Bilateral partial laminectomy: a treatment for lumbar spinal stenosis and midline disc herniation

Lower back pain is extremely common; most patients' symptoms improve with conservative treatment. This leaves only a small percentage of patients with persistent symptoms that are amenable to surgery. Various decompressions have been performed to remedy compressive conditions of the spine, with a wide range of results.

We retrospectively reviewed 152 patients with lumbar spinal stenosis or midline disc herniations surgically treated with bilateral partial laminectomy. Short-term follow-up was available for 138 patients (2 weeks to 2 months) and long-term follow-up was available for 88 patients (1-6 years, mean 3.5 years). Clinical outcome was determined by chart review and the use of a standardized questionnaire. Preoperative and postoperative back and leg pain, ambulation, employment status, and satisfaction were assessed.

Overall improvement postoperatively was noted in 88% of the spinal stenosis patients and 91% of the midline disc herniations at long-term follow-up. Average hospital stays for the spinal stenosis group and the midline disc herniation group were 3.7 days and 2.8 days, respectively. Only two patients had undergone subsequent fusions of their lumbar spine after bilateral partial laminectomy.

We believe that less radical resection of laminae and spinous processes better preserves the spine's natural architecture and may contribute to improved postoperative stability. This may reduce the number of patients needing concomitant or subsequent fusion, with its associated morbidity. As surgeons push for less radical or less invasive surgical techniques to obtain the same or better postoperative results, the bilateral partial laminectomy is a good alternative to total laminectomy.