgical technique. The overall treatment results were satisfactory. Both techniques are safe and effective options for treating patients with single-level DLSS.</jats:p></jats:sec>

Microscopic bilateral decompression by unilateral approach in spinal stenosis

“…Although several studies showed good results for bilateral decompression via unilateral approach [1,4] it is still unclear which technique is the best for decompression of spinal stenosis [4,5].…”

Treatment of Lumbar Spinal Stenosis by Microscopic Unilateral Laminectomy for Bilateral Decompression: A Technical Note

“…This requires careful evaluation of current best practice and new surgical techniques in order to provide the best available care for these patients to reduce pain and disability, and to improve mobility. Several studies have shown good outcomes for a ULBD approach for the management of LSS; however, it is not clear whether this approach is superior, as high quality evidence is lacking in the literature. That said, these studies do provide evidence suggesting that the ULBD may be associated with better outcomes than with traditional laminectomy, and reduce hospital stay and the overall cost of the intervention (REF).…”

“…Den Boogert et al retrospectively compared postoperative functional disability, pain, and patient satisfaction among 175 patients with LSS who underwent either a ULBD or a traditional laminectomy. Patients in the ULBD group reported better overall satisfaction with the procedure and a reduction in visual analogue score (VAS) leg symptoms.…”

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

“…After the first laminotomy is performed on one side, the deep cortical surface of the contralateral lamina is undercut, and drilling is extended to the contralateral lateral recess, permitting the removal of the ligamentum flavum. 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].…”

“…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]. Moreover, in a recent randomized trial [12] and in a recent systematic review [13], it has been evidenced that ULBD is as effective as open laminectomy in improving clinical functional outcome, with the additional benefits of a significantly greater decrease in pain, postoperative recovery time, time to mobilization and opioid use.…”