J Korean Neurosurg Soc.  2015 Jul;58(1):65-71. 10.3340/jkns.2015.58.1.65.

Limited Unilateral Decompression and Pedicle Screw Fixation with Fusion for Lumbar Spinal Stenosis with Unilateral Radiculopathy: A Retrospective Analysis of 25 Cases

Affiliations
  • 1Department of Orthopedic Surgery, Peking University Third Hospital, Beijing, China. liuxiaoguangpku@163.com
  • 2Department of Orthopedic Surgery, Huizhou First Hospital, Guangdong, China.
  • 3Department of Surgery, Beijing North Hospital of Ordnance Industry, Beijing, China.
  • 4Department of Orthopedic Surgery, General Hospital of Huabei Oil Field Company, Hebei, China.

Abstract


OBJECTIVE
Lumbar spinal stenosis is conventionally treated with surgical decompression. However, bilateral decompression and laminectomy is more invasive and may not be necessary for lumbar stenosis patients with unilateral radiculopathy. We aimed to report the outcomes of unilateral laminectomy and bilateral pedicle screw fixation with fusion for patients with lumbar spinal stenosis and unilateral radiculopathy.
METHODS
Patients with lumbar spinal stenosis with unilateral lower extremity radiculopathy who received limited unilateral decompression and bilateral pedicle screw fixation were included and evaluated using visual analog scale (VAS) pain and the Oswestry Disability Index (ODI) scores preoperatively and at follow-up visits. Ligamentum flavum thickness of the involved segments was measured on axial magnetic resonance images.
RESULTS
Twenty-five patients were included. The mean preoperative VAS score was 6.6+/-1.6 and 4.6+/-3.1 for leg and back pain, respectively. Ligamentum flavum thickness was comparable between the symptomatic and asymptomatic side (p=0.554). The mean follow-up duration was 29.2 months. The pain in the symptomatic side lower extremity (VAS score, 1.32+/-1.2) and the back (VAS score, 1.75+/-1.73) significantly improved (p=0.000 vs. baseline for both). The ODI improved significantly postoperatively (6.60+/-6.5; p=0.000 vs. baseline). Significant improvement in VAS pain and ODI scores were observed in patients receiving single or multi-segment decompression fusion with fixation (p<0.01).
CONCLUSION
Limited laminectomy and unilateral spinal decompression followed by bilateral pedicle screw fixation with fusion achieves satisfactory outcomes in patients with spinal stenosis and unilateral radiculopathy. This procedure is less damaging to structures that are important for maintaining posterior stability of the spine.

Keyword

Lumbar spinal stenosis; Unilateral radiculopathy; Unilateral decompression; Pedicle screw instrumentation

MeSH Terms

Back Pain
Constriction, Pathologic
Decompression*
Decompression, Surgical
Follow-Up Studies
Humans
Laminectomy
Leg
Ligamentum Flavum
Lower Extremity
Radiculopathy*
Retrospective Studies*
Spinal Stenosis*
Spine
Visual Analog Scale
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