Comparison of Three Different Surgical Treatment Procedures Used in the Treatment of Lumbar Spinal Stenosis; Retrospective Clinical Study

Abstract

Bilateral decompression via a unilateral approach (BDUA) was initially described by Young et al. (4) and then was modified by McCulloch (5). In this technique, the risk of iatrogenic instability is reduced by preserving the facet joints. Unilateral stabilization and contralateral decompression were considered to be effective in terms of operation time, surgical complications, and patient benefit visual analogue scale in comparison to other surgical techniques for the treatment of lumbar spinal stenosis. There is no doubt that a fusion procedure should be performed in the presence of accompanying instability. However, in spinal stenosis cases without instability and spondylolisthesis less than grade 1, the role of spinal fusion is controversial. This is so because spinal instrumentation in degenerative spine may cause adjacent segment degeneration and disease. Therefore, procedures such as bilateral foraminotomy, BDUA, and

Retrospective Study to Compare the Effectiveness of Minimally Invasive Microscopic Unilateral Laminotomy with Microscopic Bilateral Laminotomy for Bilateral Decompression in the Early Postoperative Period in 142 Patients with Single-Level Lumbar Spinal Stenosis

“…The primary aim of surgery for LSS is to restore the width of the spinal canal [ 3 ]. However, aggressive decompression, which can occur with some conventional methods, may lead to iatrogenic spinal instability and other complications [ 1 ]. Fusion procedures also have long-term risks, such as pseudoarthrosis and adjacent segment disease [ 23 , 24 ].…”

“…Lumbar spinal stenosis (LSS) is a disabling spinal disease that causes low back pain, leg pain, and decreased quality of life [ 1 ]. Although there is no definitive information on the prevalence of LSS, it is estimated that approximately 103 million people have symptomatic LSS worldwide [ 2 ].…”

“…Although there is no definitive information on the prevalence of LSS, it is estimated that approximately 103 million people have symptomatic LSS worldwide [ 2 ]. LSS is often based on facet joint growth, ligamentum flavum hypertrophy, disc degeneration, and osteophytes, which can lead to the narrowing of the spinal canal, lateral recess, and neuro-foramen, ultimately causing neurovascular compression [ 1 , 3 – 5 ].…”

“…The diagnosis of lumbar spinal stenosis can usually be made with a careful history and physical examination and is supported by imaging [ 2 ]. Diagnostic improvements have led to a higher frequency of LSS diagnosis, which has made LSS surgery the most frequently performed spinal surgery in recent years [ 1 , 3 ]. Surgery is performed in patients with prolonged symptoms who do not respond to conservative treatment [ 6 ].…”

“…Surgery is performed in patients with prolonged symptoms who do not respond to conservative treatment [ 6 ]. For decompression, interventions such as total laminectomy, unilateral laminotomy, bilateral laminotomy, and open-door laminoplasty are used; however, there is no consensus on the optimal surgical procedure [ 1 , 7 ]. In theory, the optimal surgical procedure should provide maximum effect with minimal trauma and should not lead to complications [ 3 ].…”