gms | German Medical Science

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.

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.

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).

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.