Comparison of the effect of 3 different approaches to the lumbar spinal canal on postoperative paraspinal muscle damage

Kim, Kyongsong; Isu, Toyohiko; Sugawara, Atsushi; Matsumoto, Ryoji; Isobe, Masanori

doi:10.1016/j.surneu.2007.04.021

Cited by 67 publications

(52 citation statements)

References 11 publications

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“…Our results do not support the presumption that more back pain will develop in patients who undergo the bilateral approach due to the more extensive bilateral stripping of the spinal muscles, as suggested by several authors. 3,24,33,54 The present study also does not support the somewhat unexpected results reported by Thomé et al, that patients who undergo unilateral surgeries develop more back pain. 58 In our study, both groups reported marked reduction in back symptoms, and there were no significant differences between groups.…”

Section: Primary Outcome Assessmentscontrasting

confidence: 99%

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

Boogert

Keers²,

Oterdoom

et al. 2015

SPI

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OBJECT 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. METHODS 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. RESULTS 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). CONCLUSIONS 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.

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Section: Primary Outcome Assessmentscontrasting

confidence: 99%

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

Boogert

Keers²,

Oterdoom

et al. 2015

SPI

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“…The authors observed decreased paraspinal cross-sectional area, decreased muscle density (indicating a higher proportion of intramuscular fat), and impaired trunk extension strength. Likewise, other research has reported LM muscle atrophy and injury following lumbar disc surgery, although this appears to vary with surgical approach 53,64,98 and the amount of intraoperative retraction time. 14,28,59,70 Moreover, such changes may be related to the development of failed back syndrome or postdiscectomy syndrome.…”

mentioning

confidence: 84%

Postoperative Rehabilitation Following Lumbar Discectomy With Quantification of Trunk Muscle Morphology and Function: A Case Report and Review of the Literature

Hébert¹,

Marcus²,

Koppenhaver³

et al. 2010

J Orthop Sports Phys Ther

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“…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].…”

Section: Excluded Studiesmentioning

confidence: 99%

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

et al. 2015

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Purpose To compare the effectiveness of techniques of posterior decompression that limit the extent of bony decompression or to avoid removal of posterior midline structures of the lumbar spine versus conventional facetpreserving laminectomy for the treatment of patients with degenerative lumbar stenosis. Methods A comprehensive electronic search of the Cochrane Central Register of Controlled Trials, MED-LINE, EMBASE, Web of Science, and the clinical trials registries ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform was conducted for relevant literature up to June 2014. Results A total of four high-quality RCTs and six lowquality RCTs met the search criteria of this review. These studies included a total of 733 participants. Three different techniques that avoid removal of posterior midline structures are compared to conventional laminectomy; unilateral laminotomy for bilateral decompression, bilateral laminotomy and split-spinous process laminotomy. Evidence of low or very low quality suggests that different techniques of posterior decompression and conventional laminectomy have similar effects on functional disability and leg pain. Only perceived recovery at final follow-up was better in patients that underwent bilateral laminotomy compared with conventional laminectomy. Unilateral laminotomy for bilateral decompression and bilateral laminotomy resulted in numerically fewer cases of iatrogenic instability, although in both cases, the incidence of instability was low. The difference in severity of postoperative low back pain following bilateral laminotomy and split-spinous process laminotomy was significantly less, but was too small to be clinically important. We found no evidence to show that the incidence of complications, length of the procedure, length of hospital stay and postoperative walking distance differed between techniques of posterior decompression. Conclusion The evidence provided by this systematic review for the effects of unilateral laminotomy for bilateral decompression, bilateral laminotomy and split-spinous process laminotomy compared with conventional laminectomy on functional disability, perceived recovery and leg pain is of low or very low quality. Therefore, further research is necessary to establish whether these techniques provide a safe and effective alternative for conventional laminectomy. Proposed advantages of these techniques regarding the incidence of iatrogenic instability and postoperative back pain are plausible, but definitive conclusions are limited by poor methodology and poor reporting of outcome measures among included studies.

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Comparison of the effect of 3 different approaches to the lumbar spinal canal on postoperative paraspinal muscle damage

Cited by 67 publications

References 11 publications

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

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

Postoperative Rehabilitation Following Lumbar Discectomy With Quantification of Trunk Muscle Morphology and Function: A Case Report and Review of the Literature

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

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