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KMID : 1099620070040030117
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Korean Journal of Spine
2007 Volume.4 No. 3 p.117 ~ p.122
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Mid-term Evaluation of Bilateral Partial Hemilaminectomy in Patients with Lumbar Spinal Stenosis
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Shin Hee-Sup
Kim Sung-Bum
Lim Young-Jin
Kim Tae-Sung
Kim Sung-Min
Rhee Bong-Arm
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Abstract
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Objectives: The surgical treatment of spinal stenosis has performed by wide laminectomy , which allows decompression of the neural structures. The success rate of procedure, however, is less than 70%. Causes of surgical failures have been known as incomplete decompression, local tissue trauma and postoperative spinal instability, which has led to a dramatic increase in lumbar fusion surgery and non-fusion surgery. The purpose of our retrospective study was to evaluate the clinical outcomes and postoperative instability after bilateral laminectomy in patients with lumbar spinal stenosis.
Methods: Retrospective studies were performed in 51 patients who underwent bilateral hemilaminectomy due to spinal stenosis without marked herniated discs from 2000 to 2004. Among 51 patients, 32 patients were selected according to the follow up period more than 12 months. The hospital records, OPD chart, radiographs were reviewed and analyzed. The postoperative stability and clinical outcome including postoperative complications were also evaluated by radiography and Prolo scale, respectively.
Results: Thirty two patients(mean age 59.3 years, range 45-71 years) with lumbar spinal stenosis refractory to adequate conservative treatment were received bilateral partial hemilaminectomy. Mean follow up period was 19.0 months(range 12- 48 months). Bilateral partial hemilaminectomy was performed at 1 level in 24 patients(75.0%) and at 2 levels in 8 patients(25.0%). Three cases showed postoperative instability(9.3%). Postoperative intervertebral disc space narrowing showed in 9 patients(28.1%). Adjacent level instability was found in no case. The clinical success rate using Prolo’s scale was 68.8%. Among poor clinical results group of 10 patients, 7 patients complained of low back pain. One case showed posto- perative infection which was treated surgically.
Conclusion: It would be concluded, in this retrospective study, that bilateral coronal hemilaminectomy with preserving midline structure provide the significant postoperative stability in spinal stenosis. This procedure would be a promising alternative treatment to the intricate fusion and non-fusion technique
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KEYWORD
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Spinal stenosis, Bilateral hemilaminectomy, Spinal fusion, Midline structure
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