engleski

Facet sparing laminectomy with fusion versus Young laminoplasty for the treatment of degenerative spinal stenosis

OBJECT: Laminectomy with fusion, traditional technique for lumbar decompression has been recently almost totally replaced with many less invasive surgical techniques allegedly equally effective. The aim of our study was comparison between long- term outcomes of Young laminoplasty (YL) as one of the less invasive techniques and Facet Sparing Laminectomy with augmented posterolateral fusion (LF). METHODS: Patients with history of neurogenic claudication and lumbar stenosis (FSL and YL mean +/- SD dural sac area (mm2) = 53, 96 +/- 8, 39 ; 54, 26 +/- 10, 11 ; p=0, 914) were surgically treated from February 2000 to September 2002 in General Hospital Pula. Instability and spondylolisthesis were exclusion criteria. Outcome was measured as difference in the Oswestry Disability Index (ODI) at 1-year and 5-year follow-up examinations. Duration of surgery, blood loss, incision length and hospital stay were measured. RESULTS: 44 patients out of 56 patients were enrolled. Twenty- six patients were randomized in LF (No=13) and YL (No=13) groups while 18 were allocated in observational LF (No=13) and YL (No=5) cohorts. Significant improvement on 1-year and 5- year follow-up was noticed in LF and YL groups (26, 65, p<0, 001 ; 30, 25, p<0, 001 ; and 16, 05, p<0, 001 ; 28, 78, p<0, 001, respectively). LF ODI was significantly better compared to YL at 5-year follow-up (27, 82 +/- 1, 918 vs 40, 74 +/- 2, 163 ; p<0, 001). No significant difference was found between the randomized and observational cohorts. LF was more invasive and two dura lacerations appeared in YL group. CONCLUSION: LF is a more invasive surgical technique than YL but with clinically significantly better long-term outcome.

Laminectomy; fusion; spinal stenosis

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