Boogert, H. den (2012) Bilateral versus a Unilateral Interlaminar Approach for Bilateral Decompression in patients withMonolevel Degenerative Lumbar Spinal Stenosis: A Multicenter Retrospective Study on PostoperativePain, Functional Disability and Patient Satisfaction. thesis, Medicine.
Full text available on request.Abstract
Background. Bilateral and unilateral interlaminar techniques for bilateral decompression are showing very promising results in the treatment of degenerative lumbar spinal stenosis (DLSS). The unilateral technique is more often considered superior because of sparing of important anatomical structures for back stability and supposedly reducing the chance of postoperative persisting back pain. However, studies directly comparing these two most used microsurgical techniques are scarce. The authors conducted a study with as primary aim to assess postoperative functional disability, pain and patient satisfaction in patients who underwent less invasive lumbar microsurgery for monolevel DLSS. Methods. In a retrospective cross-sectional study, patients from 5 participating clinics were included who underwent monolevel bilateral decompressive surgery either trough a bilateral (B) or unilateral (U) interlaminar approach between 1 November 2009 and 1 October 2011. Patients with a history of lumbar surgery or receiving additional surgery were excluded. Functional disability was measured using the Roland Morris disability questionnaire (RMDQ) and Oswestry disability index (ODI), pain was assessed by visual analog scales (VAS) and health status by the Short-Form 20 (SF-20). Also patient satisfaction and the surgical procedure were evaluated, as well as most relevant clinical, radiographic and surgical parameters. Data was obtained through home sent questionnaires and electronic patient files. Results. Of the 235 eligible patients, 175 (B: 68, U: 107) returned their questionnaire. The mean age at surgery was 68 years (range, 34-89), and the mean time since surgery 14.2 months (range, 3.3-27.4). There were no significant differences in ODI (B: 20.3, U: 22.6), RMDQ (B: 3.99, U: 4.8) and pain scores between treatment groups. Back and leg symptoms reduced in respectively 69.8% (B: 74.6%, U: 75%) and 80.9% (B: 73.1%, U: 85.4%; p = 0.048) of the cases. Of the patients 72.1% (B) and 80.0% (U) claimed to experience good overall results of treatment. In the unilateral group significantly more patients were overall satisfied with the procedure (82.1% vs. 69.1%, p = 0.047). Conclusion. There was no difference in postoperative functional disability and pain between the two surgical techniques. The significant differences in patient satisfaction and reduction of leg symptoms were not related to the surgical technique used. Overall treatment results were satisfactory, both techniques provide safe and effective treatment options for patients with monolevel DLSS.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Faculty supervisor: and Kuijlen J.M.A. MD, PhD and Department of Neurosurgery and University Medical Center Groningen |
| Supervisor name: | Keers, J. PhD and Van Swieten Scientific Institute and Martini Hospital Groningen |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:00 |
| Last Modified: | 25 Jun 2020 11:00 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2078 |
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