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9
Outcomes of Unilateral Approach for Bilateral Decompression of Lumbar Spinal Stenosis: Comparison between Younger and Geriatric Patients.
Sang Won Hwang, Seung Chul Rhim, Sung Woo Roh, Sang Ryong Jeon, Seung Jae Hyun
Department of Neurosurgery, Asan Medical Center, Collage of Medicine, University of Ulsan, Seoul, Korea. scrhim@amc.seoul.kr
Abstract
OBJECTIVE
The purpose of our retrospective study is to evaluate the surgical outcome of patients who underwent unila- teral approach for bilateral decompression surgery for lumbar spinal stenosis and to compare outcomes between geriatric and younger patients.
METHODS
We reviewed records of 85 patients with an average age of 64 years at the time of surgery after the unilateral laminotomy for bilateral decompression of degenerative lumbar spinal stenosis between 2005 and 2007. To compare clinical and functional outcomes between younger and geriatric patients, they were divided by age into 2 groups: Group A included patients 65 years of age or older and Group B contained patients younger than 65 years. The study parameters were set to ensure a follow-up period of at least 3 months and hospital records and phone-call review were analyzed for patients' clinical and demographic data, co-morbidity, type of stenosis, clinical and functional outcomes. Clinical outcomes were measured using the scale of Finneson and Cooper and the visual analog scale score for leg and back pain. Functional outcome was assessed with change of walking distance of patients.
RESULTS
Follow-up was completed in 80(94.1%) of 85 patients and Group A included 44 patients and Group B did 36 patients. The number of decompressed level showed 2.26 with similar results in both groups(group A, 2.25; Group B, 2.28). The number of co-morbidity was significantly higher incidence of 2.36 in geriatric patients than that of 1.67 in younger individuals. Other demographic data and type of stenosis were similar between two groups. For each back and leg pain, 86.3%(Group A: 86.4%; Group B, 80.6%) and 83.8%(Group A: 90.9%; Group B: 80.6%) had an excellent-to-fair operative result under the scale of Finneson and Cooper. Improvement rate of walking distance was 81.5% of patients and higher in group B(89.3%) than in group A(75.6%), however, there was not statistical significance. Three major complications were occurred in all patient groups, the first patient with chronic renal failure suffered from immediately postoperative epidural hematoma and the second patient had wound dehiscence. The third patient with no improvement was operated with fusion surgery at the other hospital nonetheless she had not improved until now.
CONCLUSIONS
The ULBD allowed sufficient and safe decompression of the neural structures and adequate preservation of vertebral stability with acceptable complication rates. This technique could provide a minimally invasive approach for LSS in elderly patients frequently having comorbidities as well as younger one.
Keywords: Decompression;Lumbar spinal stenosis;Unilateral approach;Bilateral decompression


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