gms | German Medical Science

56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

Bilateral laminotomy is superior to laminectomy and unilateral laminotomy in the treatment of lumbar stenosis

Die bilaterale Fensterung ist der Laminektomie und der unilateralen Fensterung in der Behandlung der Lumbalstenose überlegen

Meeting Abstract

  • corresponding author C. Thomé - Neurochirurgische Klinik, Universitätsklinikum Mannheim
  • O. Leheta - Neurochirurgische Klinik, Universitätsklinikum Mannheim
  • D. Zevgaridis - Neurochirurgische Klinik, Universitätsklinikum Mannheim
  • P. Schmiedek - Neurochirurgische Klinik, Universitätsklinikum Mannheim

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc09.05.-12.01

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2005/05dgnc0053.shtml

Veröffentlicht: 4. Mai 2005

© 2005 Thomé et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

Limited decompression procedures like unilateral laminotomy with contralateral undercutting (U) and bilateral laminotomy (B) are increasingly used in the treatment of lumbar stenosis, although their efficacy in comparison to traditional laminectomy (L) is unclear. The purpose of the present study was therefore to prospectively compare the clinical outcome of the three techniques after a minimum of 12 months.

Methods

117 consecutive patients aged 68±9 years with lumbar stenosis of 202 levels refractory to conservative treatment were randomized to the treatment groups (B, L, U). Patients harboring additional pathology like herniated discs or instability were excluded. Symptoms and scores, like pain (Visual Analog Scale), disability (Roland-Morris-Score) and health-related quality of life (SF-36) were assessed.

Results

110 patients were re-assessed at a mean follow-up of 16 months. Residual pain was lowest in group B (2.3±2.4 vs. 4.0±1.0 (L; p<0.05) and 3.6±2.7 (U; p<0.05); p<0.001 vs. pre-op in all groups). Neurogenic claudication subjectively improved in 92% of patients in group B, but in only 68% and 74% of patients in groups L and U (p<0.01). There were no significant differences in disability and walking distance between groups. SF-36 demonstrated significant improvement in all groups, which was most pronounced in group B. Instrumented fusion was performed for postoperative instability during follow-up in 0% (B), 9% (L) and 5% (U) of patients (n.s.). Self-reported success rates of surgery were significantly higher in group B (81±24%) vs. L (63±35%; p<0.05) and U (62±33%; p<0.05).

Conclusions

Limited decompression procedures result in a highly significant reduction of symptoms and disability and improve health-related quality of life in patients with lumbar stenosis. Outcome after unilateral laminotomy is comparable to outcome after laminectomy. Bilateral laminotomy is superior in most outcome parameters at a mean follow-up of 16 months and thus constitutes an advantageous treatment alternative.