Comparative study between microscopic bilateral decompression via unilateral approach and standard total laminectomy for treatment of degenerative lumbar canal stenosis

Abstract Background: The better patient outcomes is driving to the development of minimally invasive spine surgical techniques. There are several evidences on the use of microscopic decompressive surgery for degenerative lumbar canal stenosis; however, few of these studies compared their outcomes with the classic laminectomy and laminotomy techniques. Objectives: The aim of our study was to compare outcomes following microsurgical bilateral decompression via unilateral laminotomy approach for bilateral decompression (ULBD) of the lumbar spinal canal to the standard open laminectomy for cases with single and multiple degenerative lumbar canal stenosis. Material and methods: Cases were divided in two groups. Group (A) cases were operated by microscopic decomressive laminotomy via unilateral approach and bilateral decompression; Group (B) cases were operated by standard classical decompressive laminectomy technique. Results from both groups were compared regarding duration of surgery, blood loss, perioperative complication, and postoperative outcome and patient satisfaction. RESULTS: Statistical difference noted between the improvement rate of the two groups .Group A had higher rate of improvement than Group B. Unilateral laminotomy for bilateral micro-decompression : single and multiple levels had 88% improved VAS, 0.8% instability compared to Clinical results of decompressive laminectomy. Postoperative clinical improvement in (Group A) as regard back VAS, leg VAS, modified ODI and PSI could lead to a significant improvement of symptoms during the follow-up period. The pre- and postoperative JOA scores of the multiple level cases were significantly lower than those of the single level cases; however, there was no significant difference in the recovery rate (RR) between the groups. There is statistically significant difference between the mean VAS score for leg pain pre-operatively and post-operatively, at 3rd month ,6 th month and 12 th months follow up. Patient satisfaction varies from 57% to 81% with regard to excellent to good results. surgery met their expectations and patients were satisfied from the outcome. CONCLUSIONS: Comparing ULBD with classic laminectomy showed the efficacy of the minimally invasive technique in obtaining good surgical outcome and patient satisfaction. Unilateral laminotomy with bilateral micro-decompression technique preserves posterior midline structures with sparing of spinous process, opposite side lamina , paraspinal muscles and provides an adequate and safe bilateral decompression at multiple levels. This procedure has smaller incision, minimal perioperative blood loss, postoperative posterior scarring and back pain, less length of hospital stay and it promotes early mobilization with early return to normal routine life than classic laminectomy technique