Comparative study of minimally invasive lumbar decompression versus decompressive laminectomy with posterolateral transpedicular fixation for the treatment of degenerative lumbar canal stenosis

Abstract

Degenerative lumbar canal stenosis remains one of the most common indications for lumbar spine surgery in elderly patients. Lumbar canal stenosis is classified according to the etiology into degenerative and congenital types, and according to the site of compression into central, lateral recess, and foraminal stenosis. Symptoms vary depending on the type of stenosis; in central stenosis patients experience neurogenic claudication, patients with lateral recess stenosis usually present with radicular symptoms.Radiographic evidence of narrowing of the spinal canal is sought. MRI is the diagnostic imaging of choice with many proposed trials to classify the severity of lumbar canal stenosis. The appropriate management of lumbar canal stenosis was a subject of debate in many studies with different outcomes and recommendations, which made generating evidence-based guidelines difficult. Conservative management is usually tried including medications and physiotherapy. The classic surgical approach for lumbar stenosis was a wide bilateral decompressive laminectomy along with resection of the medial portion of the facet joints to decompress the affected neural elements. Despite its efficacy to relieve stenosis and improve symptoms, many drawbacks were reported especially increasing the possibility of iatrogenic instability. Adding instrumented lumbar fusion to the classic decompressive laminectomy improved the clinical outcomes but it was associated with some complications including increased incidence of adjacent segment degeneration and hardware- related complications. To avoid these drawbacks minimally invasive spine surgeries have been introduced; including bilateral laminotomy and unilateral laminotomy with bilateral decompression (ULBD). They are associated with minimal bleeding and less post-operative pain which shorten the recovery period.