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LUMBAR SPINAL STENOSIS: PROGNOSTIC FACTORS FOR BILATERAL MICROSURGICAL DECOMPRESSION USING A UNILATERAL APPROACH

Papavero, Luca M.D.; Thiel, Marco M.S.; Fritzsche, Erik M.D.; Kunze, Christina M.D.; Westphal, Manfred M.D.; Kothe, Ralph M.D.

doi: 10.1227/01.NEU.0000341906.65696.08
SPINE: Technique and Assessment

OBJECTIVE: We describe a prospective cohort study that investigated the effectiveness of microsurgical bilateral decompression using unilateral laminotomy for lumbar spinal stenosis and assessed the factors influencing the outcome.

METHODS: A total of 165 consecutive patients underwent decompression for lumbar spinal stenosis. They were divided into 3 age groups: A (<65 years), B (65–75 years), and C (>75 years). Further classification was perforemed according to body mass index (BMI): BMI 1 (<26), BMI 2 (26–30), and BMI 3 (>30), anesthesiological risk factors (American Society of Anesthesiologists), and the number of levels decompressed. The outcome was monitored by an independent observer at 1 week, 3 months, and 1 year after surgery. The following parameters were evaluated: pain (visual analog scale and analgesic consumption), functional improvement (Neurogenic Claudication Outcome Score), and walking performance, defined as walking distance × speed (treadmill).

RESULTS: One week after surgery, pain decreased in 85.9% of patients, and a comparison of the pre- and postoperative use of analgesics showed that 38% of nonopioid use and 74% of opioid use were discontinued, whereas nonsteroidal anti-inflammatory drug consumption increased 13%. One year after surgery, pain remained decreased in 83.9% of patients, Neurogenic Claudication Outcome Score increased in 90.3% of patients, and walking performance improved in 92.2% of patients. BMI greater than 30 was the only negative prognostic factor for pain reduction (P = 0.012) and Neurogenic Claudication Outcome Score improvement (P = 0.019). Surprisingly, patients who underwent multilevel decompression benefitted more from surgery than those who underwent single-level decompression.

CONCLUSION: Microsurgical bilateral decompression using unilateral laminotomy is an effective surgical option for lumbar spinal stenosis, even in high-risk patients with multilevel stenosis.

Center for Spine Surgery, Eilbek Medical Center, Hamburg, Germany (Papavero) (Thiel) (Kunze)

Center for Spine Surgery, City Medical Center, Dortmund, Germany (Fritzsche) (Kothe)

Department of Neurosurgery, University Medical Center Eppendorf, Hamburg, Germany (Westphal)

Reprint requests: Luca Papavero, M.D., Center for Spine Surgery, Eilbek Medical Center, Dehnhaide 120, D-22081 Hamburg, Germany. Email: lpapavero@schoen-kliniken.de

Received, September 1, 2008.

Accepted, November 11, 2008.

Copyright © by the Congress of Neurological Surgeons