Skip to main content
Top
Published in: European Spine Journal 12/2007

01-12-2007 | Original Article

Midterm outcome after unilateral approach for bilateral decompression of lumbar spinal stenosis: 5-year prospective study

Authors: Halit Çavuşoğlu, Ramazan Alper Kaya, Osman Nuri Türkmenoglu, Cengiz Tuncer, İbrahim Çolak, Yunus Aydın

Published in: European Spine Journal | Issue 12/2007

Login to get access

Abstract

The aim of our study is to evaluate the results and effectiveness of bilateral decompression via a unilateral approach in the treatment of degenerative lumbar spinal stenosis. We have conducted a prospective study to compare the midterm outcome of unilateral laminotomy with unilateral laminectomy. One hundred patients with 269 levels of lumbar stenosis without instability were randomized to two treatment groups: unilateral laminectomy (Group 1), and laminotomy (Group 2). Clinical outcomes were assessed with the Oswestry Disability Index (ODI) and Short Form–36 Health Survey (SF-36). Spinal canal size was measured pre- and postoperatively. The spinal canal was increased to 4–6.1-fold (mean 5.1 ± SD 0.8-fold) the preoperative size in Group 1, and 3.3–5.9-fold (mean 4.7 ± SD 1.1-fold) the preoperative size in Group 2. The mean follow-up time was 5.4 years (range 4–7 years). The ODI scores decreased significantly in both early and late follow-up evaluations and the SF-36 scores demonstrated significant improvement in late follow-up results in our series. Analysis of clinical outcome showed no statistical differences between two groups. For degenerative lumbar spinal stenosis unilateral approaches allowed sufficient and safe decompression of the neural structures and adequate preservation of vertebral stability, resulted in a highly significant reduction of symptoms and disability, and improved health-related quality of life.
Literature
1.
go back to reference Adachi K, Futami T, Ebihara A, Yamaya T, Kasai N, Nakazawa T, et al (2003) Spinal canal enlargement procedure by restorative laminoplasty for the treatment of lumbar canal stenosis. Spine J 3(6):471–478PubMedCrossRef Adachi K, Futami T, Ebihara A, Yamaya T, Kasai N, Nakazawa T, et al (2003) Spinal canal enlargement procedure by restorative laminoplasty for the treatment of lumbar canal stenosis. Spine J 3(6):471–478PubMedCrossRef
2.
go back to reference Adams MA, Hutton WC, Stott JR (1980) The resistance to flexion of the lumbar intervertebral joint. Spine 5(3):245–253PubMedCrossRef Adams MA, Hutton WC, Stott JR (1980) The resistance to flexion of the lumbar intervertebral joint. Spine 5(3):245–253PubMedCrossRef
3.
go back to reference Adams MA, Hutton WC (1983) The mechanical function of the lumbar apophyseal joints. Spine 8(3):327–330PubMedCrossRef Adams MA, Hutton WC (1983) The mechanical function of the lumbar apophyseal joints. Spine 8(3):327–330PubMedCrossRef
4.
go back to reference Airaksinen O, Herno A, Kaukanen E, Saari T, Sihvonen T, Suomalainen O (1996) Density of lumbar muscles 4 years after decompressive spinal surgery. Eur Spine J 5(3):193–197PubMedCrossRef Airaksinen O, Herno A, Kaukanen E, Saari T, Sihvonen T, Suomalainen O (1996) Density of lumbar muscles 4 years after decompressive spinal surgery. Eur Spine J 5(3):193–197PubMedCrossRef
5.
go back to reference Airaksinen O, Herno A, Turunen V, Saari T, Suomlainen O (1997) Surgical outcome of 438 patients treated surgically for lumbar spinal stenosis. Spine 22(19):2278–2282PubMedCrossRef Airaksinen O, Herno A, Turunen V, Saari T, Suomlainen O (1997) Surgical outcome of 438 patients treated surgically for lumbar spinal stenosis. Spine 22(19):2278–2282PubMedCrossRef
6.
go back to reference Aryanpur J, Ducker T (1990) Multilevel lumbar laminotomies: an alternative to laminectomy in the treatment of lumbar stenosis. Neurosurgery 26(3):429–432 discussion 433PubMedCrossRef Aryanpur J, Ducker T (1990) Multilevel lumbar laminotomies: an alternative to laminectomy in the treatment of lumbar stenosis. Neurosurgery 26(3):429–432 discussion 433PubMedCrossRef
7.
go back to reference Askar Z, Wardlaw D, Choudhary S, Rege A (2003) A ligamentum flavum-preserving approach to the lumbar spinal canal. Spine 28(19):E385–E390PubMedCrossRef Askar Z, Wardlaw D, Choudhary S, Rege A (2003) A ligamentum flavum-preserving approach to the lumbar spinal canal. Spine 28(19):E385–E390PubMedCrossRef
8.
go back to reference Cammisa FP Jr, Girardi FP, Sangani PK, Parvataneni HK, Cadag S, Sandhu HS (2000) Incidental durotomy in spine surgery. Spine 25(20):2663–2667PubMedCrossRef Cammisa FP Jr, Girardi FP, Sangani PK, Parvataneni HK, Cadag S, Sandhu HS (2000) Incidental durotomy in spine surgery. Spine 25(20):2663–2667PubMedCrossRef
9.
go back to reference Deyo RA, Nachemson A, Mirza SK (2004) Spinal-fusion surgery-the case for restraint. N Engl J Med 350(7):722–726PubMedCrossRef Deyo RA, Nachemson A, Mirza SK (2004) Spinal-fusion surgery-the case for restraint. N Engl J Med 350(7):722–726PubMedCrossRef
10.
go back to reference diPiero CG, Helm GA, Shaffrey CI, Chadduck JB, Henson SL, Malik JM et al (1996) Treatment of lumbar spinal stenosis by extensive unilateral decompression and contralateral autolougs bone fusion: operative technique and results. J Nuerosurg 84(2):166–173 diPiero CG, Helm GA, Shaffrey CI, Chadduck JB, Henson SL, Malik JM et al (1996) Treatment of lumbar spinal stenosis by extensive unilateral decompression and contralateral autolougs bone fusion: operative technique and results. J Nuerosurg 84(2):166–173
11.
go back to reference Epstein NE (1998) Decompression in the surgical management of degenerative spondylolisthesis: advantages of a conservative approach in 290 patients. J Spinal Disord 11(2):116–122 discussion 123PubMedCrossRef Epstein NE (1998) Decompression in the surgical management of degenerative spondylolisthesis: advantages of a conservative approach in 290 patients. J Spinal Disord 11(2):116–122 discussion 123PubMedCrossRef
12.
go back to reference Epstein NE, Maldonado VC, Cusick JF (1998) Symptomatic lumbar spinal stenosis. Surg Neurol 50(1):3–10PubMedCrossRef Epstein NE, Maldonado VC, Cusick JF (1998) Symptomatic lumbar spinal stenosis. Surg Neurol 50(1):3–10PubMedCrossRef
13.
go back to reference Fox MW, Onofrio BM, Hanssen AD (1996) Clinical outcomes and radiological instability following decompressive lumbar laminectomy for degenerative spinal stenosis: a comparison of patients undergoing concomitant arthrodesis versus decompression alone. J Neurosurg 85(5):793–802PubMed Fox MW, Onofrio BM, Hanssen AD (1996) Clinical outcomes and radiological instability following decompressive lumbar laminectomy for degenerative spinal stenosis: a comparison of patients undergoing concomitant arthrodesis versus decompression alone. J Neurosurg 85(5):793–802PubMed
14.
go back to reference Goel VK, Fromknecht SJ, Nishiyama K, Weinstein J, Liu YK (1985) The role of the lumbar spinal elements in flexion. Spine 10(6):516–523PubMedCrossRef Goel VK, Fromknecht SJ, Nishiyama K, Weinstein J, Liu YK (1985) The role of the lumbar spinal elements in flexion. Spine 10(6):516–523PubMedCrossRef
15.
go back to reference Grob D, Humke T, Dvorak J (1995) Degenerative lumbar spinal stenosis. Decompression with and without arthrodesis. J Bone Joint Surg Am 77(7):1036–1041PubMed Grob D, Humke T, Dvorak J (1995) Degenerative lumbar spinal stenosis. Decompression with and without arthrodesis. J Bone Joint Surg Am 77(7):1036–1041PubMed
16.
go back to reference Guiot BH, Khoo LT, Fessler RG (2002) A minimally invasive technique for decompression of the lumbar spine. Spine 27(4):432–438PubMedCrossRef Guiot BH, Khoo LT, Fessler RG (2002) A minimally invasive technique for decompression of the lumbar spine. Spine 27(4):432–438PubMedCrossRef
17.
go back to reference Haba K, Ikeda M, Soma M, Yamashima T (2005) Bilateral decompression of multilevel lumbar spinal stenosis through a unilateral approach. J Clinical Neurosci 12(2):169–171CrossRef Haba K, Ikeda M, Soma M, Yamashima T (2005) Bilateral decompression of multilevel lumbar spinal stenosis through a unilateral approach. J Clinical Neurosci 12(2):169–171CrossRef
18.
go back to reference Herno A, Saari T, Suomalainen O, Airaksinen O (1999) The degree of decompressive relief and its relation to clinical outcome in patients undergoing surgery for lumbar spinal stenosis. Spine 24(10):1010–1014PubMedCrossRef Herno A, Saari T, Suomalainen O, Airaksinen O (1999) The degree of decompressive relief and its relation to clinical outcome in patients undergoing surgery for lumbar spinal stenosis. Spine 24(10):1010–1014PubMedCrossRef
19.
go back to reference Herron LD, Mangelsdorf C (1991) Lumbar spinal stenosis: results of surgical treatment. J Spinal Disord 4(1):26–33PubMed Herron LD, Mangelsdorf C (1991) Lumbar spinal stenosis: results of surgical treatment. J Spinal Disord 4(1):26–33PubMed
20.
go back to reference Hindle RJ, Pearcy MJ, Cross A (1990) Mechanical function of the human lumbar interspinous and supraspinous ligaments. J Biomed Eng 12(4):340–344PubMedCrossRef Hindle RJ, Pearcy MJ, Cross A (1990) Mechanical function of the human lumbar interspinous and supraspinous ligaments. J Biomed Eng 12(4):340–344PubMedCrossRef
21.
go back to reference Hopp E, Tsou PM (1988) Postdecompression lumbar instability. Clin Orthop Relat Res 227:143–151PubMed Hopp E, Tsou PM (1988) Postdecompression lumbar instability. Clin Orthop Relat Res 227:143–151PubMed
22.
go back to reference Javid MJ, Hadar EJ (1998) Long-term follow-up review of patients who underwent laminectomy for lumbar stenosis: a prospective study. J Neurosurg 89(1):1–7PubMed Javid MJ, Hadar EJ (1998) Long-term follow-up review of patients who underwent laminectomy for lumbar stenosis: a prospective study. J Neurosurg 89(1):1–7PubMed
23.
go back to reference Ji YC, Kim YB, Hwang SN, Park SW, Kwon JT, Min BK (2005) Efficacy of Unilateral Laminectomy for bilateral decompression in elderly lumbar spinal stenosis. J Korean Neurosurg Soc 37:410–415 Ji YC, Kim YB, Hwang SN, Park SW, Kwon JT, Min BK (2005) Efficacy of Unilateral Laminectomy for bilateral decompression in elderly lumbar spinal stenosis. J Korean Neurosurg Soc 37:410–415
24.
go back to reference Johnsson KE, Willner S, Johnsson K (1986) Postoperative instability after decompression for lumbar spinal stenosis. Spine 11(2):107–110PubMedCrossRef Johnsson KE, Willner S, Johnsson K (1986) Postoperative instability after decompression for lumbar spinal stenosis. Spine 11(2):107–110PubMedCrossRef
25.
go back to reference Kalbarczyk A, Lukes A, Seiler RW (1998) Surgical treatment of lumbar spinal stenosis in the elderly. Acta Neurochir (Wien) 140(7):637–641CrossRef Kalbarczyk A, Lukes A, Seiler RW (1998) Surgical treatment of lumbar spinal stenosis in the elderly. Acta Neurochir (Wien) 140(7):637–641CrossRef
26.
go back to reference Katz JN, Lipson SJ, Larson MG, McInnes JM, Fossel AH, Liang MH (1991) The outcome of decompressive laminectomy for degenerative lumbar stenosis. J Bone Joint Surg Am 73(6):809–816PubMed Katz JN, Lipson SJ, Larson MG, McInnes JM, Fossel AH, Liang MH (1991) The outcome of decompressive laminectomy for degenerative lumbar stenosis. J Bone Joint Surg Am 73(6):809–816PubMed
27.
go back to reference Khoo LT, Fessler RG (2002) Microendoscopic decompressive laminotomy for the treatment of lumbar stenosis. Neurosurgery 51(5 Suppl):S146–S154PubMed Khoo LT, Fessler RG (2002) Microendoscopic decompressive laminotomy for the treatment of lumbar stenosis. Neurosurgery 51(5 Suppl):S146–S154PubMed
28.
go back to reference Kleeman TJ, Hiscoe AC, Berg EE (2000) Patient outcomes after minimally destabilizing lumbar stenosis decompression: the “Port-Hole” technique. Spine 25(7):865–870PubMedCrossRef Kleeman TJ, Hiscoe AC, Berg EE (2000) Patient outcomes after minimally destabilizing lumbar stenosis decompression: the “Port-Hole” technique. Spine 25(7):865–870PubMedCrossRef
29.
go back to reference Lin PM (1982) Internal decompression for multiple levels of lumbar spinal stenosis: a technical note. Neurosurgery 11(4):546–549PubMedCrossRef Lin PM (1982) Internal decompression for multiple levels of lumbar spinal stenosis: a technical note. Neurosurgery 11(4):546–549PubMedCrossRef
30.
31.
go back to reference Mackay DC, Wheelwright EF (1998) Unilateral fenestration in the treatment of lumbar spinal stenosis. Br J Neurosurg 12(6):556–558PubMedCrossRef Mackay DC, Wheelwright EF (1998) Unilateral fenestration in the treatment of lumbar spinal stenosis. Br J Neurosurg 12(6):556–558PubMedCrossRef
32.
go back to reference Mariconda M, Fava R, Gatto A, Longo C, Milano C (2002) Unilateral laminectomy for bilateral decompression of lumbar spinal stenosis: a prospective comparative study with conservatively treated patients. J Spinal Disord Tech 15(1):39–46PubMed Mariconda M, Fava R, Gatto A, Longo C, Milano C (2002) Unilateral laminectomy for bilateral decompression of lumbar spinal stenosis: a prospective comparative study with conservatively treated patients. J Spinal Disord Tech 15(1):39–46PubMed
33.
go back to reference Mayer TG, Vanharanta H, Gatchel RJ, Mooney V, Barnes D, Judge L, et al (1989) Comparison of CT scan muscle measurements and isokinetic trunk strength in postoperative patients. Spine 14(1):33–6PubMedCrossRef Mayer TG, Vanharanta H, Gatchel RJ, Mooney V, Barnes D, Judge L, et al (1989) Comparison of CT scan muscle measurements and isokinetic trunk strength in postoperative patients. Spine 14(1):33–6PubMedCrossRef
34.
go back to reference McCulloch JA (1991) Microsurgical spinal laminotomies in the adult spine: principles and practice. J.W. Frymoyer (ed) Raven Press, New York McCulloch JA (1991) Microsurgical spinal laminotomies in the adult spine: principles and practice. J.W. Frymoyer (ed) Raven Press, New York
35.
go back to reference Nakai O, Ookawa A, Yamaura I (1991) Long-term roentgenographic and functional changes in patients who were treated with wide fenestration for central lumbar stenosis. J Bone Joint Surg Am 73(8):1184–1191PubMed Nakai O, Ookawa A, Yamaura I (1991) Long-term roentgenographic and functional changes in patients who were treated with wide fenestration for central lumbar stenosis. J Bone Joint Surg Am 73(8):1184–1191PubMed
36.
go back to reference Palmer S, Turner R, Palmer R (2002) Bilateral decompression of lumbar spinal stenosis involving a unilateral approach with microscope and tubular retractor system. J Neurosurg 97(2 Suppl):213–217PubMed Palmer S, Turner R, Palmer R (2002) Bilateral decompression of lumbar spinal stenosis involving a unilateral approach with microscope and tubular retractor system. J Neurosurg 97(2 Suppl):213–217PubMed
37.
go back to reference Pinar R (2005) Reliability and construct validity of the SF-36 in Turkish cancer patients. Qual Life Res 14(1):259–264PubMedCrossRef Pinar R (2005) Reliability and construct validity of the SF-36 in Turkish cancer patients. Qual Life Res 14(1):259–264PubMedCrossRef
38.
go back to reference Prestar FJ (1982) Morphology and function of the interspinal ligaments and the supraspinal ligament of the lumbar portion of the spine. Morphol Med 2:53–58PubMed Prestar FJ (1982) Morphology and function of the interspinal ligaments and the supraspinal ligament of the lumbar portion of the spine. Morphol Med 2:53–58PubMed
39.
go back to reference Postacchini F, Cinotti G, Perugia D, Gumina S (1993) The surgical treatment of central lumbar stenosis. Multiple laminotomy compared with total laminectomy. J Bone Joint Surg Br 75(3):386–392PubMed Postacchini F, Cinotti G, Perugia D, Gumina S (1993) The surgical treatment of central lumbar stenosis. Multiple laminotomy compared with total laminectomy. J Bone Joint Surg Br 75(3):386–392PubMed
40.
go back to reference See DH, Kraft GH (1975) Electromyography in paraspinal muscles following surgery for root compression. Arch Phys Med Rehabil 56(2):80–83PubMed See DH, Kraft GH (1975) Electromyography in paraspinal muscles following surgery for root compression. Arch Phys Med Rehabil 56(2):80–83PubMed
41.
go back to reference Sengupta DK, Herkowitz HN (2003) Lumbar spinal stenosis. Treatment strategies and indications for surgery. Orthop Clin North Am 34(2):281–295PubMedCrossRef Sengupta DK, Herkowitz HN (2003) Lumbar spinal stenosis. Treatment strategies and indications for surgery. Orthop Clin North Am 34(2):281–295PubMedCrossRef
42.
go back to reference Sihvonen T, Herno A, Paljarva L, Airaksinen O, Patanen J, Tapaninaho A (1993) Local denervation atrophy of paraspinal muscles in postoperative failed back syndrome. Spine 18(5):575–581PubMedCrossRef Sihvonen T, Herno A, Paljarva L, Airaksinen O, Patanen J, Tapaninaho A (1993) Local denervation atrophy of paraspinal muscles in postoperative failed back syndrome. Spine 18(5):575–581PubMedCrossRef
43.
go back to reference Silvers HR, Lewis PJ, Asch HL (1993) Decompressive lumbar laminectomy for spinal stenosis. J Neurosurg 78(5):695–701PubMedCrossRef Silvers HR, Lewis PJ, Asch HL (1993) Decompressive lumbar laminectomy for spinal stenosis. J Neurosurg 78(5):695–701PubMedCrossRef
44.
go back to reference Spetzger U, Bertalanffy H, Naujokat C, von Keyserlingk DG, Gilsbach JM (1997) Unilateral laminotomy for bilateral decompression of lumbar spinal stenosis. Part I: Anatomical and surgical considerations. Acta Neurochir 139(5):392–396CrossRef Spetzger U, Bertalanffy H, Naujokat C, von Keyserlingk DG, Gilsbach JM (1997) Unilateral laminotomy for bilateral decompression of lumbar spinal stenosis. Part I: Anatomical and surgical considerations. Acta Neurochir 139(5):392–396CrossRef
45.
go back to reference Spetzger U, Bertalanffy H, Reinges MH, Gilsbach JM (1997) Unilateral laminotomy for bilateral decompression of lumbar spinal stenosis. Part II: Clinical experiences. Acta Neurochir 139(5):397–403CrossRef Spetzger U, Bertalanffy H, Reinges MH, Gilsbach JM (1997) Unilateral laminotomy for bilateral decompression of lumbar spinal stenosis. Part II: Clinical experiences. Acta Neurochir 139(5):397–403CrossRef
46.
go back to reference Thomas NW, Rea GL, Pikul BK, Mervis LJ, Irsik R, McGregor JM (1997) Quantitative outcome and radiographic comparisons between laminectomy and laminotomy in the treatment of acquired lumbar stenosis. Neurosurgery 41(3):567–574 discussion 574–75PubMedCrossRef Thomas NW, Rea GL, Pikul BK, Mervis LJ, Irsik R, McGregor JM (1997) Quantitative outcome and radiographic comparisons between laminectomy and laminotomy in the treatment of acquired lumbar stenosis. Neurosurgery 41(3):567–574 discussion 574–75PubMedCrossRef
47.
go back to reference Thome C, Zevgaridis D, Leheta O, Bazner H, Pockler-Schoniger C, Wohrle J et al (2005) Outcome after less-invasive decompression of lumbar spinal stenosis: a randomized comparison of unilateral laminotomy, bilateral laminotomy, and laminectomy. J Neurosurg Spine 3(2):129–141PubMed Thome C, Zevgaridis D, Leheta O, Bazner H, Pockler-Schoniger C, Wohrle J et al (2005) Outcome after less-invasive decompression of lumbar spinal stenosis: a randomized comparison of unilateral laminotomy, bilateral laminotomy, and laminectomy. J Neurosurg Spine 3(2):129–141PubMed
48.
go back to reference Tsai RY, Yang RS, Bray RS Jr (1998) Microscopic laminotomies for degenerative lumbar spinal stenosis. J Spinal Disord 11(5):389–394PubMedCrossRef Tsai RY, Yang RS, Bray RS Jr (1998) Microscopic laminotomies for degenerative lumbar spinal stenosis. J Spinal Disord 11(5):389–394PubMedCrossRef
49.
go back to reference Tuite GF, Stern JD, Doran SE, Papadopoulos SM, McGillicuddy JE, Oyedijo DI et al (1994) Outcome after laminectomy for lumbar spinal stenosis: Part I: Clinical correlations. J Neurosurg 81(5):699–706PubMed Tuite GF, Stern JD, Doran SE, Papadopoulos SM, McGillicuddy JE, Oyedijo DI et al (1994) Outcome after laminectomy for lumbar spinal stenosis: Part I: Clinical correlations. J Neurosurg 81(5):699–706PubMed
50.
go back to reference Tuite GF, Doran SE, Stern JD, McGillicuddy JE, Papadopoulos SM, Lundquist CA et al (1994) Outcome after laminectomy for lumbar spinal stenosis. Part II: Radiographic changes and clinical correlations. J Neurosurg 81(5):707–715PubMed Tuite GF, Doran SE, Stern JD, McGillicuddy JE, Papadopoulos SM, Lundquist CA et al (1994) Outcome after laminectomy for lumbar spinal stenosis. Part II: Radiographic changes and clinical correlations. J Neurosurg 81(5):707–715PubMed
51.
go back to reference Turner JA, Ersek M, Herron L, Deyo R (1992) Surgery for lumbar spinal stenosis. Attempted meta-analysis of the literature. Spine 17(1):1–8PubMedCrossRef Turner JA, Ersek M, Herron L, Deyo R (1992) Surgery for lumbar spinal stenosis. Attempted meta-analysis of the literature. Spine 17(1):1–8PubMedCrossRef
52.
go back to reference Wang JC, Bohlman HH, Riew KD (1998) Dural tears secondary to operations on the lumbar spine. Management and results after a two-year-minimum follow-up of eighty-eight patients. J Bone Joint Surg Am 80(12):1728–1732PubMed Wang JC, Bohlman HH, Riew KD (1998) Dural tears secondary to operations on the lumbar spine. Management and results after a two-year-minimum follow-up of eighty-eight patients. J Bone Joint Surg Am 80(12):1728–1732PubMed
53.
go back to reference Weiner BK, Walker M, Brower RS, McCulloch JA (1999) Microdecompression for lumbar spinal canal stenosis. Spine 24(21):2268–2272PubMedCrossRef Weiner BK, Walker M, Brower RS, McCulloch JA (1999) Microdecompression for lumbar spinal canal stenosis. Spine 24(21):2268–2272PubMedCrossRef
54.
go back to reference White AA, Panjabi MM (1990) Clinical biomechanics of the spine, 2nd edn. JB Lippincott, Philadelphia White AA, Panjabi MM (1990) Clinical biomechanics of the spine, 2nd edn. JB Lippincott, Philadelphia
55.
go back to reference Yakut E, Duger T, Oksuz C, Yorukan S, Ureten K, Turan D, et al (2004) Validation of the Turkish version of the Oswestry Disability Index for patients with low back pain. Spine 29(5):581–585 discussion 585PubMedCrossRef Yakut E, Duger T, Oksuz C, Yorukan S, Ureten K, Turan D, et al (2004) Validation of the Turkish version of the Oswestry Disability Index for patients with low back pain. Spine 29(5):581–585 discussion 585PubMedCrossRef
56.
go back to reference Yone K, Sakou T (1999) Usefulness of Posner’s definition of spinal instability for selection of surgical treatment for lumbar spinal stenosis. J Spinal Disord 12(1):40–44PubMedCrossRef Yone K, Sakou T (1999) Usefulness of Posner’s definition of spinal instability for selection of surgical treatment for lumbar spinal stenosis. J Spinal Disord 12(1):40–44PubMedCrossRef
57.
go back to reference Young S, Veerapen R, O’Laoire SA (1988) Relief of lumbar canal stenosis using multilevel subarticular fenestrations as an alternative to wide laminectomy: preliminary report. Neurosurgery 23(5):628–633PubMedCrossRef Young S, Veerapen R, O’Laoire SA (1988) Relief of lumbar canal stenosis using multilevel subarticular fenestrations as an alternative to wide laminectomy: preliminary report. Neurosurgery 23(5):628–633PubMedCrossRef
Metadata
Title
Midterm outcome after unilateral approach for bilateral decompression of lumbar spinal stenosis: 5-year prospective study
Authors
Halit Çavuşoğlu
Ramazan Alper Kaya
Osman Nuri Türkmenoglu
Cengiz Tuncer
İbrahim Çolak
Yunus Aydın
Publication date
01-12-2007
Publisher
Springer-Verlag
Published in
European Spine Journal / Issue 12/2007
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-007-0471-2

Other articles of this Issue 12/2007

European Spine Journal 12/2007 Go to the issue