Abstract
Introduction
The objective of decompressive surgery for lumbar or cervical stenosis is to treat the compressive pathology while minimizing iatrogenic destabilization of the spine. The surgical technique has consequently evolved from the radical laminectomy to a facet-sparing laminectomy and more recently to midline preserving techniques including bilateral laminotomy. Cadaveric studies have supported and characterized the biomechanical advantages of the bilateral laminotomy over facet-sparing laminectomy. In this study, we characterize and compare outcome and long-term follow-up between patients who have been treated with either of these two techniques at our institution.
Patients and Methods
We reviewed 100 patients comprising 50 who underwent bilateral facet-sparing laminectomy and 50 who underwent bilateral laminotomy. Clinical outcome measures include reduction in pain as assessed using visual analog scale. Biomechanical outcome measures included segmental motion at the operated segment as measured on postoperative flexion–extension X-rays obtained at long-term follow-up.
Results
Analyses of each of the surgical technique cohorts were performed. Clinical outcome as assessed by visual analog scale ratings was comparable between the two groups of patients undergoing either of bilateral laminectomy or bilateral laminotomy. An increase in the segmental angular movement at the operated level as measured from flexion extension studies was less in the patients undergoing bilateral laminotomy as compared with those undergoing bilateral laminectomy.
Conclusion
The bilateral laminotomy achieves successful decompression of spinal stenosis while preserving biomechanical stability of the involved spinal segments. For properly selected patients, this may provide a surgical option with clinical and biomechanical outcomes which are superior to those provided by facet-sparing laminectomy, which has supplanted to original radical laminectomy. Sparing of the midline osteoligamentous structures, as achieved using the bilateral laminotomy, represents a further advancement in surgical technique in the treatment of spinal stenosis, providing satisfactory clinical outcomes while further minimizing disruption of the normal spinal biomechanical stability.