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. 2014 Jan;23(1):80-6.
doi: 10.1007/s00586-013-2888-0. Epub 2013 Jul 13.

Clinical outcomes following sublaminar-trimming laminoplasty for extensive lumbar canal stenosis

Wen-Jiunn Liu  1 , Shih-Wun Hong, Da-Yon Liou, Tung-Wu Lu
Affiliations

Clinical outcomes following sublaminar-trimming laminoplasty for extensive lumbar canal stenosis

Wen-Jiunn Liu et al. Eur Spine J. 2014 Jan.

Abstract

Purpose: Current surgical approaches for treatment of lumbar canal stenosis are often associated with relatively high rates of reoperation and recurrent stenosis. We have developed a new approach for treatment of this condition: sublaminar-trimming laminoplasty. To describe the surgical approach of sublaminar-trimming laminoplasty and to assess associated outcomes.

Methods: Patients with extensive lumbar canal stenosis who received sublaminar-trimming laminoplasty from 2006 to 2008 were considered for inclusion in the study. The surgery comprised aspects of laminotomy and laminectomy. The following were assessed before surgery and 3 years after surgery: leg and back pain by visual analog scale (VAS), extent of disability by Oswestry Disability Index (ODI), severity of back pain by Japanese Orthopedic Association Score for Back Pain (JOA), walking tolerance, and leg numbness. Complications were noted.

Results: A total of 49 patients were included in the study (mean age 65.6 ± 10.6 years). VAS leg and back pain, ODI, and JOA scores significantly changed from before surgery to 3 years after surgery (P < 0.001). Mean changes (95 % confidence interval) were -6.2 (-6.7, -5.7), -4.3 (-4.8, -3.8), -21.4 (-23.4, -19.5), and 13.4 (12.1, 14.7) for leg pain, back pain, ODI, and JOA scores, respectively. Patients experienced significant improvements in walking tolerance and leg numbness (P < 0.001). There were no instances of recurrent stenosis or postoperative spinal instability. Complications included intraoperative dural tear (n = 2), postoperative urinary tract infection (n = 2), and inadequate decompression and junctional stenosis during follow-up (both n = 1).

Conclusion: Sublaminar-trimming laminoplasty shows promise as an effective treatment for extensive lumbar canal stenosis.

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Figures

Fig. 1
Fig. 1
Schematic illustrating key parts of the sublaminar-trimming laminoplasty procedure. a Surgical procedure: laminotomy, and sublaminar trimming. b Thickness of the lamina before trimming: L3, mean = 9.0 mm (male = 9.5 mm, female = 8.0 mm); L4, mean = 10.0 mm (male = 11.0 mm, female = 9.5 mm); L5, mean = 9.0 mm (male = 9.5 mm, female = 8.5 mm). c Thickness of the lamina after trimming: mean = 3.5 mm
Fig. 2
Fig. 2
Representative a X-ray image and b photograph showing the lumbar spine after sublaminar-trimming laminoplasty
See this image and copyright information in PMC

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