Outcome after Surgery of Lumbar Spinal Stenosis: A Randomized Comparison of Bilateral Laminotomy, Trumpet Laminectomy, and Conventional Laminectomy

Abstract

BackgroundLaminectomy is the traditional operating method for the decompression of spinal canal stenosis. New partial decompression processes have been suggested in the treatment of lumbar stenosis. The benefit of a micro surgical approach is the chance of an extensive bilateral decompression of the spinal canal or foramen at one or numerous levels, through a minimal para-spinal muscular separation.PurposeTo match the safety and the clinical consequences after a bilateral laminotomy, laminectomy and trumpet laminectomy in patients with lumbar spinal stenosis who were randomized to one of three treatment groups.Study designProspective study.MethodsOne hundred twenty consecutive patients with 227 levels of lumbar stenosis without significant herniated discs or instability were randomized to three treatment groups [bilateral laminotomy (Group 1), laminectomy (Group 2), and trumpet laminectomy (Group 3)]. Perioperative parameters and complications were documented. Symptoms and scores, such as a visual analog scale (VAS), Oswestry Disability Index, and patient satisfaction, were assessed preoperatively at 3, 6, and 12 months after surgery. Adequate decompression was achieved in all patients on the basis of surgeon satisfaction.ResultsThe global complication rate was lowest in patients who had undertaken bilateral laminotomy (Group 1). The minimum follow-up of 12 months was achieved in 100% of patients. Matched with that experience in Group 1, but, with more remaining back and leg pain was found in Group 2, 3.85 ± 0.28 and 1.60 ± 0.44, respectively and 3.24 ± 0.22 and 2.44 ± 0.26 in Group 3, respectively compared with 1.84 ± 0.28 and 1.25 ± 0.12 (Group 1) at the 1-year follow-up assessment (p < 0.05). It was the same for the ODI scores, which reached 14 ± 8% (Group 1), 28 ± 12% (Group 2), and 26 ± 16 after 12 months of surgery (Group 3) (significant, p < 0.01 compared with preoperative scores). Patient satisfaction was higher in Group 1, with 7.5, 20, and 25% of patients displeased (in Groups 1, 2, and 3, respectively; p < 0.01).ConclusionBilateral Laminotomy is certified acceptable and harmless in decompression of lumbar stenosis, causing a highly significant decrease of symptoms and disability.

Timing of Adjuvant Radiation Therapy and Risk of Wound-Related Complications Among Patients With Spinal Metastatic Disease

“…Finally, a study by Onimus et al in a similar cohort showed that none of their patients (0/16) developed a wound complication when treated with RT 7 days following surgery. 19,20 Our findings echo much of these clinical data and indicate that early RT does not increase the risk of wound complications following resection of a spinal metastasis.…”

Comparison of Three Different Paraspinous Unilateral Approaches to the Spinal Canal for Lumbar Decompression-Minimally 2-Year Postoperative Evaluation

“…Using this data, there is no statistical difference in operative time per level decompressed among the 3 groups. Once the definite learning curve is over and experience has been acquired, the operative time should be shorter than at the beginning of a case series [18][19][20][21].…”

Role of Minimally Invasive Spine Surgery in Adults with Degenerative Lumbar Scoliosis: A Narrative Review

“…The results of some studies on clinical consequences in patients with degenerative scoliosis showed the efficiency of minimally invasive decompression specially in isolated lateral listhesis [42][43][44][45].…”

“…Recognition and treatment of osteoporosis is essential and may require delaying the surgery 6-18 month while pharmacological intervention is taking place [40,41]. Most common indications for surgery are devastating pain unresponsive to non-operative approaches and severely disturbing the quality of life, neurological disorders, and infrequently cosmetic appearance [40,44,45]. The goal of surgery is the decompression of neural elements by restoration and the maintenance of sagittal and coronal balance [42,46].…”

“…Epidural and facet injections, selective nerve root blocks, and trigger point injections have a limited role in treatment and diagnosis. The preservation of an active level of physical activity and lifestyle in adult deformity patients is vital [42,45].…”