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Quantitative Outcome and Radiographic Comparisons between Laminectomy and Laminotomy in the Treatment of Acquired Lumbar Stenosis

Thomas, Nicholas W.M. MD; Rea, Gary L. MD, PhD; Pikul, Brian K. MD; Mervis, Lawrence J. MD; Irsik, Ronald MD; McGregor, John M. MD

Clinical Studies

OBJECTIVE: The objective of this study was to conduct a comparative quantitative analysis of outcomes, radiographic findings, and magnetic resonance imaging results after laminectomy or laminotomy was performed for patients with lumbar stenosis. Such an analysis had not previously been conducted.

METHODS: Twenty-six patients with no exclusion criteria who were treated surgically for acquired stenosis at the Division of Neurological Surgery at The Ohio State University from 1990 to 1993 were studied retrospectively. At follow-up examinations, each patient completed a detailed questionnaire that included visual analog scales, functional assessments, and the medical outcome study short form health survey, SF-36. Each patient underwent plain static and dynamic radiography that detailed vertebral body sagittal listhesis and rotation and magnetic resonance imaging that evaluated dural sac compression.

RESULTS: The mean follow-up duration was 36.7 months. Good outcome was defined by the presence of three criteria: no greater than mild leg pain (Grades 0-4), the ability to walk more than one block without developing lower extremity pain, and the ability to walk without assistance devices. Fifty-eight percent of the patients who had undergone laminectomies and 50% of the patients who had undergone laminotomies had good outcomes. All were judged to have had adequate decompression. The average maximum postoperative listhesis was 17.3± 9.9% in the laminectomy group and 17.6 ± 12.5% in the laminotomy group. In contrast to some previous studies, pre- or postoperative listhesis was not statistically related to outcome in either group. Patients in each poor outcome category seemed to have worse comorbid medical conditions than did patients in the good outcome category. The SF-36 measurements of poor functioning because of health factors and bodily pain correlated somewhat with poor outcomes in the patients who had undergone laminectomies. In patients who had undergone laminotomies, the only statistically significant finding among the outcome groups was the effect of poor emotional health on activity for the patients with poor outcomes.

CONCLUSION: This study indicates that laminotomy can adequately decompress lumbar canal stenosis, that laminectomy and laminotomy have the same degree of postoperative listhesis, and that the quantitative outcome of any treatment for lumbar stenosis is dependent not only on surgical factors but also on comorbid physical and psychological factors.

Division of Neurological Surgery (NWMT, GLR, BKP, LJM, JMM) and Department of Radiology (RI), The Ohio State University, Columbus, Ohio

Received, April 15, 1996. Accepted, April 7, 1997.

Reprint requests: Gary L. Rea, M.D., Ph.D., Division of Neurosurgery, N007 Upham Hall, 473 West 12th Avenue, The Ohio State University, Columbus, OH 43210.

Copyright © by the Congress of Neurological Surgeons