Our Summary

This study compared two types of surgery used to treat upper lumbar spinal stenosis, a condition where the spinal canal in the lower back narrows, causing back and leg pain. The two types of surgery they looked at were microendoscopic laminectomy (MEL) and open laminectomy.

The study analyzed patients who had one of these surgeries at one of 12 different spine centers between April 2017 and September 2021. They collected information about the patients before and one year after the surgery, as well as looking at their imaging results.

Out of the 2487 patients they looked at, 118 had a single-level decompression surgery at the L1-L2 or L2-L3 levels of the spine, which are the upper lumbar levels. Of these, 80 patients (51 in the MEL group and 29 in the open group) had sufficient post-surgery data to analyze.

The results showed that patients in the MEL group had better scores on a test measuring quality of life (the EuroQol 5-Dimension) compared to the open group. The MEL group also had a lower rate of preserving the facet joints (the small joints between the vertebrae in the spine), but this did not result in more instability after surgery. The open group had a higher rate of retrolisthesis, a condition where a vertebra slips backwards.

In conclusion, the results suggest that while both types of surgery have similar overall outcomes, MEL surgery may offer some advantages in terms of improving quality of life. Despite the lower preservation rate of facet joints in the MEL group, this did not lead to more instability after surgery.

FAQs

  1. What is the difference between microendoscopic laminectomy (MEL) and open laminectomy?
  2. What were the findings of the comparison between single-level decompression cases at L1-L2 or L2-L3 between MEL and open laminectomy?
  3. What are the potential advantages of the MEL group in enhancing EuroQol 5-Dimension scores?

Doctor’s Tip

A helpful tip a doctor might tell a patient about spinal laminectomy is to discuss with them the potential advantages of a microendoscopic laminectomy (MEL) compared to open laminectomy for upper lumbar levels. Patients should be informed that while the MEL approach may have a lower facet preservation rate, it may still lead to improved postoperative outcomes, such as better EuroQol 5-Dimension scores. It is important for patients to understand the potential benefits and risks associated with each type of surgery in order to make an informed decision about their treatment.

Suitable For

Patients who are typically recommended for spinal laminectomy include those with lumbar spinal stenosis at the upper levels (L1-L2 or L2-L3) who have not responded to conservative treatments such as physical therapy or medication. These patients may experience symptoms such as leg pain, numbness, weakness, and difficulty walking due to compression of the spinal nerves. Additionally, patients with severe spinal stenosis causing significant disability and impairment in quality of life may also be candidates for spinal laminectomy. It is important for patients to undergo a thorough evaluation by a spine specialist to determine if they are appropriate candidates for this surgical procedure.

Timeline

  • Before spinal laminectomy:
  1. Patient experiences symptoms of lumbar spinal stenosis such as lower back pain, leg pain, numbness, and weakness.
  2. Patient undergoes imaging studies such as MRI or CT scans to diagnose the spinal stenosis.
  3. Patient consults with a spine specialist to discuss treatment options, including the possibility of spinal laminectomy.
  • After spinal laminectomy:
  1. Patient undergoes preoperative evaluations and tests to ensure they are healthy enough for surgery.
  2. Patient undergoes spinal laminectomy surgery to relieve pressure on the spinal cord and nerves.
  3. Patient experiences postoperative pain and discomfort, which is managed with medication.
  4. Patient undergoes physical therapy to regain strength and mobility in the back and legs.
  5. Patient gradually resumes normal activities and experiences relief from symptoms of spinal stenosis.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with a spinal laminectomy procedure?
  2. How long is the recovery period after a spinal laminectomy and what can I expect during the recovery process?
  3. Will I need physical therapy or rehabilitation after the surgery?
  4. How long do the effects of a spinal laminectomy typically last?
  5. Are there any alternative treatment options to consider before proceeding with a spinal laminectomy?
  6. How will a spinal laminectomy affect my overall mobility and daily activities?
  7. What is the success rate of spinal laminectomy procedures for patients with my specific condition?
  8. Will I need any additional imaging tests or follow-up appointments after the surgery?
  9. How experienced are you in performing spinal laminectomy procedures and what is your success rate?
  10. Are there any specific lifestyle changes or precautions I should take after a spinal laminectomy to prevent further issues with my spine?

Reference

Authors: Yamato Y, Nagata K, Kawamura N, Higashikawa A, Takeshita Y, Tozawa K, Fukushima M, Urayama D, Ono T, Hara N, Okamoto N, Azuma S, Iwai H, Sugita S, Yoshida Y, Hirai S, Masuda K, Jim Y, Ohtomo N, Nakamoto H, Kato S, Taniguchi Y, Tanaka S, Oshima Y. Journal: World Neurosurg. 2024 Mar;183:e408-e414. doi: 10.1016/j.wneu.2023.12.109. Epub 2023 Dec 23. PMID: 38143029