Comparison of bilateral decompression via unilateral laminotomy and conventional laminectomy for single-level degenerative lumbar spinal stenosis regarding low back pain, functional outcome, and quality of life - A Randomized Controlled, Prospective Trial

Abstract

Background Conventional posterior open lumbar surgery is associated with considerable trauma to the paraspinal muscles. Severe damage to the paraspinal muscles could cause low back pain (LBP), resulting in poor functional outcomes. Thus, several studies have proposed numerous surgical techniques that can minimize damage to the paraspinal muscles, particularly unilateral laminotomy for bilateral decompression. The purpose of this study is to compare the degree of postoperative LBP, functional outcome, and quality of life of patients between bilateral decompression via unilateral laminotomy (BDUL; group U) and conventional laminectomy (CL; group C). Methods Of 87 patients who underwent diagnostic and decompression surgery, 50 patients who met the inclusion and exclusion criteria and were followed up for > 2 years were enrolled. The patients were asked to record their visual analog scale pain score after 6, 12, and 24 months postoperatively. BDUL was used for group U, whereas CL was used for group C. The patients were randomly divided based on one of the two techniques, and they were followed up for over 2 years. Functional outcomes were assessed by the Oswestry Disability Index (ODI), Roland–Morris Disability Questionnaire (RMDQ), and SF-36. Results Operation time was significantly shorter in group U than in group C ( p = 0.003). At 6, 12, and 24 months, there was no significant difference between the two groups in terms of spine-related pain (all p > 0.05). Functional outcomes using ODI and RMDQ and quality of life using SF-36 were not significantly different between the groups (all p > 0.05). Conclusions Regarding single-level decompression for degenerative lumbar spinal stenosis, group U had the advantages of shorter operation time than group C, but not in terms of back pain, functional outcome, and quality of life.

Inside-Out Approach of Lumbar Endoscopic Unilateral Laminotomy for Bilateral Decompression: A Detailed Technical Description, Rationale and Outcomes

“…Many studies have reported on comparable short and longterm favorable clinical outcomes between open facet sparing laminectomy and minimally invasive ULBD in lumbar central and lateral recess stenosis. [29][30][31] The benefit extends even to lumbar stenosis cases with spondylolisthesis. 32 Additionally, there are also several studies describing similar favorable results bewww.e-neurospine.org S95 tween microsurgical or tubular techniques of ULBD and endoscopic lumbar decompression in the setting of lumbar stenosis, with shorter hospital stay and less collateral tissue injury.…”

“…Many studies have reported on comparable short and long-term favorable clinical outcomes between open facet sparing laminectomy and minimally invasive ULBD in lumbar central and lateral recess stenosis [ 29 - 31 ]. The benefit extends even to lumbar stenosis cases with spondylolisthesis [ 32 ].…”

Vertebral Tumor Detection and Segmentation Using Analytical Transform Assisted Statistical Characteristic Decomposition Model

“…The backbone is divided to thoracic (T1-T12), cervical (C1-C7), sacroiliac (S-Fused) and lumbar areas (L1-L5) as well as coccyx (4 fused). Literature review shows that the main cause of low back pain is degenerative spinal stenosis [14]. It is considered as one of the most common indices of spinal surgery which leads to tumor and spinal dislocation.…”

“…As shown in equations (11) and (12), the covariance matrix is determined from a block covariance matrix to determine the difference in the variance points of the vertebral region as shown in Figure 5. As shown in Figure 5, the eigen decomposition of equation 12is obtained from equation (14) which allows the eigen values ⋀ l|k and eigen vectors φ l|k that depicts the conditional variability k l  in accordance with Eigen time factor between shapes y j,l and y j,k , with more and less distortion points during segmentation which helps to evaluate the ROC for the image. The Yellow region shows good ROC point prediction using variance analysis, Further the conditional models are represented as follows:…”

“…By substituting equations (11) and (14), the combined conditional models are obtained and represented as follows:…”