Modified unilateral laminotomy for bilateral decompression for lumbar spinal stenosis: technical note

Area of Science:

• Spinal Surgery
• Orthopedics
• Minimally Invasive Procedures

Background:

• Conventional laminectomy for lumbar spinal stenosis (LSS) can lead to multifidus muscle atrophy and chronic low back pain.
• Muscle damage is linked to prolonged retraction, extensive stripping, and posterior ramus injury during traditional laminectomy.

Purpose of the Study:

• To describe the minimally invasive unilateral laminotomy for decompression (M-ULBD) technique for LSS.
• To report the 2-year follow-up results of M-ULBD in LSS patients.
• To compare M-ULBD outcomes with conventional laminectomy.

Main Methods:

• A prospective study involving 56 LSS patients randomly assigned to M-ULBD (27 patients) or conventional laminectomy (29 patients).
• Clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) for pain, creatine phosphokinase (CPK) levels, and multifidus cross-sectional area (CSA).

Main Results:

• Both groups showed significant postoperative improvement in JOA and VAS scores.
• M-ULBD group demonstrated significantly lower postoperative CPK, VAS pain scores, and multifidus atrophy rates compared to the conventional laminectomy group.
• Dural tears occurred in 11.1% of the M-ULBD group and 3.4% of the conventional laminectomy group.

Conclusions:

• M-ULBD is an effective treatment for LSS over a 2-year follow-up period.
• The technique appears to minimize muscle damage and postoperative pain compared to conventional laminectomy.
• Long-term follow-up and comparative studies with other modified techniques are recommended.