Comparative Study of Unilateral Laminotomy versus Conventional Laminectomy
Authors: Anilbhai Thaker R. , Goda N. , Shukla S. , Chaddha R. 
Published: May 2014

Introduction

Prolapsed intervertebral disc and lumbar canal stenosis have been major challenging problem of mankind since ages. Many different methods have been evolved for its diagnosis and management. The purpose of this study is to determine the efficacy and safety of unilateral laminotomy for decompression in case of PIVD and lumbar canal stenosis compared with conventional laminectomy.

Materials and Methods

A retrospective and prospective study of 40 patients who had undergone surgery for PIVD or lumbar canal stenosis at our institute was performed. They were assigned in the two groups: Group 1 ( n = 20) consisted of patients who underwent laminotomy for decompression, and Group 2 ( n = 20) consisted of patients treated by decompressive laminectomy. Neurological status of the patients was evaluated by physical examination both pre- and postoperatively. Pain, disability, and other criteria were assessed by Greenough scoring system. Plain AP and lateral radiographs and MRI of concerned segment of every patient were obtained. Lumbar flexion-extension films were obtained to assess spinal instability. Minimum follow-up was done at 6 months and results were assessed by using Greenough scoring system and radiographs at final follow-up.

Results

Excellent clinical outcome was obtained in 80% of patients in Group 1 and in 65% of patients in Group 2. Increase in Greenough score was more in Group 1. Postoperative spinal instability occurred in four patients in Group 2, none in Group 1. Early rehabilitation and early return to work was more possible in Group 1. There was one surgical complication in the each group (dural tear dealt during surgery). Postoperative infection developed in four patients (two in each group) among which one require surgical debridement in Group 2. Neurological impairment occurred in one patient in Group 2.

Conclusion

Duration of hospital stay is significantly reduced amongst the patients operated by unilateral laminotomy compared with laminectomy, and rehabilitation was also faster by starting earlier sitting and thereby reducing morbidity and burden to hospital. Consequent earlier return to normal routine life can be expected. Although overall outcome of the patients at final follow-up remains mostly unchanged, technique of sparing unilateral paraspinal muscles and thereby sparing supraspinous and interspinous ligaments does help in earlier rehabilitations of the patients, fastens the recovery, and thereby reducing psychiatric problems related to it, saves many man hours of one's life going in wastage and brings in overall feeling of well-being and patient satisfaction. Disclosure of Interest None declared References Young S, Veerapen R, O’Laoire SA. Relief of lumbar canal stenosis using multilevel subarticular fenestrations as an alternative to wide laminectomy: preliminary report. Neurosurgery 1988;23(5):628–633 Spetzger U, Bertalanffy H, Naujokat C, von Keyserlingk DG, Gilsbach JM. Unilateral laminotomy for bilateral decompression of lumbar spinal stenosis. Part I: Anatomical and surgical considerations. Acta Neurochir (Wien) 1997;139(5):392–396 Weiner BK, Walker M, Brower RS, McCulloch JA. Microdecompression for lumbar spinal canal stenosis. Spine 1999;24(21):2268–2272 Cavuşoğlu H, Türkmenoğlu O, Kaya RA, et al. Efficacy of unilateral laminectomy for bilateral decompression in lumbar spinal stenosis. Turk Neurosurg 2007;17(2):100–108 Guiot BH, Khoo LT, Fessler RG. A minimally invasive technique for decompression of the lumbar spine. Spine 2002;27(4):432–438 Kim SW, Ju CI, Kim CG, Lee SM, Shin H. Minimally invasive lumbar spinal decompression: a comparative study between bilateral laminotomy and unilateral laminotomy for bilateral decompression. J Korean Neurosurg Soc 2007;42(3):195-199 Greenough CG, Fraser RD. Assessment of outcome in patients with low-back pain. Spine 1992;17(1):36–41 Greenough CG. Results of treatment of lumbar spine disorders. Effects of assessment techniques and confounding factors. Acta Orthop Scand Suppl 1993;251(Suppl 251):126–129