Clinical results of microsurgical bilateral decompression via unilateral approach for lumbar canal stenosis with multiple-level involvement

Tanaka, Nobuhiro; Nakanishi, Kazuyoshi; Kamei, Naosuke; Yamamoto, Risako; Nakamae, Toshio; Izumi, Bunichiro; Ohta, Ryo; Fujioka, Yuki; Ochi, Mitsuo

doi:10.1007/s00590-014-1532-y

Cited by 4 publications

(4 citation statements)

References 28 publications

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“…Ideally, a randomized clinical trial that compares conventional laminectomy and ULBD should be conducted to demonstrate causality. However, conventional laminectomy may lead to the residual LBP because of the postoperative instability of decompression segment and ULBD is superior in the clinical outcome [4, 5, 7, 8]. Thus, such study is precluded by ethical constraints.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, less invasive surgery such as unilateral laminectomy for bilateral decompression (ULBD) as first introduced by Young et al has been studied [3]. Favorable results for low back pain (LBP) and lower extremity pain (LEP) and numbness (LEN) in patients with LSS treated with ULBD have been demonstrated [4–8]. In most of those studies, a conventional visual analog scale (VAS) score and Oswestry disability index (ODI) were used to evaluate LBP.…”

Section: Introductionmentioning

confidence: 99%

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Unilateral laminectomy for bilateral decompression improves low back pain while standing equally on both sides in patients with lumbar canal stenosis: analysis using a detailed visual analogue scale

Takahashi

Aoki

Saito

et al. 2019

BMC Musculoskelet Disord

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Background Unilateral laminectomy for bilateral decompression (ULBD) for lumbar spinal stenosis (LSS) is a less invasive technique compared to conventional laminectomy. Recently, several authors have reported favorable results of low back pain (LBP) in patients of LSS treated with ULBD. However, the detailed changes and localization of LBP before and after ULBD for LSS remain unclear. Furthermore, unsymmetrical invasion to para-spinal muscle and facet joint may result in the residual unsymmetrical symptoms. To clarify these points, we conducted an observational study and used detailed visual analog scale (VAS) scores to evaluate the characteristics and bilateral changes of LBP and lower extremity symptoms. Methods We included 50 patients with LSS treated with ULBD. A detailed visual analogue scale (VAS; 100 mm) score of LBP in three different postural positions: motion, standing, and sitting, and bilateral VAS score (approached side versus opposite side) of LBP, lower extremity pain (LEP), and lower extremity numbness (LEN) were measured. Oswestry Disability Index (ODI) was used to quantify the clinical improvement. Results Detailed LBP VAS score before surgery was 51.5 ± 32.5 in motion, 63.0 ± 30.1 while standing, and 37.8 ± 31.8 while sitting; and showed LBP while standing was significantly greater than LBP while sitting ( p < 0.01). After surgery, LBP while standing was significantly improved relative to that while sitting ( p < 0.05), and levels of LBP in the three postures became almost the same with ODI improvement. Bilateral VAS scores showed significant improvement equally on both sides ( p < 0.01). Conclusions ULBD improves LBP while standing equally on both sides in patients with LCS. The improvement of LBP by the ULBD surgery suggests radicular LBP improved because of decompression surgery. Furthermore, the symmetric improvement of LBP by the ULBD surgery suggests unsymmetrical invasion of the paraspinal muscles and facet joints is unrelated to residual LBP.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Unilateral laminectomy for bilateral decompression improves low back pain while standing equally on both sides in patients with lumbar canal stenosis: analysis using a detailed visual analogue scale

Takahashi

Aoki

Saito

et al. 2019

BMC Musculoskelet Disord

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“…To clarify this point, further exploration (for example, of direct comparison between spinous process floating procedures [456] versus spinous process intact procedures [111314]) is needed. This is one of major limitations of the present study.…”

Section: Discussionmentioning

confidence: 99%

Baastrup's Disease Is Associated with Recurrent of Sciatica after Posterior Lumbar Spinal Decompressions Utilizing Floating Spinous Process Procedures

et al. 2016

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Study DesignRetrospective case-control study.PurposeTo determine whether kissing spine is a risk factor for recurrence of sciatica after lumbar posterior decompression using a spinous process floating approach.Overview of LiteratureKissing spine is defined by apposition and sclerotic change of the facing spinous processes as shown in X-ray images, and is often accompanied by marked disc degeneration and decrement of disc height. If kissing spine significantly contributes to weight bearing and the stability of the lumbar spine, trauma to the spinous process might induce a breakdown of lumbar spine stability after posterior decompression surgery in cases of kissing spine.MethodsThe present study included 161 patients who had undergone posterior decompression surgery for lumbar canal stenosis using a spinous process floating approaches. We defined recurrence of sciatica as that resolved after initial surgery and then recurred. Kissing spine was defined as sclerotic change and the apposition of the spinous process in a plain radiogram. Preoperative foraminal stenosis was determined by the decrease of perineural fat intensity detected by parasagittal T1-weighted magnetic resonance imaging. Preoperative percentage slip, segmental range of motion, and segmental scoliosis were analyzed in preoperative radiographs. Univariate analysis followed by stepwise logistic regression analysis determined factors independently associated with recurrence of sciatica.ResultsStepwise logistic regression revealed kissing spine (p=0.024; odds ratio, 3.80) and foraminal stenosis (p<0.01; odds ratio, 17.89) as independent risk factors for the recurrence of sciatica after posterior lumbar spinal decompression with spinous process floating procedures for lumbar spinal canal stenosis.ConclusionsWhen a patient shows kissing spine and concomitant subclinical foraminal stenosis at the affected level, we should sufficiently discuss the selection of an appropriate surgical procedure.

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“…However, MIS-TLIF is usually performed under direct vision of naked eyes, muscles adhere to articular process need to be detached to achieve good exposure, and the contralateral undermined decompression is difficult without assistance of endoscope. [ 5 ]…”

Section: Introductionmentioning

confidence: 99%

Bilateral decompression and intervertebral fusion via unilateral fenestration for complex lumbar spinal stenosis with a mobile microendoscopic technique

Xu¹,

Xu²,

Ma³

et al. 2018

Medicine

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For complex lumbar spinal stenosis, using of endoscopy technique may provide clear vision with less invasive dissection of paravertebral muscle. The objective of this study was to evaluate the feasibility and clinical efficacy of bilateral decompression and intervertebral fusion via unilateral fenestration for complex lumbar spinal stenosis using mobile microendoscopic discectomy (MMED) technique.A total of 61 patients with complex lumbar spinal stenosis (lumbar canal stenosis combined with degenerative spondylolisthesis, instability, and scoliosis) were treated with this procedure. Patients with isolated lumbar spinal stenosis or spondylolisthesis greater than grade II were excluded. The index levels included L4/5 in 52 patients, L5/S1 in 6 patients, L3-L5 in 2 patients and L4-S1 in 1 patient. The preoperative Oswestry Disability Index (ODI) score was 42.6 ± 10.2, lumbar visual analog scale (VAS) score was 6.1 ± 4.2, and leg VAS score was 7.1 ± 5.1. During the operation, ipsilateral enlarged fenestration was made using the MMED technique. The disc and cartilage endplate were thoroughly removed, and the contralateral ligamentum flavum and the inner layer of lamina were undercut to release the contralateral nerve root. The intervertebral space was released and prepared, followed by bone grafting and cage insertion. Percutaneous pedicle system was used for reduction and fixation. The operative time and blood loss were recorded, and patients were followed-up for at least 3 years (36–48 months, average 41 months) to evaluate the clinical efficacy.The procedure was successful in all patients, with no nerve injury or conversion to open operation. The mean operative time was 120 minutes (range, 100–180 minutes), with a mean blood loss of 100 mL (range, 50–200 mL). Postoperative x-ray and CT showed sufficient decompression and improvement of spinal alignment. At 3 years after surgery, the ODI scores, lumbar and leg VAS scores decreased from preoperative 42.6 ± 10.2, 6.1 ± 4.2, and 7.1 ± 5.1 to 8.6 ± 7.0, 1.8 ± 1.3, and 0.9 ± 0.6, respectively (P = .00 for each comparison). The clinical results were excellent in 36 cases, good in 23, and fair in 2, according to the MacNab scale.The procedure of bilateral decompression and intervertebral fusion via unilateral fenestration using the MMED technique can provide satisfactory clinical results for complex lumbar spinal stenosis.

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Clinical results of microsurgical bilateral decompression via unilateral approach for lumbar canal stenosis with multiple-level involvement

Cited by 4 publications

References 28 publications

Unilateral laminectomy for bilateral decompression improves low back pain while standing equally on both sides in patients with lumbar canal stenosis: analysis using a detailed visual analogue scale

Unilateral laminectomy for bilateral decompression improves low back pain while standing equally on both sides in patients with lumbar canal stenosis: analysis using a detailed visual analogue scale

Baastrup's Disease Is Associated with Recurrent of Sciatica after Posterior Lumbar Spinal Decompressions Utilizing Floating Spinous Process Procedures

Bilateral decompression and intervertebral fusion via unilateral fenestration for complex lumbar spinal stenosis with a mobile microendoscopic technique

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