gms | German Medical Science

65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

11. - 14. Mai 2014, Dresden

Microsurgical decompression of lumbar spinal stenosis via unilateral laminotomy: Reoperations and long-term outcome in a large retrospective series

Meeting Abstract

  • Karsten Schöller - Neurochirurgische Klinik, Universitätsklinikum Gießen
  • Thomas Steingrüber - Neurochirurgische Klinik, Universitätsklinikum Gießen
  • Marco Stein - Neurochirurgische Klinik, Universitätsklinikum Gießen
  • Eberhard Uhl - Neurochirurgische Klinik, Universitätsklinikum Gießen

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocMI.01.07

doi: 10.3205/14dgnc268, urn:nbn:de:0183-14dgnc2682

Veröffentlicht: 13. Mai 2014

© 2014 Schöller et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen ( Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.



Objective: Surgical treatment of lumbar spinal stenosis (LSS) is known to be more effective compared to conservative therapy. The unilateral laminotomy approach with undercutting has the theoretical advantage to preserve the contralateral facet joint and, thus, minimize the risk of secondary instability. However, there is still limited data on reoperation rate and long-term outcome with this technique.

Method: 375 consecutive patients who underwent microsurgical decompression of LSS via an unilateral approach over a period of 6 years (between 2005 and 2010) were retrospectively analyzed. Clinical outcome was measured using a 5-point scale for back and leg pain as well as claudication (1 point=no pain, 2 points=markedly improved pain, 3 points=somewhat improved pain, 4 points=pain unchanged compared to preop., 5 points=pain worse compared to preop.), the visual analog scale (VAS), and the EQ-5D quality of life (QoL) score (100 points=best QoL). Outcome in diabetic patients was compared to non-diabetic patients using age- and gender-matched pairs.

Results: The median age of our patient cohort was 77 years and the median duration of preop. symptoms was 4 months. In 264 patients uni- and in 111 patients multi-segmental surgery was carried out. Long-term (>3 months) follow-up data were available in 149 patients; the median follow-up was 60 months. The median 5-point score within the first postoperative week was 2 (range (=r.) 1-4), 1 (r. 1-4), and 1 (r. 1-4) for back pain, leg pain, and claudication. At last follow-up (LFU), the median score was 2 (r. 1-4), 2 (r. 1-5), and 2 (r. 1-5), respectively. The median VAS at LFU was 4 (r. 1-9) and 4 (r. 1-10) for back and leg pain, respectively. There was no difference in diabetic compared to non-diabetic patients regarding pain-related outcome. However, EQ-5D showed a better (p=0.027) QoL in non-diabetic patients. Reoperations had to be carried out in 15.9% of patients including revision surgery due to complications within 1 month after the first operation in 4.8% of patients (primarily wound infections, in 1.6% enlargement of decompression because of persisting pain). Instability that required fusion surgery was detected in 3.7% of patients.

Conclusions: Microsurgical decompression of LSS via unilateral laminotomy leads to sustained improvement of pain and claudication in diabetic and non-diabetic patients with a low rate of instability. However, the rate of reoperations is not negligible and should be mentioned to the patient when informed consent is obtained.