Our Summary

Lumbar spinal stenosis is a condition often caused by aging, where the spinal canal gets compressed, leading to leg pain and difficulty in walking. Surgery is usually considered when non-surgical methods don’t work or if the patient’s condition worsens quickly. Traditionally, this involves a procedure called a laminectomy, but a newer, less invasive option, called unilateral laminectomy for bilateral decompression (ULBD), appears to have better outcomes after surgery, as it only requires exposing one side of the spine. The ULBD procedure involves making a cut along the middle of the back, pulling back the muscles on one side, and then removing part of the spine and relieving pressure in the spinal canal. However, there’s no consensus on which side of the spine should be approached during ULBD. In this paper, we propose a decision-making process for choosing the side to approach during ULBD, based on factors such as the position and angle of the spine, which side is most compressed, and the surgeon’s dominant hand.

FAQs

  1. What is lumbar spinal stenosis and how is it typically treated?
  2. What is the unilateral laminectomy for bilateral decompression (ULBD) procedure and how does it differ from traditional surgery?
  3. How do surgeons decide which side to approach for the ULBD procedure?

Doctor’s Tip

A doctor might tell a patient that spinal decompression, specifically through a procedure like unilateral laminectomy for bilateral decompression (ULBD), can provide relief from symptoms of spinal stenosis such as leg pain and walking disability. It is important to discuss with your surgeon the decision on which side to approach the decompression based on factors like the position of the spinous process and angulation, side of maximal compression, and surgeon handedness. Following proper postoperative care and rehabilitation can help optimize the outcomes of the procedure.

Suitable For

Patients who are typically recommended for spinal decompression include those with lumbar spinal stenosis, which is a degenerative condition that leads to compression of the spinal canal and lateral recess. These patients often experience leg pain and walking disability as a result of the compression. Surgical management is typically recommended after non-surgical options have been exhausted or if there is rapidly worsening neurological impairment.

One newer minimally invasive option for spinal decompression is unilateral laminectomy for bilateral decompression (ULBD), which has been shown to have better postoperative outcomes compared to traditional approaches. ULBD involves a midline incision, opening the thoracolumbar fascia, retracting the paravertebral muscles unilaterally, and performing a hemilaminectomy, flavectomy, and decompression of the spinal canal with foraminotomy or partial facetectomy.

The decision on which side to approach spinal stenosis with ULBD has not been widely discussed in the literature. However, an algorithm based on factors such as the position of the spinous process and angulation, the side of maximal compression, and the surgeon’s handedness can help determine the appropriate approach for ULBD in individual patients.

Timeline

Before undergoing spinal decompression, a patient typically experiences symptoms such as back pain, leg pain, numbness, tingling, and weakness in the legs. They may have tried conservative treatments such as physical therapy, medications, and injections without success. After deciding to undergo spinal decompression surgery, the patient will undergo preoperative testing and evaluation to ensure they are a good candidate for the procedure.

During the spinal decompression surgery, the patient is placed under general anesthesia and the surgeon makes a small incision in the back. The surgeon then removes a portion of the lamina to relieve pressure on the spinal nerves and create more space in the spinal canal. This allows for better blood flow and healing of the affected area.

After the surgery, the patient will typically stay in the hospital for a few days for monitoring and pain management. They will then begin a rehabilitation program to help strengthen the muscles surrounding the spine and improve mobility. Over time, the patient should experience a reduction in their symptoms and an improvement in their overall quality of life.

What to Ask Your Doctor

  1. What is spinal decompression and how can it help with my condition?
  2. What are the risks and benefits of spinal decompression surgery?
  3. How long is the recovery process after spinal decompression surgery?
  4. Are there any alternative treatments to spinal decompression that I should consider?
  5. How many spinal decompression surgeries have you performed and what is your success rate?
  6. What can I expect in terms of pain management after the surgery?
  7. Will I need physical therapy or rehabilitation after the surgery?
  8. What are the potential complications or side effects of spinal decompression surgery?
  9. How long will the effects of spinal decompression surgery last?
  10. Do you recommend any specific lifestyle changes or precautions after spinal decompression surgery?

Reference

Authors: Phan K, Teng I, Schultz K, Mobbs RJ. Journal: Orthop Surg. 2017 May;9(2):241-246. doi: 10.1111/os.12335. Epub 2017 May 26. PMID: 28547809