A COMPARATIVE STUDY OF FUNCTIONAL OUTCOME OF LAMINECTOMY AND LAMINOTOMY FOR THE SURGICAL MANAGEMENT OF LUMBAR SPINE STENOSIS IN SOUTH INDIAN POPULATION

Dr. R. Selvan MS. MCH and *Dr. S. Subikshavarthni MBBS MEM

ABSTRACT

Background: Laminectomy and bilateral laminotomy as a fenestration method have been used to improve pain, neurogenic claudication and neurological impairment in patients with lumbar stenosis. It is not known whether the two surgical procedures have the same effectiveness in management of lumbar canal stenosis. This clinical descriptive study aims to establish if differences exist in functional outcome, as well as disability, in patients undergoing laminectomy or laminotomy surgery for lumbar spinal stenosis. Methods: We conducted a single centre, prospective study of 60 patients undergoing laminectomy or laminotomy surgery for LSS, from June 2016 to 2018. Clinical outcome for back and leg pain were analysed using Oswestry Disability Index (ODI) questionnaires and visual analogue scale (VAS) scores collected preoperatively, at 6 weeks and 6 months. Results: 53% were males (n=32) and 43% were females(n=28) with a mean age of 65.3 years and L4/5 being the level most frequently decompressed. Considering all surgeries, a statistically significant reduction in VAS back pain between pre-op and 6 weeks was seen (P<0.001). There was a significant (P<0.0001) average reductions in LBP and leg pain after six months, with minimal difference between laminectomy and laminotomy. ODI scores significantly improved for laminectomy and laminotomy from pre-op to 6 weeks and six months with no statistically significant difference between groups. Conclusions: Both surgeries were equally effective in improving leg pain and LBP, and disability for a longer period but the use of bilateral laminotomy in lumbar stenosis can provide good surgical outcome comparable to that in laminectomy in short term follow up like in our study at six weeks .On the basis of functional outcomes and disability both are not superior to each other but for a faster recovery and minimal complication laminotomy can be performed.

Keywords: Laminectomy; laminotomy; Visual Analogue Scale.