Laminotomy Versus Laminectomy in Surgical Treatment of Multilevel Lumbar Spinal Stenosis in Patients More Than 65 Years Old

Farzad Omidi-Kashani^1, , Ebrahim Ghayem Hasankhani¹, Mohammad Dawood Rahimi² and Venus Golshani³

¹Associate Professor of Orthopedic, Orthopedic Research Center, Orthopedic Department, Imam Reza Hospital, Faculty of medicine, Mashhad University of medical Sciences, Mashhad, Iran

²Medical Doctor, General Practitioner, Orthopaedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

³Medical Student, Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Cite this paper:
Farzad Omidi-Kashani, Ebrahim Ghayem Hasankhani, Mohammad Dawood Rahimi and Venus Golshani. Laminotomy Versus Laminectomy in Surgical Treatment of Multilevel Lumbar Spinal Stenosis in Patients More Than 65 Years Old. Global Journal of Surgery. 2014; 2(1):7-11. doi: 10.12691/js-2-1-3

Abstract

Background: In some patients with refractory lumbar spinal stenosis (LSS) surgical decompression is necessary. However, a fear of iatrogenic instability has always been associated with extensive decompression. In this study, we aim to evaluate the surgical outcomes of laminotomy versus laminectomy in the geriatric patients with multilevel LSS. Methods: We retrospectively evaluated 79 (29 male and 50 female) geriatric patients with multilevel degenerative but stable LSS from August 2008 to September 2011. The mean age and follow-up period was 74 ± 12.1 (ranged; 65 to 83 years old) and 34 ± 6.5 (ranged; 25 to 51 months), respectively. We placed our patients into two groups; A: laminotomy (44 cases) and B: laminectomy (35 patients). Preoperatively and at the last follow-up visit, the patients were assessed by visual analogue scale (VAS) and Oswestry disability index (ODI). Satisfaction rate was also recorded. Then, an intra- and postoperative comparison between these two techniques was carried out, statistically. Results: No significant differences existed between the two groups in terms of sex distribution, age and duration of follow-up. Intergroup comparison showed that patient satisfaction rate and the mean improvement in VAS and ODI was comparable. Mean blood loss and operating time were both greater in laminotomy group but only the latter was statistically significant. Conclusions: In geriatric patients more than 65 years old with multilevel but stable degenerative LSS, due to its more simplicity and less operative time, we still prefer and recommend laminectomy versus laminotomy.

Keywords:
laminectomy laminotomy lumbar spinal stenosis

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References:

[1]	Fritz JM, Delitto A, Welch WC, Erhard RE. Lumbar spinal stenosis: a review of current concepts in evaluation, management, and outcome measurements. 1998; 79(6): 700-8.
[2]	Lee JY, Whang PG, Lee JY, Phillips FM, Patel AA. Lumbar spinal stenosis. Instr Course Lect. 2013; 62: 383-96.
[3]	Katz JN, Stucki G, Lipson SJ, Fossel AH, Grobler LJ, Weinstein JN. Predictors of surgical outcome in degenerative lumbar spinal stenosis. Spine.1999; 24(21): 2229-33.
[4]	Postacchini F. Surgical management of lumbar spinal stenosis. Spine 1999; 24(10): 1043-7.
[5]	Herron LD, Mangelsdorf C. Lumbar spinal stenosis: results of surgical treatment. J Spinal Disord 1991; 4(1): 26-33.
[6]	Sanderson PL, Wood PL. Surgery for lumbar spinal stenosis in old people. J Bone Joint Surg Br 1993; 75(3): 393-7.
[7]	Hopp E, Tsou PM. Postdecompression lumbar instability. Clin Orthop Relat Res. 1988; 227: 143-51.
[8]	Johnsson KE, Willner S, Johnsson K. Postoperative instability after decompression for lumbar spinal stenosis. Spine. 1986; 11(2):107-10.
[9]	Katz JN, Lipson SJ, Larson MG, McInnes JM, Fossel AH, Liang MH. The outcome of decompressive laminectomy for degenerative lumbar stenosis. 1991; 73(6): 809-16.
[10]	Lu WW, Luk KD, Ruan DK, Fei ZQ, Leong JC. Stability of the whole lumbar spine after multilevel fenestration and discectomy. Spine. 1999; 24(13): 1277-82.
[11]	Tsai RY, Yang RS, Bray RS Jr. Microscopic laminotomies for degenerative lumbar spinal stenosis. J Spinal Disord 1998; 11(5): 389-94.
[12]	Tuite GF, Stern JD, Doran SE, et al. Outcome after laminectomy for lumbar spinal stenosis. Part I: Clinical correlations. J Neurosurg. 1994; 81(5): 699-706.
[13]	Tai CL, Hsieh PH, Chen WP, Chen LH, Chen WJ, Lai PL. Biomechanical comparison of lumbar spine instability between laminectomy and bilateral laminotomy for spinal stenosis syndrome - an experimental study in porcine model. BMC Musculoskelet Disord. 2008; 9: 84.
[14]	Herron LD, Pheasant HC. Bilateral laminotomy and discectomy for segmental lumbar disk disease. Decompression with stability. Spine. 1983; 8(1): 86-97.
[15]	Lee TT, Manzano GR, Green BA. Modified open-door cervical expansive laminoplasty for spondylotic myelopathy: Operative technique, outcome, and predictors for gait improvement. J Neurosurg. 1997; 86(1): 64-8.
[16]	Weiner BK, Walker M, Brower RS, McCulloch JA. Microdecompression for lumbar spinal canal stenosis. Spine. 1999; 24(21): 2268-72.
[17]	Xu BS, Tan QS, Xia Q, Ji N, Hu YC. Bilateral decompression via unilateral fenestration using mobile microendoscopic discectomy technique for lumbar spinal stenosis. Orthop Surg. 2010; 2(2): 106-10.
[18]	Lee MJ, Hacquebord J, Varshney A, et al. Risk factors for medical complication after lumbar spine surgery: a multivariate analysis of 767 patients. 2011; 36(21): 1801-6.
[19]	Jenis LG, Hsu WK, O'Brien J, Whang PG. Recent advances in the prevention and management of complications associated with routine lumbar spine surgery. J Bone Joint Surg Am. 2013; 95(10): 944-50.
[20]	Wewers ME, Lowe NK. A critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health. 1990; 13(4): 227-36.
[21]	Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine. 2000, 25(22): 2940-52.
[22]	Mousavi SJ, Parnianpour M, Mehdian H, Montazeri A, Mobini B. The Oswestry Disability Index, the Roland-Morris Disability Questionnaire, and the Quebec Back Pain Disability Scale: translation and validation studies of the Iranian versions. Spine. 2006, 31(14): E454-9.
[23]	Henderson ED. Results of the surgical treatment of spondylolisthesis. J Bone J Surg Am 1966; 48(4): 619-42.
[24]	Kaptan H, Kasimcan O, Cakiroglu K, Ilhan MN, Kilic C. Lumbar spinal stenosis in elderly patients. Ann NY Acad Sci. 2007; 1100: 173-8.
[25]	Rahman M, Summers LE, Richter B, Mimran RI, Jacob RP. Comparison of techniques for decompressive lumbar laminectomy: the minimally invasive versus the "classic" open approach. 2008; 51(2): 100-5.
[26]	Delank KS, Eysel P, Zöllner J, Drees P, Nafe B, Rompe JD. Undercutting decompression versus laminectomy. Clinical and radiological results of a prospective controlled trial. Orthopade. 2002; 31(11): 1048-56; discussion 1057.
[27]	Yu CS, Tay BK. Wide versus selective decompression in the operative treatment of lumbar spinal stenosis. Singapore Med J. 1992; 33(4): 378-9.
[28]	Krämer R, Wild A, Haak H, Borowski S, Krauspe R. The effect of limited interlaminar decompression versus complete laminectomy on intrathecal volume in degenerative lumbar spinal stenosis. Biomed Tech (Berl). 2002; 47(6): 159-63.
[29]	Lee MJ, Bransford RJ, Bellabarba C, et al. The effect of bilateral laminotomy versus laminectomy on the motion and stiffness of the human lumbar spine: a biomechanical comparison. Spine. 2010; 35(19): 1789-93.
[30]	Thomé C, Zevgaridis D, Leheta O, et al. Outcome after less-invasive decompression of lumbar spinal stenosis: a randomized comparison of unilateral laminotomy, bilateral laminotomy, and laminectomy. J Neurosurg Spine. 2005; 3(2): 129-41.