ABSTRACT

Introduction:

The purpose of the study is to present a new surgical technique in the surgical treatment of degenerative lumbar spinal stenosis in middle-aged patient population in whom there is central canal stenosis requiring intervertebral disc removal and stabilization with or without involvement of the nerve roots.

Materials and Methods:

Twelve patients with symptomatic degenerative lumbar spinal stenosis were treated in our center. Plain X-rays including dynamic views, CT, myelo-CT, axial loading CT, axial loading MRI and neurophysiologic studies were performed. Postoperative follow-up data were gathered by means of VAS, Oswestry score and patientsʼ declaration of satisfaction. In the surgery, after posterior pedicle screw instrumentation of the effected levels; following procedures were done in order: unilateral hemilaminectomy in the effected or symptomatic side, removal of ipsilateral ligamentum flavum, removal of the contralateral ligamentum flavum as well as cortical bone on the ventral surface of the spinous processes, ipsilateral facetectomy, intervertebral disc removal and interbody fusion then finally contralateral posterior fusion.

Results:

The patients comprised 7 women and 5 men with a mean age of 57 (range; 52 to 63) years. The mean postoperative follow-up was 24 months. Seven patients underwent hemilaminectomies at two adjacent levels, 3 at three levels, one at four levels and one at five levels. The average hospital stay was 6.2 days. The VAS score decreased from 9.6 to 2.8 and Oswestry Score from 28.5 to 8 at follow-up review. All patients had satisfied with the procedure. During the follow-up period; no pseudoarthrosis, no infection and no neurological events were seen.

Conclusion:

The results from this initial study of a new surgical intervention for the treatment of lumbar stenosis appear encouraging. Discectomy and interbody fusion, and contralateral decompression via unilateral approach prevents the formation of dead space. The procedure appears safe with very few complications, minimal blood loss, and brief hospital stays. However, more definitive conclusions about its success will require a long-term follow-up review and a prospective randomized study of the procedure.