Treatment of lumbar spinal stenosis by extensive unilateral decompression and contralateral autologous bone fusion: operative technique and results

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✓ A new surgical technique for the treatment of lumbar spinal stenosis features extensive unilateral decompression with undercutting of the spinous process and, to preserve stability, uses contralateral autologous bone fusion of the spinous processes, laminae, and facets. The operation was performed in 29 patients over a 19-month period ending in December of 1991. All individuals had been unresponsive to conservative treatment and presented with low-back pain in addition to signs and symptoms consistent with neurogenic claudication or radiculopathy. Nine had undergone previous lumbar decompressive surgery. The minimum and mean postoperative follow-up times were 2 and 2 1/2 years, respectively. The mean patient age was 64 years; only two patients were younger than 50 years of age.

Of the patients with neurogenic claudication, 69% reported complete pain relief at follow-up review. Of those with radicular symptoms, 41% had complete relief and 23% had mild residual pain that was rated 3 or less on a pain—functionality scale of 0 to 10. For the entire sample, this surgery decreased pain from 9.2 to 3.3 (p < 0.0001) on the scale. Sixty-nine percent of patients were satisfied with surgery. Low-back pain was significantly relieved in 62% of all patients (p < 0.0001). Low-back pain relief correlated negatively with number of levels decompressed (p < 0.05). To assess fusion, follow-up flexion/extension radiographs were obtained, and no motion was detected at the surgically treated levels in any patient.

The results suggest that this decompression procedure safely and successfully treats not only the radicular symptoms caused by lateral stenosis but also the neurogenic claudication symptoms associated with central stenosis. In addition, the procedure, by using contralateral autologous bone fusion along the laminae and spinous processes, can preserve stability without instrumentation.

Article Information

Address reprint requests to: Charles G. diPierro, M.D., Department of Neurological Surgery, Box 212, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Drawings depicting the operative procedure. A: Elevation of soft tissue from bone for the ipsilateral surgical approach to the stenotic vertebral canal. B: Unilateral approach for the extensive bilateral decompression by undercutting the spinous process and removing the contralateral ligamentum flavum after hemilaminectomy. C: Lateral decompression including total pediculectomy. D: Decortication of the contralateral spine in preparation for autologous bone graft. E: Contralateral decompression of the nerve is achieved by extensive undercutting or partial hemilaminectomy and transfacetal removal of the ligamentum flavum or superior articular lip. F: Fascial closure over completed procedure with contralateral autologous fusion mass in place.

  • View in gallery

    Fine-slice computerized tomography scans, axial view, showing (A) preoperative and (B) 6-month postoperative spine in a patient with primarily radicular symptoms; and (C) preoperative and (D) 10-week postoperative spine in a patient with primarily neurogenic claudication symptoms.

  • View in gallery

    Three-dimensional reconstruction of fine-slice computerized tomography data showing the postoperative result of a left-sided decompression and contralateral fusion.

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