Outcomes after decompressive laminectomy for lumbar spinal stenosis: comparison between minimally invasive unilateral laminectomy for bilateral decompression and open laminectomy: clinical article.
OBJECT
The development of minimally invasive surgical techniques is driven by the quest for better patient outcomes. There is some evidence for the use of minimally invasive surgery for degenerative lumbar spine stenosis (LSS), but there are currently no studies comparing outcomes with matched controls. The object of this study was to compare outcomes following minimally invasive unilateral laminectomy for bilateral decompression (ULBD) to a standard "open" laminectomy for LSS.


METHODS
The authors conducted a prospective, 1:1 randomized trial comparing ULBD to open laminectomy for degenerative LSS. The study enrolled 79 patients between 2007 and 2009, and adequate data for analysis were available in 54 patients (27 in each arm of the study). Patient demographic characteristics and clinical characteristics were recorded and clinical outcomes were obtained using pre- and postoperative Oswestry Disability Index (ODI) scores, visual analog scale (VAS) scores for leg pain, patient satisfaction index scores, and postoperative 12-Item Short Form Health Survey (SF-12) scores.


RESULTS
Significant improvements were observed in ODI and VAS scores for both open and ULBD interventions (p < 0.001 for both groups using either score). In addition, the ULBD-treated patients had a significantly better mean improvement in the VAS scores (p = 0.013) but not the ODI scores (p = 0.055) compared with patients in the open-surgery group. ULBD-treated patients had a significantly shorter length of postoperative hospital stay (55.1 vs. 100.8 hours, p = 0.0041) and time to mobilization (15.6 vs. 33.3 hours, p < 0.001) and were more likely to not use opioids for postoperative pain (51.9% vs. 15.4%, p = 0.046).


CONCLUSIONS
Based on short-term follow-up, microscopic ULBD is as effective as open decompression in improving function (ODI score), with the additional benefits of a significantly greater decrease in pain (VAS score), postoperative recovery time, time to mobilization, and opioid use.
['Mobbs|Ralph Jasper|RJ|', 'Li|Jane|J|', 'Sivabalan|Praveenan|P|', 'Raley|Darryl|D|', 'Rao|Prashanth J|PJ|']
D000368:Aged D015897:Comorbidity D019299:Decompression, Surgical D004185:Disability Evaluation D005260:Female D006801:Humans D007796:Laminectomy D008159:Lumbar Vertebrae D008297:Male D019060:Minimally Invasive Surgical Procedures D010147:Pain Measurement D011446:Prospective Studies D013130:Spinal Stenosis D016896:Treatment Outcome
laminectomy lumbar stenosis minimally invasive surgery degenerative IV = intravenous LSS = lumbar spinal stenosis MIS = minimally invasive surgery ODI = Oswestry Disability Index PSI = patient satisfaction index SF-12 = 12-Item Short Form Health Survey ULBD = unilateral laminectomy for bilateral decompression VAS = visual analog scale