TREATMENT OF LUMBAR SPINAL STENOSIS BY EXTENSIVE UNILATERAL DECOMPRESSION AND CONTRALATERAL AUTOLOGOUS BONE FUSION - OPERATIVE TECHNIQUE AND RESULTS

A new surgical technique for the treatment of lumbar spinal stenosis f eatures extensive unilateral decompression with undercutting of the sp inous process and, to preserve stability, uses contralateral autologou s bone fusion of the spinous processes, laminae, and facets. The opera tion was performed in 29 patients over a 19-month period ending in Dec ember of 1991. All individuals had been unresponsive to conservative t reatment and presented with low-back pain in addition to signs and sym ptoms consistent with neurogenic claudication or radiculopathy. Nine h ad undergone previous lumbar decompressive surgery. The minimum and me an postoperative follow-up times were 2 and 2 1/2 years, respectively. The mean patient age was 64 years; only two patients were younger tha n 50 years of age. Of the patients with neurogenic claudication, 69% r eported complete pain relief at follow-up review. Of those with radicu lar symptoms, 41% had complete relief and 23% had mild residual pain t hat was rated 3 or less on a pain-functionality scale of 0 to 10. For the entire sample, this surgery decreased pain from 9.2 to 3.3 (p < 0. 0001) on the scale. Sixty-nine percent of patients were satisfied with surgery. Low-back pain was significantly relieved in 62% of all patie nts (p < 0.0001). Low-back pain relief correlated negatively with numb er of levels decompressed (p < 0.05). To assess fusion, follow-up flex ion/extension radiographs were obtained, and no motion was detected at the surgically treated levels in any patient. The results suggest tha t this decompression procedure safely and successfully treats not only the radicular symptoms caused by lateral stenosis but also the neurog enic claudication symptoms associated with central stenosis. In additi on, the procedure, by using contralateral autologous bent fusion along the laminae and spinous processes, can preserve stability without ins trumentation.