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WP1-4 Bilateral laminotomy through a unilateral approach (minimally invasive) vs open laminectomy for lumbar spinal stenosis
  1. J Horan1,
  2. MB Husein2,
  3. C Bolger2
  1. 1UCD Medical School, Dublin, Ireland
  2. 2Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland

Abstract

Objectives The purpose of our prospective randomised study is to compare safety and functional outcomes in traditional laminectomy versus minimally invasive (MI) bilateral laminectomy via unilateral approach for lumbar spinal stenosis (LSS).

Design This is a prospective randomised trial comparing two procedures for LSS.

Subjects 62 patients were treated for LSS and randomised to one of two groups over a 6 month period.

Methods Group A comprised 37 patients that underwent MI intersegmental unilateral decompression. Group B comprised 25 patients that underwent traditional laminectomy. Follow-up duration was 3 years. The primary outcomes were walking distance, the visual analogue scale (VAS) pain outcome score and the Oswestry Disability Index (ODI).

Results VAS pain outcome was reduced from 9 to 2 and 8 to 5 in MI and open, ODI improved from 56.5 to 13 and 58 to 24 in MI and open respectively. Complication rates were lower in MI compared to open (8% vs 56%) and consisted of CSF leak, temporary leg pain, TIA, urinary retention and wound infections. Length of stay was 1–3 days compared to 7–30 days in MI against open respectively.

Conclusions Bilateral laminectomy through a unilateral approach (MI) and traditional laminectomy are both effective in improving pain, ODI and walking distance in LSS. MI procedures have an advantage in shorter hospital stays, sparing of more bony structures and lower complication rates. We conclude that MI unilateral decompression is at least as good as laminectomy in the treatment of pain and disability in LSS.

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