ABSTRACT

Degenerative lumbar stenosis is defined as narrowing of the spinal canal with symptomatic compression of neural and vascular elements. Consequently, persistent back pain and neurological symptoms becomes the indications for surgical treatment. The aim of the study is to evaluate the outcome of limited laminotomy and selective decompression in comparison to standard laminectomy and wide decompression in patients with degenerative lumbar stenosis.

We performed a retrospective study of 45 (38 female, 7 male) patients with degenerative lumbar stenosis who underwent decompressive surgery between 2003 and 2007. Standard laminectomy was performed in 31 patients, and limited laminotomy in 14 patients. Radiographic evaluation was performed using anteroposterior, lateral, and oblique radiographs. Any concomitant instability was assessed with additional dynamic lateral flexion and extension radiographs. Magnetic resonance imaging was used in all patients to demonstrate and evaluate the level and degree of stenosis. VAS was used tomeasure pain while walking and during daily activities and pain at rest and night.

The mean age was 62.8 years (37- 80) at surgery. Overall, a total number of 67 decompressions were performed. 26 (57.8%) patients were decompressed at one level, 16 (35.5%) at two levels, and 3 (6.7%) at three levels. A mean of 5.3 (2-15) segments were fused in limited laminotomy group, and amean of 4.6 (3-9) segments in standard decompressive laminectomy group. The mean postoperative follow-up period was 45.7 months (8-84). VAS results improved from 8.5 to 2.2 at limited laminotomy group, and from 8 to 3.5 at wide decompression group. We have one surgery related complication as intraoperative cerebrospinal fluid leakage. No other complications occurred during follow-up period for two groups.

Limited laminotomy is an effective method for surgical treatment of degenerative lumbar stenosis. It provides adequate decompression and pain relief and improves quality of life.