Application effect and safety analysis of unilateral laminectomy and bilateral decompression under unilateral biportal endoscopy and microendoscope in lumbar spinal stenosis / 中国内镜杂志

Objective To analyze the efficacy and safety of unilateral laminectomy and bilateral decompression under unilateral biportal endoscopy(UBE)and microendoscope(MED)in lumbar spinal stenosis.Methods 80 patients with lumbar spinal stenosis from January 2021 to December 2022 were selected and divided into two groups by numerical table method,the control group and the study group,and the number of cases was 40.The grouping method was random number table method.The control group was treated with unilateral laminectomy and bilateral decompression under MED,while the study group was treated with unilateral laminectomy and bilateral decompression under UBE.Operation time,intraoperative blood loss,Oswestry disability index(ODI)and visual analogue scale(VAS)of lumbago and leg pain were obtained before surgery,1,3 months after surgery and at the last follow-up,efficacy and complications were compared between the two groups.Result There were no significant differences in operative time and blood loss between the study group and the control group(P>0.05).1,3 months after surgery and at the last follow-up,ODI in both groups were lower than those before surgery(P<0.05),but there was no difference between the study group and the control group(P>0.05).The VAS of lumbago and leg pain in both groups were lower than those before surgery(P<0.05),at 1,3 months after surgery and the last follow-up,and the study group was significantly lower than the control group(P<0.05).The excellent and good rate of clinical treatment in the study group was 97.50%,and there was no difference compared with 92.50%in the control group(P>0.05).The complication rate of the study group was 2.50%,significantly lower than that of the control group(15.00%)(P<0.05).Conclusion Unilateral laminectomy and bilateral decompression under the UBE and MED have similar efficacy in the treatment of lumbar spinal stenosis,both of which can effectively promote functional recovery,but UBE can reduce pain more effectively and has fewer postoperative complications.

Surgical Results after Unilateral Laminectomy for the Removal of Spinal Cord Tumors

OBJECTIVE: To reduce the risk of postoperative spinal instability or deformity, unilateral laminectomy (UL) has been recommended to remove spinal space-occupying lesions. The purpose of this study was to determine whether there were any advantages of UL for removal of spinal cord tumors. METHODS: From May 1995 to May 2010, 94 patients with spinal cord tumors, who underwent tumor removal via UL in our institute, were enrolled in this study. Intramedullary spinal cord tumors were excluded. Simple radiographs were obtained for accessing the restoration of the spinal column. Spinal magnetic resonance imaging (MRI) was also obtained during the follow-up period to evaluate tumor recurrence. RESULTS: There were 51 women and 43 men; their mean age was 47.8 years (range, 9-83 years). The mean follow-up period was 52.6 months (range, 24 month-16 years). The sites of the tumors were cervical in 21 cases, thoracic in 37, lumbar in 33, and sacral in 3. These cases included 85 intradural extramedullary (IDEM) and 9 extradural (ED) lesions. IDEM tumors consisted mainly of neurilemmomas (56.3%) and meningiomas (22.3%).Tumors were totally removed in 80 cases and subtotally removed in 14 cases. Postoperative neurological status was improved in 53 cases, unchanged in 31 cases, and worsened in 10 cases. During follow-up, MRI showed tumor recurrence in 4 patients. Histopathologically, three cases were meningiomas and one case was neurilemmoma. None of the patients showed spinal instability or kyphotic deformity at last follow-up. CONCLUSION: UL is an optimal approach for providing sufficient exposure of spinal cord tumors without development of postoperative spinal instability and regional sagittal imbalance in any location of spinal column. In cases of meningioma, careful long-term follow up is needed due to it's relatively high recurrence rate after removal via UL.

Efficacy of Unilateral Laminectomy for Bilateral Decompression in Elderly Lumbar Spinal Stenosis

OBJECTIVE: The aim of our study is to evaluate the effectiveness of unilateral hemilaminectomy for bilateral decompression in elderly patients with degenerative spinal stenosis. For this purpose, we studied the co-morbid condition and clinical outcome of patients who underwent decompressive surgery using the unilateral approach technique. METHODS: Thirty-four patients over 65years of age who underwent unilateral partial laminectomy for bilateral decompression from January 2000 to October 2003 were analyzed. These patients were studied for preoperative co-morbid condition and physical status according to the American Society of Anesthesiologists(ASA) classification, postoperative morphometrical change, and clinical outcomes, including visual analogue scale(VAS) score. The mean follow-up was 23months (range 6-48months). RESULTS: A patient's physical status was recorded as class I, II, or III by ASA classification, which correlated to 41.2%, 44.1%, and 14.7% of patients, respectively. The cross-sectional area of the pre- and postoperative dural sac at the level of the stenosis was 52.5+/-19.9mm2 and 110.6+/-18.2mm2, respectively. The outcome was excellent in 8.8%, good in 58.8%, fair in 23.6%, and poor in 8.8% of the patients. The VAS was changed postoperatively to 3.1+/-1.2. There was no operation-related transfusion yet there was no evidence of postoperative instability at the follow-up examination. CONCLUSION: Unilateral laminectomy for bilateral decompression, in spite of the limited exposure, can result in satisfactory decompression of the lumbar spinal stenosis and tolerable clinical outcome. This approach is thought to be appropriate for elderly patients who have a greater surgical burden.

Microsurgical Decompression of Lumbar Stenosis: Technical Innovations and Early Experience of 20 Cases

Between March 1995 and March 1996, we used a newly-designed neurosurgical procedure, based on 'keyhole surgery', to operate on 20 patients diagnosed as suffering from lumbar spinal stenosis without instability. The unique surgical steps involved in this procedure are: 1) three-quarter prone position of the patient; 2) small paramedian skin incision; 3) half-way incision of the spinous process; 4) small turnover funnel shaped unilateral laminectomy and wide forminotomy using high speed drills; 5) extensive ligament flavectomy; 6) microsurgical decompression without using nerve root retractor; 7) cosmetic wound closure. In some cases, if bilateral radicular symptom was present, the contralateral nerve root was explored through the unilateral laminectomy opening; this was achieved by changing the inclination of the base of the spinous process and extensively removing of the ligamentum flavum. Compared with conventional procedures, these technical innovations offer both procedural adventages and a better clinical outcome. Because of the small patient populations and short follow-up period, this technique requires further investigation, but we hope it will provide another option for future lumbar stenosis surgery. Further technical refinements and long-term follow-up results will be reported elsewhere.