Research
The authors describe a hybrid technique that involves a combination of open decompression and posterior lumbar interbody fusion (PLIF) and percutaneously inserted pedicle screws.
This technique allows performance of PLIF and decompression via a midline incision and approach without compromising operative time and visualization.
From the 1Faculty of Medicine, University of New South Wales (UNSW), Sydney; 2NeuroSpine Surgery Research Group (NSURG), Sydney; 3Department of Neurosurgery, Prince of Wales Hospital, Sydney; 4Matrix Medical, Sydney; 5Faculty of Medicine, University of Sydney, Sydney; 63DMorphic, UNSW, Sydney; and 7SORL, Surgical & Orthopaedic Research Labs, UNSW, Sydney, Australia
Summary
OBJECT
The development of minimally invasive surgical techniques is driven by the quest for better patient outcomes. There is some evidence for the use of minimally invasive surgery for degenerative lumbar spine stenosis (LSS), but there are currently no studies comparing outcomes with matched controls. The object of this study was to compare outcomes following minimally invasive unilateral laminectomy for bilateral decompression (ULBD) to a standard “open” laminectomy for LSS.
METHODS
The authors conducted a prospective, 1:1 randomized trial comparing ULBD to open laminectomy for degenerative LSS. The study enrolled 79 patients between 2007 and 2009, and adequate data for analysis were avail- able in 54 patients (27 in each arm of the study). Patient demographic characteristics and clinical characteristics were recorded and clinical outcomes were obtained using pre- and postoperative Oswestry Disability Index (ODI) scores, visual analog scale (VAS) scores for leg pain, patient satisfaction index scores, and postoperative 12-Item Short Form Health Survey (SF-12) scores.
RESULTS
Significant improvements were observed in ODI and VAS scores for both open and ULBD interventions (p < 0.001 for both groups using either score). In addition, the ULBD-treated patients had a significantly better mean improvement in the VAS scores (p = 0.013) but not the ODI scores (p = 0.055) compared with patients in the open- surgery group. ULBD-treated patients had a significantly shorter length of postoperative hospital stay (55.1 vs 100.8 hours, p = 0.0041) and time to mobilization (15.6 vs 33.3 hours, p < 0.001) and were more likely to not use opioids for postoperative pain (51.9% vs 15.4%, p = 0.046).
CONCLUSIONS
Based on short-term follow-up, microscopic ULBD is as effective as open decompression in im- proving function (ODI score), with the additional benefits of a significantly greater decrease in pain (VAS score), postoperative recovery time, time to mobilization, and opioid use. (http://thejns.org/doi/abs/10.3171/2014.4.SPINE13420)
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Keywords
degenerative, laminectomy, lumbar, stenosis, minimally invasive surgery
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