Surgical outcome and radiographic changes after microsurgical bilateral decompression via a unilateral approach (MBDU) for lumbar spinal canal stenosis during midterm follow-up periods (> 2 years) have not been reported. The authors retrospectively investigated surgical outcomes after MBDU in patients with lumbar degenerative spondylolisthesis with stenosis in comparison with patients with degenerative stenosis during a minimum follow-up period of 2 years. Radiographic changes at the affected intervertebral level were analyzed during that follow-up period.
Forty-eight patients (23 in the spondylolisthesis group, 25 in the degenerative stenosis group) were included in the study. The average follow-up period was 46 months (range 24–71 months). Surgical outcome was evaluated using the Neurogenic Claudication Outcome Score (NCOS) and the Oswestry Disability Index (ODI). Additionally, the back pain score within the NCOS was also compared. There were no statistically significant differences between the spondylolisthesis group and the degenerative stenosis group with regard to sex, age, follow-up period, operating time, blood loss, surgical sites, approach side, preoperative NCOS, preoperative back pain score, and preoperative ODI. Comparisons were also made between groups using 2 satisfaction measurements at the last follow-up visit. Radiographically, intervertebral angles of 80 sites and slip percentages of 24 sites were measured preoperatively and at the last follow-up.
No patient in either group had additional surgery in the lumbar spine, including fusion procedures. The NCOS, back pain score, and ODI had significantly improved at the last follow-up in both groups. There were no significant differences between the 2 groups in these 3 parameters and the 2 satisfaction measurements at the last follow-up, although those for the spondylolisthesis group indicated a somewhat worse outcome. Intervertebral angles, dynamic intervertebral angles, and dynamic slip percentage did not significantly change after surgery, whereas only slip percentage significantly increased postoperatively (p = 0.0319).
A satisfactory outcome of MBDU persisted for a period longer than 2 years for patients with degenerative spondylolisthesis with stenosis as well as for those with degenerative stenosis. Radiographically in both groups this less invasive procedure was not likely to result in postoperative dynamic instability at the affected level, although the slippage progressed in the spondylolisthesis group.
Abbreviations used in this paper: LSCS = lumbar spinal canal stenosis; MBDU = microsurgical bilateral decompression via a unilateral approach; NCOS = Neurogenic Claudication Outcome Score; ODI = Oswestry Disability Index.
Address correspondence to: Kunihiko Sasai, M.D., Ph.D., Department of Orthopedic Surgery, Kansai Medical University, 2-3-1 Shinmachi, Hirakata City, Osaka, 573-1191, Japan. email:
FujiwaraAKobayashiNSaikiKKitagawaTTamaiKSaotomeK: Association of the Japanese Orthopaedic Association score with the Oswestry Disability Index, Roland-Morris Disability Questionnaire, and short-form 36. Spine28:1601–16072003
FujiwaraA, KobayashiN, SaikiK, KitagawaT, TamaiK, SaotomeK: Association of the Japanese Orthopaedic Association score with the Oswestry Disability Index, Roland-Morris Disability Questionnaire, and short-form 36. 28:1601–1607, 2003)| false
PalmerSTurnerRPalmerR: Bilateral decompressive surgery in lumbar spinal stenosis associated with spondylolisthesis: unilateral approach and use of a microscope and tubular retractor system. Neurosurg Focus13:1E42002
PalmerS, TurnerR, PalmerR: Bilateral decompressive surgery in lumbar spinal stenosis associated with spondylolisthesis: unilateral approach and use of a microscope and tubular retractor system. 13:1E4, 2002)| false
ThomeCZevgaridisDLehetaOBaznerHPockler-SchonigerCWohrleJ: Outcome after less-invasive decompression of lumbar spinal stenosis: a randomized comparison of unilateral laminotomy, bilateral laminotomy, and laminectomy. J Neurosurg Spine3:129–1412005
ThomeC, ZevgaridisD, LehetaO, BaznerH, Pockler-SchonigerC, WohrleJ, : Outcome after less-invasive decompression of lumbar spinal stenosis: a randomized comparison of unilateral laminotomy, bilateral laminotomy, and laminectomy. 3:129–141, 2005)| false