Top

Published in:

01-02-2017 | Original Article

Unilateral tubular approach for bilateral laminotomy: effect on ipsilateral and contralateral buttock and leg pain

Authors: Marjan Alimi, Christoph P. Hofstetter, Jose M. Torres-Campa, Rodrigo Navarro-Ramirez, Guang-Ting Cong, Innocent Njoku Jr., Roger Härtl

Published in: European Spine Journal | Issue 2/2017

Abstract

Purpose

Tubular laminotomy is an effective procedure for treatment of lumbar spinal stenosis (LSS) and lateral recesses stenosis. Most surgeons familiar with the procedure agree that the tubular approach appears to afford a more complete decompression of the contralateral thecal sac and nerve root, as compared to the ipsilateral approach. With this study we sought to answer the question whether this is reflected in clinically significant differences between the ipsilateral and contralateral side pain improvements.

Methods

In a retrospective case study, patients with LSS and lateral recesses stenosis who started out with VAS scores that were similar on the right and left side were included. All patients underwent a tubular (MIS) “over the top” laminotomy from a unilateral approach and through one incision. Surgeries were performed by a single surgeon in a single center. At the last follow-up, the extent of VAS score improvement on the approach (ipsilateral) side was compared to that of the contralateral side.

Results

Thirty-three patients were included in. At the latest follow-up of 25.8 ± 3.4 months, there were statistically significant improvements in ODI and back VAS scores (p = 0.002 and p < 0.0001, respectively). In addition, buttock VAS scores were significantly improved both on the ipsilateral and the contralateral side (p < 0.001, and p = 0.001, respectively). Similarly, leg VAS scores were improved significantly on both sides (p < 0.001, and p = 0.001, respectively). There were no statistically significant differences between the extent of pain improvement on the ipsilateral and the contralateral side.

Conclusions

MIS tubular laminotomy through a unilateral approach results in clinically effective bilateral decompression of LSS and lateral recesses, regardless of the approach side.

Dejerine J (1911) Intermittent claudication of the spinal cord [French]. Press Med 19:981–984

Paine KW (1976) Results of decompression for lumbar spinal stenosis. Clin Orthop Relat Res:115:96–100

Kanamori M, Matsui H, Hirano N, Kawaguchi Y, Kitamoto R, Tsuji H (1993) Trumpet laminectomy for lumbar degenerative spinal stenosis. J Spinal Disord 6:232–237CrossRefPubMed

McCulloch J, Young P (1998) Musculoskeletal and neuroanatomy of the lumbar spine. Essentials of spinal microsurgery. Lippincott-Raven, Philadelphia, pp 249–292

Celik SE, Celik S, Goksu K, Kara A, Ince I (2010) Microdecompressive laminatomy with a 5-year follow-up period for severe lumbar spinal stenosis. J Spinal Disord Tech 23:229–235. doi:10.1097/BSD.0b013e3181a3d889 CrossRefPubMed

Mayer HM, List J, Korge A, Wiechert K (2003) Microsurgery of acquired degenerative lumbar spinal stenosis. Bilateral over-the-top decompression through unilateral approach. Orthopade 32:889–895. doi:10.1007/s00132-003-0536-9 CrossRefPubMed

Wiltse LL, Spencer CW (1988) New uses and refinements of the paraspinal approach to the lumbar spine. Spine (Phila Pa 1976) 13:696–706CrossRef

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 (Wien) 139:392–396CrossRef

Spetzger U, Bertalanffy H, Reinges MH, Gilsbach JM (1997) Unilateral laminotomy for bilateral decompression of lumbar spinal stenosis. Part II: Clinical experiences. Acta Neurochir (Wien) 139:397–403CrossRef

10.

Foley KT, Smith MM (1997) Microendoscopic discectomy. Tech Neurosurg 3:301–307

11.

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 97:213–217PubMed

12.

Mayer HM (2006) Microsurgical decompression of acquired (degenerative) central and lateral spinal canal stenosis. In: Schröder G (ed) Minimally invasive spine surgery. Springer, Berlin, pp 397–408CrossRef

13.

Parikh K, Tomasino A, Knopman J, Boockvar J, Hartl R (2008) Operative results and learning curve: microscope-assisted tubular microsurgery for 1- and 2-level discectomies and laminectomies. Neurosurg Focus 25:E14. doi:10.3171/foc/2008/25/8/e14 CrossRefPubMed

14.

Fairbank JC, Couper J, Davies JB, O’Brien JP (1980) The Oswestry low back pain disability questionnaire. Physiotherapy 66:271–273PubMed

15.

Beurskens AJ, de Vet HC, Koke AJ, van der Heijden GJ, Knipschild PG (1995) Measuring the functional status of patients with low back pain. Assessment of the quality of four disease-specific questionnaires. Spine (Phila Pa 1976) 20:1017–1028CrossRef

16.

Fritz JM, Irrgang JJ (2001) A comparison of a modified Oswestry Low Back Pain Disability Questionnaire and the Quebec Back Pain Disability Scale. Phys Ther 81:776–788PubMed

17.

Hagg O, Fritzell P, Nordwall A (2003) The clinical importance of changes in outcome scores after treatment for chronic low back pain. Eur Spine J 12:12–20. doi:10.1007/s00586-002-0464-0 PubMed

18.

Weinstein JN, Tosteson TD, Lurie JD, Tosteson A, Blood E, Herkowitz H, Cammisa F, Albert T, Boden SD, Hilibrand A, Goldberg H, Berven S, An H (2010) Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial. Spine (Phila Pa 1976) 35:1329–1338. doi:10.1097/BRS.0b013e3181e0f04d CrossRef

19.

Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Blood E, Hanscom B, Herkowitz H, Cammisa F, Albert T, Boden SD, Hilibrand A, Goldberg H, Berven S, An H (2008) Surgical versus nonsurgical therapy for lumbar spinal stenosis. N Engl J Med 358:794–810. doi:10.1056/NEJMoa0707136 CrossRefPubMedPubMedCentral

20.

Härtl R, Korge A (2012) Minimally invasive spine surgery: techniques, evidence, and controversies. Thieme, StuttgartCrossRef

21.

Khoo LT, Fessler RG (2002) Microendoscopic decompressive laminotomy for the treatment of lumbar stenosis. Neurosurgery 51:S146–S154PubMed

22.

Kim S, Mortaz Hedjri S, Coyte PC, Rampersaud YR (2012) Cost-utility of lumbar decompression with or without fusion for patients with symptomatic degenerative lumbar spondylolisthesis. Spine J 12:44–54. doi:10.1016/j.spinee.2011.10.004 CrossRefPubMed

23.

Musluman AM, Cansever T, Yilmaz A, Cavusoglu H, Yuce I, Aydin Y (2012) Midterm outcome after a microsurgical unilateral approach for bilateral decompression of lumbar degenerative spondylolisthesis. J Neurosurg Spine 16:68–76. doi:10.3171/2011.7.spine11222 CrossRefPubMed

24.

Palmer S, Davison L (2012) Minimally invasive surgical treatment of lumbar spinal stenosis: two-year follow-up in 54 patients. Surg Neurol Int 3:41. doi:10.4103/2152-7806.94294 CrossRefPubMedPubMedCentral

25.

Palmer S, Turner R, Palmer R (2002) Bilateral decompressive surgery in lumbar spinal stenosis associated with spondylolisthesis: unilateral approach and use of a microscope and tubular retractor system. Neurosurg Focus 13:E4PubMed

26.

Pao JL, Chen WC, Chen PQ (2009) Clinical outcomes of microendoscopic decompressive laminotomy for degenerative lumbar spinal stenosis. Eur Spine J 18:672–678. doi:10.1007/s00586-009-0903-2 CrossRefPubMedPubMedCentral

27.

Hong SW, Choi KY, Ahn Y, Baek OK, Wang JC, Lee SH, Lee HY (2011) A comparison of unilateral and bilateral laminotomies for decompression of L4–L5 spinal stenosis. Spine (Phila Pa 1976) 36:E172–E178. doi:10.1097/BRS.0b013e3181db998c CrossRef

28.

Orpen NM, Corner JA, Shetty RR, Marshall R (2010) Micro-decompression for lumbar spinal stenosis: the early outcome using a modified surgical technique. J Bone Joint Surg Br 92:550–554. doi:10.1302/0301-620x.92b4.22050 CrossRefPubMed

29.

Castro-Menendez M, Bravo-Ricoy JA, Casal-Moro R, Hernandez-Blanco M, Jorge-Barreiro FJ (2009) Midterm outcome after microendoscopic decompressive laminotomy for lumbar spinal stenosis: 4-year prospective study. Neurosurgery 65:100–110. doi:10.1227/01.neu.0000347007.95725.6f (discussion 110; quiz A112) CrossRefPubMed

30.

Asgarzadie F, Khoo LT (2007) Minimally invasive operative management for lumbar spinal stenosis: overview of early and long-term outcomes. Orthop Clin North Am 38:387–399. doi:10.1016/j.ocl.2007.02.006 (abstract vi–vii) CrossRefPubMed

31.

Rahman M, Summers LE, Richter B, Mimran RI, Jacob RP (2008) Comparison of techniques for decompressive lumbar laminectomy: the minimally invasive versus the “classic” open approach. Minim Invasive Neurosurg 51:100–105. doi:10.1055/s-2007-1022542 CrossRefPubMed

32.

Jansson KA, Nemeth G, Granath F, Blomqvist P (2005) Spinal stenosis re-operation rate in Sweden is 11 % at 10 years—a national analysis of 9664 operations. Eur Spine J 14:659–663. doi:10.1007/s00586-004-0851-9 CrossRefPubMedPubMedCentral

33.

Fourney DR, Dettori JR, Norvell DC, Dekutoski MB (2010) Does minimal access tubular assisted spine surgery increase or decrease complications in spinal decompression or fusion? Spine (Phila Pa 1976) 35:S57–S65. doi:10.1097/BRS.0b013e3181d82bb8 CrossRef

34.

Berra LV, Foti D, Ampollini A, Faraca G, Zullo N, Musso C (2010) Contralateral approach for far lateral lumbar disc herniations: a modified technique and outcome analysis of nine patients. Spine (Phila Pa 1976). doi:10.1097/BRS.0b013e3181bac710

35.

Yeom JS, Kim KH, Hong SW, Park KW, Chang BS, Lee CK, Buchowski JM (2008) A minimally invasive technique for L5-S1 intraforaminal disc herniations: microdiscectomy with a tubular retractor via a contralateral approach. J Neurosurg Spine 8:193–198. doi:10.3171/spi/2008/8/2/193 CrossRefPubMed

36.

James A, Laufer I, Parikh K, Nagineni VV, Saleh TO, Hartl R (2012) Lumbar juxtafacet cyst resection: the facet sparing contralateral minimally invasive surgical approach. J Spinal Disord Tech 25:E13–E17. doi:10.1097/BSD.0b013e31822ac4e5 CrossRefPubMed

37.

Komp M, Hahn P, Oezdemir S, Giannakopoulos A, Heikenfeld R, Kasch R, Merk H, Godolias G, Ruetten S (2015) Bilateral spinal decompression of lumbar central stenosis with the full-endoscopic interlaminar versus microsurgical laminotomy technique: a prospective, randomized, controlled study. Pain Physician 18:61–70PubMed

38.

Ang CL, Phak-Boon Tow B, Fook S, Guo CM, Chen JL, Yue WM, Tan SB (2015) Minimally invasive compared with open lumbar laminotomy: no functional benefits at 6 or 24 months after surgery. Spine J 15:1705–1712. doi:10.1016/j.spinee.2013.07.461 CrossRefPubMed

39.

Alimi M, Hofstetter CP, Pyo SY, Paulo D, Härtl R (2013) Minimally invasive lamiontomy through tubular retractors for lumbar spinal stenosis decompression in patients with and without pre-operative spondylolisthesis: clinical outcome and re-operation rate. In: 29th Annual meeting of the AANS/CNS section on disorders of the spine and peripheral nerves Phoenix, AZ

40.

Thome C, Zevgaridis D, Leheta O, Bazner H, Pockler-Schoniger C, Wohrle J, Schmiedek P (2005) Outcome after less-invasive decompression of lumbar spinal stenosis: a randomized comparison of unilateral laminotomy, bilateral laminotomy, and laminectomy. J Neurosurg Spine 3:129–141. doi:10.3171/spi.2005.3.2.0129 CrossRefPubMed

41.

Overdevest G, Vleggeert-Lankamp C, Jacobs W, Thome C, Gunzburg R, Peul W (2015) Effectiveness of posterior decompression techniques compared with conventional laminectomy for lumbar stenosis. Eur Spine J 24:2244–2263. doi:10.1007/s00586-015-4098-4 CrossRefPubMed

42.

Cavusoglu H, Kaya RA, Turkmenoglu ON, Tuncer C, Colak I, Aydin Y (2007) Midterm outcome after unilateral approach for bilateral decompression of lumbar spinal stenosis: 5-year prospective study. Eur Spine J 16:2133–2142. doi:10.1007/s00586-007-0471-2 CrossRefPubMedPubMedCentral

43.

Choi WS, Oh CH, Ji GY, Shin SC, Lee JB, Park DH, Cho TH (2014) Spinal canal morphology and clinical outcomes of microsurgical bilateral decompression via a unilateral approach for lumbar spinal canal stenosis. Eur Spine J 23:991–998. doi:10.1007/s00586-013-3116-7 CrossRefPubMed

44.

Alimi M, Njoku I Jr, Cong GT, Pyo SY, Hofstetter CP, Grunert P, Hartl R (2014) Minimally invasive foraminotomy through tubular retractors via a contralateral approach in patients with unilateral radiculopathy. Neurosurgery. doi:10.1227/neu.0000000000000358 PubMed

Title: Unilateral tubular approach for bilateral laminotomy: effect on ipsilateral and contralateral buttock and leg pain
Authors: Marjan Alimi
Christoph P. Hofstetter
Jose M. Torres-Campa
Rodrigo Navarro-Ramirez
Guang-Ting Cong
Innocent Njoku Jr.
Roger Härtl
Publication date: 01-02-2017
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 2/2017
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-016-4594-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Unilateral tubular approach for bilateral laminotomy: effect on ipsilateral and contralateral buttock and leg pain

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2017

Treating multi-level cervical disc disease with hybrid surgery compared to anterior cervical discectomy and fusion: a systematic review and meta-analysis

Efficacy of intraoperative direct electrical stimulation of the spinal root and measurement of distal motor latency in lumbar spinal stenosis

Predictors of improvement in quality of life and pain relief in lumbar spinal stenosis relative to patient age: a study based on the Spine Tango registry

The effectiveness of decompression alone compared with additional fusion for lumbar spinal stenosis with degenerative spondylolisthesis: a pragmatic comparative non-inferiority observational study from the Norwegian Registry for Spine Surgery

Radiographic assessment of degenerative lumbar spinal stenosis: is MRI superior to CT?

Determinants of patient satisfaction after surgery for central spinal stenosis without concomitant spondylolisthesis: a register study of 5100 patients