Spinal canal morphology and clinical outcomes of microsurgical bilateral decompression via a unilateral approach for lumbar spinal canal stenosis

Won Seok Choi, Chang Hyun Oh, Gyu Yeul Ji, Sung Chan Shin, Jang Bo Lee, Dong-Hyuk Park, Tai Hyoung Cho

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Purpose: Microsurgical bilateral decompression via a unilateral approach for lumbar spinal stenosis is a less invasive technique compared to conventional laminectomy. Although many technical reports have demonstrated acceptable overall surgical outcomes for this approach, no studies have attempted to clarify the clinical outcomes thereof in regard to anatomical variance of the spinal canal. This study was conducted to analyze the clinical outcomes of microsurgical bilateral decompression via a unilateral approach according to spinal canal morphology in degenerative lumbar spinal stenosis. Methods: Between January 2008 and December 2009, 144 patients with single-level spinal lumbar stenosis underwent microsurgical bilateral decompression via a unilateral approach by a single surgeon. Patients were categorized into three groups according to spinal canal shape: round (n = 42), oval (n = 36), and trefoil (n = 66), and clinical parameters were assessed both before and after surgery with 2-3 years of follow-up. Results: Mean visual analog scale (VAS) and Oswestry disability index (ODI) decreased after surgery, respectively, from 8.1 and 59.8 % to 2.1 and 19.1 % in the round shaped spinal canal group, from 7.2 and 47.1 % to 2.2 and 15.1 % in the oval shaped spinal canal group, and from 6.8 and 53.6 % to 3.6 and 33.3 % in the trefoil shaped spinal canal group. In all groups, VAS and ODI scores significantly improved postoperatively (p < 0.01), although less improved VAS and ODI scores were observed in the trefoil shaped spinal canal group (p < 0.01). The overall patient satisfaction rate was 66.7 %; however, statistically significant lower satisfaction rates were reported in the trefoil shaped spinal canal group (p < 0.01). Conclusions: Microsurgical bilateral decompression via a unilateral approach may be a good modality for treating round or oval shape spinal canal stenosis, but is not recommended for trefoil-shaped-stenosis. The current authors recommend performing the bilateral decompression technique in cases of trefoil-shaped-spinal canal stenosis.

Original languageEnglish
Pages (from-to)991-998
Number of pages8
JournalEuropean Spine Journal
Volume23
Issue number5
DOIs
Publication statusPublished - 2014 Jan 1

Fingerprint

Spinal Stenosis
Spinal Canal
Decompression
Visual Analog Scale
Laminectomy
Patient Satisfaction
Loteae
Pathologic Constriction

Keywords

  • Clinical result
  • Microsurgical bilateral decompression
  • Spinal canal stenosis
  • Unilateral approach

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Spinal canal morphology and clinical outcomes of microsurgical bilateral decompression via a unilateral approach for lumbar spinal canal stenosis. / Choi, Won Seok; Oh, Chang Hyun; Ji, Gyu Yeul; Shin, Sung Chan; Lee, Jang Bo; Park, Dong-Hyuk; Cho, Tai Hyoung.

In: European Spine Journal, Vol. 23, No. 5, 01.01.2014, p. 991-998.

Research output: Contribution to journalArticle

@article{65759022c12e42c3a294442d25f7d555,
title = "Spinal canal morphology and clinical outcomes of microsurgical bilateral decompression via a unilateral approach for lumbar spinal canal stenosis",
abstract = "Purpose: Microsurgical bilateral decompression via a unilateral approach for lumbar spinal stenosis is a less invasive technique compared to conventional laminectomy. Although many technical reports have demonstrated acceptable overall surgical outcomes for this approach, no studies have attempted to clarify the clinical outcomes thereof in regard to anatomical variance of the spinal canal. This study was conducted to analyze the clinical outcomes of microsurgical bilateral decompression via a unilateral approach according to spinal canal morphology in degenerative lumbar spinal stenosis. Methods: Between January 2008 and December 2009, 144 patients with single-level spinal lumbar stenosis underwent microsurgical bilateral decompression via a unilateral approach by a single surgeon. Patients were categorized into three groups according to spinal canal shape: round (n = 42), oval (n = 36), and trefoil (n = 66), and clinical parameters were assessed both before and after surgery with 2-3 years of follow-up. Results: Mean visual analog scale (VAS) and Oswestry disability index (ODI) decreased after surgery, respectively, from 8.1 and 59.8 {\%} to 2.1 and 19.1 {\%} in the round shaped spinal canal group, from 7.2 and 47.1 {\%} to 2.2 and 15.1 {\%} in the oval shaped spinal canal group, and from 6.8 and 53.6 {\%} to 3.6 and 33.3 {\%} in the trefoil shaped spinal canal group. In all groups, VAS and ODI scores significantly improved postoperatively (p < 0.01), although less improved VAS and ODI scores were observed in the trefoil shaped spinal canal group (p < 0.01). The overall patient satisfaction rate was 66.7 {\%}; however, statistically significant lower satisfaction rates were reported in the trefoil shaped spinal canal group (p < 0.01). Conclusions: Microsurgical bilateral decompression via a unilateral approach may be a good modality for treating round or oval shape spinal canal stenosis, but is not recommended for trefoil-shaped-stenosis. The current authors recommend performing the bilateral decompression technique in cases of trefoil-shaped-spinal canal stenosis.",
keywords = "Clinical result, Microsurgical bilateral decompression, Spinal canal stenosis, Unilateral approach",
author = "Choi, {Won Seok} and Oh, {Chang Hyun} and Ji, {Gyu Yeul} and Shin, {Sung Chan} and Lee, {Jang Bo} and Dong-Hyuk Park and Cho, {Tai Hyoung}",
year = "2014",
month = "1",
day = "1",
doi = "10.1007/s00586-013-3116-7",
language = "English",
volume = "23",
pages = "991--998",
journal = "European Spine Journal",
issn = "0940-6719",
publisher = "Springer Verlag",
number = "5",

}

TY - JOUR

T1 - Spinal canal morphology and clinical outcomes of microsurgical bilateral decompression via a unilateral approach for lumbar spinal canal stenosis

AU - Choi, Won Seok

AU - Oh, Chang Hyun

AU - Ji, Gyu Yeul

AU - Shin, Sung Chan

AU - Lee, Jang Bo

AU - Park, Dong-Hyuk

AU - Cho, Tai Hyoung

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Purpose: Microsurgical bilateral decompression via a unilateral approach for lumbar spinal stenosis is a less invasive technique compared to conventional laminectomy. Although many technical reports have demonstrated acceptable overall surgical outcomes for this approach, no studies have attempted to clarify the clinical outcomes thereof in regard to anatomical variance of the spinal canal. This study was conducted to analyze the clinical outcomes of microsurgical bilateral decompression via a unilateral approach according to spinal canal morphology in degenerative lumbar spinal stenosis. Methods: Between January 2008 and December 2009, 144 patients with single-level spinal lumbar stenosis underwent microsurgical bilateral decompression via a unilateral approach by a single surgeon. Patients were categorized into three groups according to spinal canal shape: round (n = 42), oval (n = 36), and trefoil (n = 66), and clinical parameters were assessed both before and after surgery with 2-3 years of follow-up. Results: Mean visual analog scale (VAS) and Oswestry disability index (ODI) decreased after surgery, respectively, from 8.1 and 59.8 % to 2.1 and 19.1 % in the round shaped spinal canal group, from 7.2 and 47.1 % to 2.2 and 15.1 % in the oval shaped spinal canal group, and from 6.8 and 53.6 % to 3.6 and 33.3 % in the trefoil shaped spinal canal group. In all groups, VAS and ODI scores significantly improved postoperatively (p < 0.01), although less improved VAS and ODI scores were observed in the trefoil shaped spinal canal group (p < 0.01). The overall patient satisfaction rate was 66.7 %; however, statistically significant lower satisfaction rates were reported in the trefoil shaped spinal canal group (p < 0.01). Conclusions: Microsurgical bilateral decompression via a unilateral approach may be a good modality for treating round or oval shape spinal canal stenosis, but is not recommended for trefoil-shaped-stenosis. The current authors recommend performing the bilateral decompression technique in cases of trefoil-shaped-spinal canal stenosis.

AB - Purpose: Microsurgical bilateral decompression via a unilateral approach for lumbar spinal stenosis is a less invasive technique compared to conventional laminectomy. Although many technical reports have demonstrated acceptable overall surgical outcomes for this approach, no studies have attempted to clarify the clinical outcomes thereof in regard to anatomical variance of the spinal canal. This study was conducted to analyze the clinical outcomes of microsurgical bilateral decompression via a unilateral approach according to spinal canal morphology in degenerative lumbar spinal stenosis. Methods: Between January 2008 and December 2009, 144 patients with single-level spinal lumbar stenosis underwent microsurgical bilateral decompression via a unilateral approach by a single surgeon. Patients were categorized into three groups according to spinal canal shape: round (n = 42), oval (n = 36), and trefoil (n = 66), and clinical parameters were assessed both before and after surgery with 2-3 years of follow-up. Results: Mean visual analog scale (VAS) and Oswestry disability index (ODI) decreased after surgery, respectively, from 8.1 and 59.8 % to 2.1 and 19.1 % in the round shaped spinal canal group, from 7.2 and 47.1 % to 2.2 and 15.1 % in the oval shaped spinal canal group, and from 6.8 and 53.6 % to 3.6 and 33.3 % in the trefoil shaped spinal canal group. In all groups, VAS and ODI scores significantly improved postoperatively (p < 0.01), although less improved VAS and ODI scores were observed in the trefoil shaped spinal canal group (p < 0.01). The overall patient satisfaction rate was 66.7 %; however, statistically significant lower satisfaction rates were reported in the trefoil shaped spinal canal group (p < 0.01). Conclusions: Microsurgical bilateral decompression via a unilateral approach may be a good modality for treating round or oval shape spinal canal stenosis, but is not recommended for trefoil-shaped-stenosis. The current authors recommend performing the bilateral decompression technique in cases of trefoil-shaped-spinal canal stenosis.

KW - Clinical result

KW - Microsurgical bilateral decompression

KW - Spinal canal stenosis

KW - Unilateral approach

UR - http://www.scopus.com/inward/record.url?scp=84900793804&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84900793804&partnerID=8YFLogxK

U2 - 10.1007/s00586-013-3116-7

DO - 10.1007/s00586-013-3116-7

M3 - Article

C2 - 24292345

AN - SCOPUS:84900793804

VL - 23

SP - 991

EP - 998

JO - European Spine Journal

JF - European Spine Journal

SN - 0940-6719

IS - 5

ER -