Microsurgical unilateral approach for bilateral decompression of segmental lumbar canal stenosis / Alaa Ahmed Abdulkawy Tolba ; Supervised Omar Alfalaky , Ehab Abdelhalem , Ahmed Hamdy Ashry

Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Neurosurgery

Lumbar spinal stenosis is an encroachment on the neural structure by surrounding soft tissue and bone.1 It is the most common reason for spine surgery in adults over 60 years1. Open laminectomy has been regarded as the standard surgical method up to date in degenerative spinal stenosis.The conventional method may lead to instabilityand provoke chronic lower back pain by scarifying facet joint, posterior ligamentous complex as well as paraspinal muscle. For this reason, the new technique usingminimally invasive unilateral laminotomy with microsurgical bilateral decompressionhas been performed for lumbar canal stenosis, which could protect soft tissue and facetjointwith the advantage of potentiallymaintaining more stability by preserving more of the osseousstructures.The subject of this study is to evaluate the benefit and assess the clinical outcomes and safety of the microsurgicalunilateral approach for performing bilateral decompression ofsegmental lumbar canal stenosis. 20 patients with degenerative segmental lumbar canal stenosis underwent microsurgical bilateral decompression of the stenotic segment/s through a unilateral approach. Therewere 9 male patients (45 %) and 11 female patients (55 %) whose mean age was (49.75 ± SD 7.21 years) (range 29{u2013}60 years). Clinical outcomes were assessed, Low-back and leg pain were evaluated according to theVisual AnalogueScale (VAS) both preoperatively and postoperatively. Disability was evaluated according to the OswestryDisability Index (ODI) preoperatively and at 3 months postoperatively.Spinal canal dimensions and crosssectional area (CSA) were measuredpre- and postoperatively. VAS for low back pain (LBP) improved from 7.25 ± 1.5 to 2.95 ± 1.23, while VAS for leg pain improved from 8.7 ± 1.08 to 1.7 ± 1.2. ODI significantly decreased from 44.9 ± 11.8 % to 11.9 ± 3.3 %

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