Introduction: This prospective observational study was undertaken for analysis of 823 patients with 2213 levels of degenerative lumbar spinal stenosis with or without disc herniation who underwent bilateral decompression via a unilateral approach between 2000 and 2010. We have conducted a study to compare the initial chief complaint, neurological status and outcome of patients. Recurrence rate of disc herniation was also reviewed.
Methods: 183 of 823 patients underwent concomitant discectomies at the index level. All patients were followed-up regularly at intervals of 1, 6, 12 months, and were followed up annually thereafter. All patients underwent MR-imaging studies one year after surgery. Routine radiological investigations including neutral, flexion/extension lateral radiographs at these time intervals were taken routinely. Clinical outcomes were assessed using the Oswestry Disability Index (ODI), and Short Form–36 (SF-36).
Results: Surgery outcomes generally have been good to excellent and none of the patients were made worse by the procedure. The early postoperative outcomes were significantly better in the degenerative lumbar spinal stenosis without disc herniation groups. Other positive outcome factors were short duration and sudden onset of symptoms. No radiograph revealed an increase in the degree of spondylolisthesis in the late postoperative period. No postoperative instability developed requiring instrumentation assisted secondary fusion.
Conclusions: For degenerative lumbar spinal stenosis with or without disc herniation unilateral approaches allowed sufficient and safe decompression of the neural structures and adequate preservation of vertebral stability, resulted in a highly significant reduction of symptoms and disability, and improved health-related quality of life.
Patient Care: This minimally invasive approach may be the potential to decrease a patient’s postoperative pain and disability as well as to decrease the length of hospital stay and thereby the treatment costs.
Learning Objectives: We think that the goal of the unilateral approach to treat lumbar spinal stenosis is to achieve adequate decompression of the neural elements.