TITLE:
Technical Nuances of Minimal Invasive Interlaminar Decompression in Lumbar Spinal Stenosis: The Role of Minimal Invasive Bilateral Approach
AUTHORS:
Nicola Montano, Fabio Papacci, Fabrizio Pignotti, Eduardo Fernandez
KEYWORDS:
Lumbar Spinal Stenosis, Laminectomy, Spine, Spondylolisthesis, Minimal Invasive Approach, Interlaminar Decompression
JOURNAL NAME:
Open Journal of Modern Neurosurgery,
Vol.6 No.2,
March
31,
2016
ABSTRACT: We report a series of
patients operated for one or multilevel lumbar spinal stenosis (with and without
spondylolisthesis) using the minimal invasive bilateral interlaminar
decompression. We discuss our results, comparing this procedure (from a
technical point of view) with the muscle-preserving interlaminar decompression
(MILD) and the unilateral approach for bilateral decompression (ULBD). Clinical and outcome data of 62 consecutive patients
were reviewed, using the Visual Analogue Scale for both low back pain (LBP) and
legs pain and the Oswestry Disability Index (ODI) for the degree of disability.
Mean age was 68.88 ± 9.54 years and mean follow-up (FU) was 16.38 ± 11.12
months. A statistically
significant improvement of LBP, legs pain and ODI was globally observed. At
latest FU, patients with multilevel lumbar spinal stenosis significantly improved all scores and patients
with spondylolisthesis significantly decreased their disability. No major
complications occurred. Two cerebrospinal fluid (CSF) collections were treated
conservatively. No wound infection occurred. No progression of
spondylolisthesis was observed. No reoperation was needed. Although efficacious
in patients with lumbar spinal stenosis, MILD and ULBD can have both some
limitations. MILD has been found to decrease lumbar function in multilevel
decompression (increasing sagittal
translation and lumbar lordosis probably due to the removal of half of the
spinous processes) and ULBD shows some disadvantages due to the difficulty of
manipulating instruments through a small portal and the inadequate
decompression due to a minimal exposure. The minimal invasive
bilateral interlaminar decompression (in this technique, the access is bilateral but the supraspinous and
interspinous ligaments and the spinous processes are preserved) allows wide
access (bilateral exposure) with minimal invasiveness and very low morbidity in
patients with lumbar spinal stenosis at one or more levels.