Spinal canal stenosis: comparative analysis of minimally invasive bilateral decompression through a unilateral approach and laminectomy

Abstract

Objective. To analyze and compare the results of treatment of lumbar spinal stenosis using minimally invasive unilateral decompression and classical laminectomy.Material and Methods. The retrospective comparative monocentric study included 68 patients (2 groups of 34 patients each) operated on in 2018–2021 for spinal stenosis in the lumbar spine who met certain eligibility criteria. Patients of one group were operated on using minimally invasive bilateral decompression through a unilateral approach, while patients in the other group were operated on using classical laminectomy. The results of surgical treatment were compared during 24 months by assessing pre- and postoperative indicators of the intensity of pain in the back and lower extremities using a 10-point VAS, and the patient’s functional activity – using the Oswestry index.Results. A statistically significant clinical effect of surgical treatment was noticed in both groups. At the end of the follow-up period, the results of back pain relief in the minimally invasive surgery group were significantly better (0.3 vs 0.9, respectively), and the improvement in functional activity was comparable to the laminectomy group (8.8 vs 9.8, respectively). A clinical effect of pain relief in the lower extremities was obtained in both groups (up to 1.2 and 1.4, respectively). The length of hospital stay, time to activation, and volume of blood loss were significantly lower in minimally invasive decompression group.Conclusion. Minimally invasive unilateral decompression of the spinal canal for lumbar spinal stenosis demonstrates a better effect in relieving back pain than classical laminectomy, with no significant difference in relieving pain in the lower extremities. The minimally invasive technique allows patients to rehabilitate as quickly as possible and return to everyday life and work. It has socio-economic advantages compared to classical laminectomy – a shorter period of activation and hospital treatment, and less blood loss.