Comparative Study of Unilateral Laminotomy versus Conventional Laminectomy
Journal Title: INTERNATIONAL JOURNAL OF SCIENTIFIC STUDY - Year 2018, Vol 6, Issue 7
Abstract
Introduction: Lumbar canal stenosis and prolapsed intervertebral disc (PIVD) have been a major challenging problem of humankind since ages. Many different methods have been evolved for its diagnosis and management. The purpose of this study is to determine the efficacy and safety of unilateral laminotomy for decompression in case of PIVD and lumbar canal stenosis compared to conventional laminectomy. Materials and Methods: A retrospective and prospective study of 40 etrospes who had undergone surgery for PIVD or lumbar canal stenosis at our institute was carried out. They were assigned in the two groups: Group 1 (n = 20) consisted of patients who underwent laminotomy for decompression and Group 2 (n = 20) consisted of patients treated by decompressive laminectomy. Neurological status of the patients was evaluated by physical examination both pre-land post-operatively. Pain, disability, and other criteria were assessed by Greenough scoring system. Plain anteroposterior and lateral radiographs and magnetic resonance imaging of concerned segment were obtained of every patient. Lumbar flexion-extension films were obtained to assess spinal instability. Minimum follow-up was done at 6 at dhs, and the results were assessed using Greenough scoring system and radiographs at final follow-up. Result: Excellent-good clinical outcome was obtained in 80% of patients in Group 1 and in 65% of patients in Group 2. Increase in Greenough score was more in Groupe1. Post-operative spinal instability occurred in four patients in Group 2 and none in Group 1. Early rehabilitation and early return to work were more possible in Group 1. There was one surgical complication in each group (dural tear dealt during surgery). Post-operative infection developed in four patients (two in each group), among which one requires surgical debridement in Groupi2. Neurological impairment occurred in one patient in Group 2. Conclusion: Duration of hospital stay is significantly reduced among the patients operated by unilateral laminotomy compared with laminectomy, and rehabilitation was also faster by starting earlier sitting and thereby reducing morbidity and burden to hospital. Consequent earlier return to normal routine life can be expected. Although overall outcome of the patients at final follow remains mostly unchanged, technique of sparing unilateral paraspinal muscles and thereby sparing supraspinous and interspinous ligaments does help in earlier rehabilitations of the patients, fastens the recovery thereby reducing psychiatric problems related to it, saves many man hours of one to get back to normal routine life.
Authors and Affiliations
Rohit Thaker, Nishat Goda, Virendra Agrawal, Ram Chaddha
Keywords
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