engleski

Microdecompressive Laminotomy vs. Facet Sparing Laminectomy in the Treatment of Lumbar Spine Stenosis: Randomized controlled trial

Aim Facet-sparing laminectomy (FSL) is an effective method for the treatment of lumbar stenosis. Young and McCulloch introduced a microdecompressive laminotomy (MDL) consisting of unilateral mutifidus retraction, ipsilateral interlaminectomy and contralateral decompression under the midline posterior structures. Interest for MDL further increases with introduction of endoscopic surgical techniques. There is no study comparing MDL with FSL. Method Randomized controlled trial including forty-four patients with a lumbar stenosis individually randomized into the trial (MDL, n=22) and control group (FSL, n=22) was planed (alpha = 0.05 ; beta = 0.90). Patients with backache, neurological claudications, symptoms lasting longer than 3 months and unsuccessful conservative therapy, were included. Exclusion criteria were degenerative instability and deformity, and depression defined as Back’ s grading scale score >17. Surgical time, blood loss, and incision length were measured. After one year follow-up the patients were asked about standing time, and walking distance. Preoperative and 1-year follow-up activity (E) and pain (F) score according to Prolo scale were assessed. Results Between February 15, 2000, and December 1, 2002, 56 patients were recruited, and 44 patients were included in the study. Three patients were lost for follow-up examination. Among 41 patients examined after 1 year follow-up, there were 17 male and 24 female patients, the mean age was 64.15± 14.24 years. The average patients ability to walk increased from approximately 100 meters to more than a full kilometer, and average standing time increased from 10 minutes to a half hour in both studied groups. In the MDL and FSL groups, the average values on the E and F scales were significantly higher after surgery. There were no differences between trial and control group in blood loss (217± 51.2ml vs.225± 48.2, p=0.614), and incision length (45 (35-50) vs. 42 (35-50), p=0.077). There were two dura lacerations in trial group, which repair prolonged surgical time (100min (80-170 vs. 90 (60-120), p=0.041). In the control group both activity and pain outcome were better than in trial group (E grade: 4, 25± 0.72 vs. 3.65± 0.59, p=0.017 ; F grade: 4.65± 0.59 vs. 4.00± 0.97, p=0.030). Conclusion Our results suggest that MDL is not as effective and less invasive in comparison with FSL.

decompression; lumbar region; minimal surgical procedure; spinal stenosis

nije evidentirano