gms | German Medical Science

Objective: Limited decompression procedures have gained increasing importance in the treatment of acquired lumbar stenosis in recent years. Long-term comparative data, however, is lacking. The objective of this study was to prospectively compare the long-term outcome of unilateral laminotomy with contralateral undercutting decompression (U) and bilateral laminotomy (B) versus laminectomy (L).

Methods: 120 consecutive patients aged 68±9 years with acquired lumbar stenosis of 207 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; 0–10), walking distance, disability and Patient Satisfaction Index were assessed preoperatively and at regular follow-up intervals using standardized questionnaires. After 8.8 ± 0.9 years 94% of alive patients (n=78) were available for follow-up (minimum follow-up interval: 7.3 years).

Results: Preoperative parameters and symptoms did not differ significantly between groups. At long-term follow-up residual pain was lowest in group B (3.3±2.8 vs. 4.8±2.9 (L; p<0.05) and 5.0±3.1 (U; p<0.05); p<0.01 vs. Pre-op in all groups). Walking distance increased to 3,169±4,153 m (B), 1,675±2,399 m (L) and 1,952±3,647 m (U) (n.s. between groups; p<0.01 vs. Pre-op). Reoperations were significantly less in group B (8%) versus groups L (43%) and U (33%). Patient satisfaction was significantly superior in group B (85%) vs. Group L (62%) and group U (61%).

Conclusions: Limited decompression procedures result in a highly significant reduction of symptoms in patients with acquired lumbar stenosis. Long-term outcome after unilateral laminotomy is comparable to outcome after laminectomy. Bilateral laminotomy demonstrates a significant benefit in several outcome parameters at a mean follow-up of 9 years and thus constitutes the most advantageous treatment alternative.