CC BY-NC-ND 4.0 · Indian Journal of Neurosurgery 2021; 10(02): 121-127
DOI: 10.1055/s-0041-1726604
Original Article

Comparing Ipsilateral and Contralateral Laminotomy with Bilateral Decompression in Cases with Far Lateral Disk Herniation and Lumbar Spinal Stenosis

1   Department of Neurosurgery, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
,
2   Department of Neurosurgery, Okan University, Istanbul, Turkey
,
2   Department of Neurosurgery, Okan University, Istanbul, Turkey
,
3   Department of Neurosurgery, Neurospinal Academia, Istanbul, Turkey
,
2   Department of Neurosurgery, Okan University, Istanbul, Turkey
› Author Affiliations

Abstract

Introduction The aim of this study was to compare clinical results of bilateral decompression and laminotomy and contralateral laminotomy following discectomy from the same side in patients who have far lateral disk herniation and lumbar spinal stenosis at the same level.

Materials and Methods Twenty-four patients with far lateral disk herniation have been divided into two groups: group 1 (n = 14), those who have been through bilateral canal decompression with far lateral discectomy and ipsilateral approach, and group 2 (n = 10), those who have been through far lateral discectomy and bilateral decompression with unilateral approach from contralateral side. Early postoperative, 1st month, and 12th month back and leg pain Visual Analogue Scale (VAS) scores of the patients have been retrospectively evaluated.

Results There is no significant difference between 1st month back and leg pain VAS scores of the groups. But 12th month back and leg pain VAS scores of group 1 are significantly higher than 1st month VAS scores. Also, 12th month back and leg pain VAS scores of group 1 are significantly higher than group 1. In the scanning carried out when the complaints of eight patients in group 1 continued, pars interarticularis fracture has been observed on the side where the surgery has been performed (57.1%). Six of these eight patients have been through stabilization surgery (42.8%).

Conclusion Long-term postoperative results are better in cases who have been performed bilateral decompression with unilateral approach from contralateral side with median incision following paramedian incision discectomy in patients with far lateral disk herniation and spinal stenosis.



Publication History

Article published online:
15 July 2021

© 2021. Neurological Surgeons’ Society of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 
  • References

  • 1 Salame K, Lidar Z. Minimally invasive approach to far lateral lumbar disc herniation: technique and clinical results. Acta Neurochir (Wien) 2010; 152 (04) 663-668
  • 2 Hodges SD, Humphreys SC, Eck JC, Covington LA. The surgical treatment of far lateral L3-L4 and L4-L5 disc herniations. A modified technique and outcomes analysis of 25 patients. Spine 1999; 24 (12) 1243-1246
  • 3 Wiltse LL, Bateman JG, Hutchinson RH, Nelson WE. The paraspinal sacrospinalis-splitting approach to the lumbar spine. J Bone Joint Surg Am 1968; 50 (05) 919-926
  • 4 Getty CJM, Johnson JR, Kirwan EO, Sullivan MF. Partial undercutting facetectomy for bony entrapment of the lumbar nerve root. J Bone Joint Surg Br 1981; 63-B (03) 330-335
  • 5 Nakai O, Ookawa A, Yamaura I. Long-term roentgenographic and functional changes in patients who were treated with wide fenestration for central lumbar stenosis. J Bone Joint Surg Am 1991; 73 (08) 1184-1191
  • 6 Akar E, Somay H. Comparative morphometric analysis of congenital and acquired lumbar spinal stenosis. J Clin Neurosci 2019; 68: 256-261
  • 7 Arnoldi CC, Brodsky AE, Cauchoix J. et al. Lumbar spinal stenosis and nerve root entrapment syndromes. Definition and classification. Clin Orthop Relat Res 1976; (115) 4-5
  • 8 Javid MJ, Hadar EJ. Long-term follow-up review of patients who underwent laminectomy for lumbar stenosis: a prospective study. J Neurosurg 1998; 89 (01) 1-7
  • 9 Mayer HM, List J, Korge A, Wiechert K. [Microsurgery of acquired degenerative lumbar spinal stenosis. Bilateral over-the-top decompression through unilateral approach] [in German]. Orthopade 2003; 32 (10) 889-895
  • 10 Jönsson B. Vertebral slipping after decompression for spinal stenosis. Acta Orthop Scand Suppl 1993; 251: 76-77
  • 11 Thomé C, Zevgaridis D, Leheta O. et al. Outcome after less-invasive decompression of lumbar spinal stenosis: a randomized comparison of unilateral laminotomy, bilateral laminotomy, and laminectomy. J Neurosurg Spine 2005; 3 (02) 129-141
  • 12 Rahman M, Summers LE, Richter B, Mimran RI, Jacob RP. Comparison of techniques for decompressive lumbar laminectomy: the minimally invasive versus the “classic” open approach. Minim Invasive Neurosurg 2008; 51 (02) 100-105
  • 13 Ogrenci A, Koban O, Yaman O, Yilmaz M, Dalbayrak S. Clinical comparison between patients operated for unilateral radiculopathy via a contralateral (facet-sparing) and ipsilateral side approach. Turk Neurosurg 2018; 28 (04) 610-615
  • 14 Choi WS, Oh CH, Ji GY. et al. Spinal canal morphology and clinical outcomes of microsurgical bilateral decompression via a unilateral approach for lumbar spinal canal stenosis. Eur Spine J 2014; 23 (05) 991-998
  • 15 Oertel MF, Ryang YM, Korinth MC, Gilsbach JM, Rohde V. Long-term results of microsurgical treatment of lumbar spinal stenosis by unilateral laminotomy for bilateral decompression. Neurosurgery 2006; 59 (06) 1264-1269
  • 16 O’Toole JE, Eichholz KM, Fessler RG. Minimally invasive far lateral microendoscopic discectomy for extraforaminal disc herniation at the lumbosacral junction: cadaveric dissection and technical case report. Spine J 2007; 7 (04) 414-421
  • 17 Al-Khawaja DO, Mahasneh T, Li JC. Surgical treatment of far lateral lumbar disc herniation: a safe and simple approach. J Spine Surg 2016; 2 (01) 21-24
  • 18 Ivanov AA, Faizan A, Ebraheim NA, Yeasting R, Goel VK. The effect of removing the lateral part of the pars interarticularis on stress distribution at the neural arch in lumbar foraminal microdecompression at L3-L4 and L4-L5: anatomic and finite element investigations. Spine 2007; 32 (22) 2462-2466