gms | German Medical Science

Lumbar spinal canal stenosis burdens usually elderly patients. At this age the correlation between magnitude of the surgical procedure and postoperative morbidity is close. The unilateral approach for microsurgical bilateral decompression is supposed to decrease the soft tissue damage by half. In a prospective study the surgical impact on pain intensity, walking performance and analgetics consumption were investigated postoperatively and one year after surgery.

125 Patients (65 females, mean age 69 years) presenting bilateral neurogenic claudication and medical risk factors (mean ASA 2.2) were decompressed via the clinically dominant side. Two- (36) and three-level (2) procedures were also performed. Pain intensity (VAS), walking capacity (treadmill-test) and analgetic medication (none, light, medium, heavy) were assessed by an independent observer (a) before , (b) one-week and (c) one-year after surgery.

The patients were mobilized the day of surgery. Pain was rated VAS 7.4 (a), 3.3 (b) and 3.2 (c). The walking capacity increased nine- (b) and tenfold (c). The intake of analgetics decreased by two classes (b) and stopped in 83 % of the patients (c). Four patients did not benefit from surgery. Complications were dural tears (3) sealed intraoperatively, wrong level surgery (1) and epidural haematoma (1). No urinary infections, thrombotic complications or pulmonary embolism were observed.

The reduced soft tissue traumatisation of the uniportal approach allows for immediate mobilisation which is beneficial especially in elderly patients. One year after surgery the benefit of the enlarged spinal canal is still consistent.