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European Spine Journal

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Open Access 01-10-2015 | Review Article

Effectiveness of posterior decompression techniques compared with conventional laminectomy for lumbar stenosis

Authors: Gijsbert Overdevest, Carmen Vleggeert-Lankamp, Wilco Jacobs, Claudius Thomé, Robert Gunzburg, Wilco Peul

Published in: European Spine Journal | Issue 10/2015

Abstract

Purpose

To compare the effectiveness of techniques of posterior decompression that limit the extent of bony decompression or to avoid removal of posterior midline structures of the lumbar spine versus conventional facet-preserving laminectomy for the treatment of patients with degenerative lumbar stenosis.

Methods

A comprehensive electronic search of the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Web of Science, and the clinical trials registries ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform was conducted for relevant literature up to June 2014.

Results

A total of four high-quality RCTs and six low-quality RCTs met the search criteria of this review. These studies included a total of 733 participants. Three different techniques that avoid removal of posterior midline structures are compared to conventional laminectomy; unilateral laminotomy for bilateral decompression, bilateral laminotomy and split-spinous process laminotomy. Evidence of low or very low quality suggests that different techniques of posterior decompression and conventional laminectomy have similar effects on functional disability and leg pain. Only perceived recovery at final follow-up was better in patients that underwent bilateral laminotomy compared with conventional laminectomy. Unilateral laminotomy for bilateral decompression and bilateral laminotomy resulted in numerically fewer cases of iatrogenic instability, although in both cases, the incidence of instability was low. The difference in severity of postoperative low back pain following bilateral laminotomy and split-spinous process laminotomy was significantly less, but was too small to be clinically important. We found no evidence to show that the incidence of complications, length of the procedure, length of hospital stay and postoperative walking distance differed between techniques of posterior decompression.

Conclusion

The evidence provided by this systematic review for the effects of unilateral laminotomy for bilateral decompression, bilateral laminotomy and split-spinous process laminotomy compared with conventional laminectomy on functional disability, perceived recovery and leg pain is of low or very low quality. Therefore, further research is necessary to establish whether these techniques provide a safe and effective alternative for conventional laminectomy. Proposed advantages of these techniques regarding the incidence of iatrogenic instability and postoperative back pain are plausible, but definitive conclusions are limited by poor methodology and poor reporting of outcome measures among included studies.

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Title: Effectiveness of posterior decompression techniques compared with conventional laminectomy for lumbar stenosis
Authors: Gijsbert Overdevest
Carmen Vleggeert-Lankamp
Wilco Jacobs
Claudius Thomé
Robert Gunzburg
Wilco Peul
Publication date: 01-10-2015
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 10/2015
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-015-4098-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Effectiveness of posterior decompression techniques compared with conventional laminectomy for lumbar stenosis

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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