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ULBD: Unilateral Laminectomy Bilateral
Decompression
August 14, 2015 Upper Chesapeake Medical Center
Mixter and Barr JBJS 1934 was the first description of herniated discs causing sciatica with surgery as a successful treatment
Henk Verbiest1909-1997Dutch neurosurgeon introduced the concept of a developmental spinal stenosis 1940 due to a small AP diameter spinal canal
Red flag Nocturnal
pain Pain at rest Progressive
neurological deficit
Suspicious for cancer or infection
High index of suspicion
H/O cancer Osteoporosis/
steroids/immunosuppression
AS 10/10 Weight loss IVDA UTI/sepsis
Case 1 continued 81 year old man with long h/o L>R LE pain LBP PMH: prostate seeds age 44, HTN SH: retired carpenter EXAM: 6’ 220lb neuro intact
Kleeman, T.J., Hiscoe, A.C., Berg, E.E.: “Patient Outcomes Following Minimally DestabilizingLumbar Stenosis Decompression: The ‘Port Hole’ Technique”, Spine, April 2000.
Toyoda et al. Clinical Outcome of Microsurgical Bilateral Decompression via Unilateral Approach for Lumbar Canal Stenosis. Spine 2011; 36:410-415 Poletti CE. Central Lumbar Stenosis caused by ligamentum flavum unilateral laminectomy for bilateral ligamentectomy. Neurosurgery 1995; 37: 343-347
Prone Position
OSI Jackson Table 1
Slide a Ligamentumflavum
Optimal anatomy
L5S1
L4L5
L3L4
L2L3
L1L2
T12L1
T11T12
85 year old man with LBP and Bilateral sciatica with ambulation thatResolves with sitting
L5S1
L4L5
L4
L3L4
L3
L2L3
L2
81 year old man with long h/o L>R LE pain LBP PMH: prostate seeds age 44, HTN SH: retired carpenter EXAM: 6’ 220lb neuro intact
Case 1
144 single level, korea, Trefoil canal stenosis patients were more difficult to decompression due to angle of approach and patients had worse outcomes
J Neurosurg Spine. 2014 Aug;21(2):179-86. doi: 10.3171/2014.4.SPINE13420. Epub 2014 May 30.
Outcomes after decompressive laminectomy for lumbar spinal stenosis: comparison between minimally invasive unilateral laminectomy for bilateral decompression and open laminectomy: clinical article.
Mobbs RJ1, Li J, Sivabalan P, Raley D, Rao PJ.
79 patients prospective 1:1 ULBD v. open laminectomy, oswestry disability andPatient satisfaction were similar, ULBD had shorter stay 55 h v 100 h, shorter timeTo mobilize 15h v 33 h and more people not requiring opiates 51% v 15%
Neurosurgery. 2006 Dec;59(6):1264-9; discussion 1269-70.Long-term results of microsurgical treatment of lumbar spinal stenosis by
unilateral laminotomy for bilateral decompression.Oertel MF1, Ryang YM, Korinth MC, Gilsbach JM, Rohde V.
133 patients mean fu 5.6 years up to 10 years
Reoperation 11%, 2 instability, 7 restenosis
85% excellent to fair long term results
Dr M F Oertel Department of Neurosurgery, University Hospital, School of Medicine, Aachen University, Pauwelsstrasse 30, 52057 Aachen, Germany
ULBD pitfalls complications Restenosis( contralateral side) Dural tear Nerve injury Instability Persistent pain from facet Pars fracture Inadequate decompression
Normal?
Boden article: JBJS Vol. 72-A, No. 8, Sept 1990
<40 years N=167
<40 years >40 years N=97
>40 years
MAJOR MINORHerniated disc
3% 4% 1% 4%
Bulging disc 0 5% 1% 5%Foraminal stenosis
3% 4% 9% 14%
Disc space narrowing
2% 11% 16% 22%
Degenerative disc
8% 37%
Spurs 3% 14% 6% 34%Abnormal cord
9% 9% 1% 18%
FEATURE CASE: 77 year old woman cc L leg pain LBP s/p previous decompression 2 years ago
Short pedicles developmental/congenital stenosis
Case 2 58 year old man L>R LE pain s/p L L5S1 disc years ago
Case 2 58 year old man L>R LE pain s/p L L5S1 disc years ago
Case 2 58 year old man L>R LE pain s/p L L5S1 disc years ago
Case 2 58 year old man L>R LE pain s/p L L5S1 disc years ago
Case 2 58 year old man L>R LE pain s/p L L5S1 disc years ago
Case 2 58 year old man L>R LE pain s/p L L5S1 disc years ago
Case 3: 84 year old woman with L sciatica
Case 3: 84 year old woman with L sciatica
Case 3: 84 year old woman with L sciatica
Case 3: 84 year old woman with improved LBP postoperatively but worsened L sciatica
Thanks!
