Lumbar Spinal Stenosis: Ipsilateral Facet-sparing Unilateral Laminotomy for Bilateral Decompression: Technical Note and Preliminary Results

Abstract

Microsurgical unilateral laminotomy for bilateral decompression (ULBD) decompresses effectively lumbar stenosis. Whenever low grade degenerative spondylolisthesis, sagittal oriented facet joints, scoliotic deformity, tall disc, and obesity jeopardize postoperative segmental stability, a maximum facet-preserving decompression is desirable. The medialized ULBD (mULBD) aims to preserve the facet joint on the approach side. Sixty-four patients presenting with neurogenic claudication underwent single or multilevel decompression with ULBD or mULBD according to the judgement of the surgeon. The volume of the target facet joints and the dural cross sectional area (CT-DCSA) were measured pre-and postoperatively by an ultra-low-dose CT with a specific software. Forty-three pairs of facet joints were addressed with ULBD and 43 pairs with mULBD. Postoperatively, the mean percentage of the preoperative facet joint volume preserved on the approach side was 70% ± 4% (ULBD) and 88% ± 6% (mULBD); (p < 0.001). The mean facet joint volume preserved contraleral to the approach side was 87% ± 6% (ULBD) and 91% ± 6% (mULBD); (p = 0.4). The mean postoperative CT-DCSA was 152 ± 30 mm² (ULBD) and 153 ± 26 mm² (mULBD); (p = 0.43). The mUBLD decompresses lumbar spinal stenosis effectively as ULBD and preserves better the facet joint on the approach side.

Syndromic Assessment of Degenerative Disorders of the Lumbar Spine in Elderly Patients

“…Использование предложенного нами алгоритма показало, что в 62% случаев доминирующим клиническим и рентгенологическим синдромом у этих больных является изолированная компрессия нервных кореш-ков в различных отделах ПК, несмотря на наличие у 12,8% из них дегенеративного спондилолистеза и у 3,4% -сколиоза. О превалировании болевого синдрома в ногах (ВАШ >5 баллов) над болью в спине у пациентов старшего возраста, которым необходимо проводить локальные изолированные декомпрессии по технологии MIS, указывается и в исследовании L. Papavero с соавторами [26]. Современные публикации показывают, что выполнение микрохирургических декомпрессий обеспечивает получение отличных результатов у этой категории пациентов [27,28,29].…”

Outcomes of Microscopic-Assisted Decompression Surgery Without Instrumented Fixation in Patients With Spinal Canal Stenosis and First-Degree Degenerative Spondylolisthesis: A Prospective Case Series

“…Surgical interventions can be broadly classified into decompression alone or decompression with fusion (posterolateral fusion/interbody fusion) when obvious dynamic instability is present [12,13]. Although the conventional open techniques of decompression (which involve laminectomy) remain the gold standard of treatment [12,14], problems with paraspinal musculature denervation [15] and possibility of secondary lumbar instability [16] and creation of dead space [17] resulted in increased interest in less invasive techniques [18][19][20][21][22], with reported noninferior clinical outcomes [21,22]. Among them, the minimally invasive surgical (MIS) decompression via a unilateral laminotomy with bilateral decompression-the 'over-the-top' approach, is thought to be less destabilizing than all other techniques [23][24][25][26].…”

“…While several innovations and techniques exist to perform less invasive decompressions, including subarticular fenestration and multiple laminotomies [19][20][21], microscopic decompression [25,31] and tubular decompression [32][33][34][35], the aim of this study is to report our outcomes of microscopic-assisted decompression in first-degree symptomatic DS cases through over-the-top technique, particularly regarding clinical improvement and radiological progression of instability. Despite the presence of similar published reports regarding the same tech-nique [24][25][26], the existing prospective studies were few and the results were nonconsistent specially regarding slip progression.…”