Clinical outcomes following sublaminar-trimming laminoplasty for extensive lumbar canal stenosis

Abstract

Purpose Current surgical approaches for treatment of lumbar canal stenosis are often associated with relatively high rates of reoperation and recurrent stenosis. We have developed a new approach for treatment of this condition: sublaminar-trimming laminoplasty. To describe the surgical approach of sublaminar-trimming laminoplasty and to assess associated outcomes. Methods Patients with extensive lumbar canal stenosis who received sublaminar-trimming laminoplasty from 2006 to 2008 were considered for inclusion in the study. The surgery comprised aspects of laminotomy and laminectomy. The following were assessed before surgery and 3 years after surgery: leg and back pain by visual analog scale (VAS), extent of disability by Oswestry Disability Index (ODI), severity of back pain by Japanese Orthopedic Association Score for Back Pain (JOA), walking tolerance, and leg numbness. Complications were noted. Results A total of 49 patients were included in the study (mean age 65.6 ± 10.6 years). VAS leg and back pain, ODI, and JOA scores significantly changed from before surgery to 3 years after surgery (P \ 0.001). Mean changes (95 % confidence interval) were -6.2

Sublaminar Decompression and Fusion in the Management of Stenotic Lumbar Degenerative Disorders

“…The mean ODI improved from 76±7.5 (Range, 60-90) to 29.5±8.3 (Range, 20-50) showing 61.2% improvement at the last follow up (P<0.001). This was comparable to Liu et al, 6 study with improvement of 69.9% of ODI at the last follow up. In our study, we had 95% fusion rate which was more than that in the study of Peddada e al, 10 study that showed 88% fusion rate.…”

“…3 The mean age was 47.7±10.4 years old comparing to other studies, mean age was 60 (Range: 19-78) 10 and 65.6±10.6 years. 6 The mean operative time was 127.5±35.3 (Range, 85-200) minutes that was comparable to Liu et al, 6 study who reported an operative time of 126.6 minutes for sublaminar trimming laminoplasty alone that was increased up to 259.7 minutes for the whole procedure. However, the mean operative time was less than that of Peddada et al, 10 study which was 322 minutes but this may be due to their long fusion segments and some patients have deformity correction.…”

Sublaminar Decompression and Fusion Versus Sublaminar Trimming Laminoplasty: A Retrospective Cohort

“…3 Different modifications of the standard decompressive laminectomy technique have been discussed to adequately cure patients with spinal canal stenosis while increasing preservation of the spinal structural anatomy including conventional laminectomy, bilateral laminotomy, unilateral laminotomy with contralateral recess decompression, partial facetectomy and splitspinous process laminotomy/laminoplasty. [4][5][6] Postero-lateral fusion and laminectomy with instrumentation was the standard treatment option for spinal stenosis. In this technique, decompression is completed by laminectomies which involves removal of spinous process, interspinous ligament, supraspinous ligament, entire lamina, ligamentum flava and partial facets leaving only very small surface of transverse processes and remaining facet joints allowed for fusion; this explains high incidence of non-union reaching up to 27 to 30%.…”

“…This technique comprises aspects of laminotomy and laminectomy and proposed to remove tissue around the thecal sac and nerve root to widen the spinal canal, while preserving structures that stabilize the spine, such as the facet joint, interspinous ligament, and supraspinous ligament. 6 Kebaish et al 2017 7 described a new technique, sublaminar decompression, which includes partial laminectomy and facetectomy providing a wide central, foraminal and lateral recess decompression while leaving maximum bone posteriorly and postero-laterally to allow adequate fusion.…”

“…Different modifications of the standard decompressive laminectomy technique have been discussed to adequately cure patients with spinal canal stenosis while increasing preservation of the spinal structural anatomy including conventional laminectomy, bilateral laminotomy, unilateral laminotomy with contralateral recess decompression, partial facetectomy and split-spinous process laminotomy/laminoplasty 4–6 …”