Improved Surgical Treatment for Degenerative Lumbar Spinal StenosisSurgeons are looking for less invasive ways to surgically treat degenerative lumbar spinal stenosis (DLSS). DLSS is a common problem in older adults. Changes in the soft tissues, discs, and spinal joints lead to compression of the spinal nerves. The result can be back and/or leg pain and loss of function.
When conservative care fails, surgery may be the next step. But poor health and problems with spinal instability after surgical decompression make this a less than favorable option. That's why finding a minimally invasive operation with better results is so important.
In this study, neurosurgeons from Italy review the results of 374 patients who had surgery for DLSS. A microsurgical decompression technique with a unilateral (from one side) approach was used. Bilateral decompression was possible. This means that pressure was taken off the spinal nerves on both sides using a single-sided approach.
A detailed description of the surgery is provided. Computer-generated drawings and corresponding CT scans help show what was done. The procedure is called a unilateral laminotomy. A surgical microscope was used to give constant clear pictures of the spinal anatomy and nearby soft tissue structures.
The goals were to reduce the amount of time in surgery, bleeding, and other complications. The surgeons hoped to improve results with better long-term pain control and function. Meeting these goals would mean more patients could have this operation with good results.
Analysis of the data show that almost 90 per cent of the patients had improvement in pain levels and function. They had a shorter hospital stay and faster recovery. Only a few patients ended up with spinal instability. They could be treated conservatively. No further surgery was needed.
The authors say they have adopted this approach for their patients with single or multi-level DLSS. The results show the procedure is safe and effective and can be used in both young and elderly patients.
Francesco Costa, MD, et al. Degenerative Lumbar Spinal Stenosis: Analysis of Results in a Series of 374 Patients Treated with Unilateral Laminotomy for Bilateral Microdecompression. In Journal of Neurosurgery: Spine. December 2007. Vol. 7. No. 6. Pp. 579-586.
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