The Effect of Unilateral Laminotomy Decompression in the Prevention of Adjacent Spinal Canal Stenosis During Lumbar...

Lumbar fusion surgery is a significant surgical approach for degenerative lumbar spine diseases. However, lumbar fusion can cause adjacent vertebral diseases, about 50% of which is spinal stenosis. Unilateral laminectomy is an effective treatment for lumbar spinal stenosis. Therefore, this study aims to assess whether concurrent unilateral laminotomy decompression of the proximal adjacent vertebrae during primary lumbar fusion reduces long-term adjacent spinal stenosis incidence.

Patients (n = 179) who underwent lumbar fusion surgery between January 2021 and June 2023 were included in this retrospective analysis. A total of 110 patients underwent single-segment lumbar fusion surgery, including 28 (A1) in the adjacent vertebral decompression group and 82 (B1) in the non-decompression group. The mean follow-up duration was 11.74 ± 4.64 months for group A1 and 12.01 ± 4.83 months for group B1. 69 patients underwent two-segment lumbar fusion surgery, including 28 (A2) in the adjacent vertebral decompression group and 41 (B2) in the non-decompression group. The mean follow-up duration was 12.49 ± 4.57 months for group A2 and 12.12 ± 5.97 months for group B2. The visual analog scale (VAS) score, Oswestry disability index (ODI), and dural sac cross-sectional area (DSCA) were used to evaluate clinical outcomes. Operation time, blood loss, and complications were recorded. All continuous variables with normal distribution were analyzed using the t-test, while count data were compared using the chi-square test or Fisher's exact test.

After surgery, the DSCA of the adjacent vertebral canal in the adjacent vertebral decompression group was significantly increased (A1: 111.64 ± 24.45 vs. 135.69 ± 35.46 mm², p < 0.001; A2: 99.95 mm² ± 16.81 vs. 115.29 ± 21.19 mm², p < 0.001). The DSCA of the adjacent vertebral canal in the non-decompression group was significantly decreased (B1: 114.38 ± 28.83 vs. 111.41 ± 30.73 mm², p = 0.032; B2: 109.28 ± 23.39 mm²vs. 102.04 ± 25.52 mm², p = 0.001). There was no significant difference between the decompression and non-decompression group in preoperative pain scores (A1 vs. B1: 5.29 ± 1.41 vs. 5.42 ± 1.31, p = 0.661; A2 vs. B2: 6.07 ± 1.78 vs. 5.88 ± 1.81, p = 0.662), ODI (A1 vs. B1: 57.07 ± 15.73 vs. 55.44 ± 12.49, p = 0.578; A2 vs. B2: 62.07 ± 14.86 vs. 59.46 ± 16.69, p = 0.508) and postoperative pain scores (A1 vs. B1:0.93 ± 0.94 vs. 1.22 ± 0.96, p = 0.166; A2 vs. B2: 1.21 ± 1.07 vs. 1.46 ± 0.95, p = 0.313), ODI (A1 vs. B1: 7.14 ± 4.40 vs. 8.05 ± 5.03, p = 0.398; A2 vs. B2:7.71 ± 5.62 vs. 9.12 ± 6.28, p = 0.344). The difference in complication incidence was not significant.

These results showed that decompression of adjacent spine would maintain the spinal canal after lumbar fusion surgery.