THE SURGICAL-TREATMENT OF CENTRAL LUMBAR STENOSIS - MULTIPLE LAMINOTOMY COMPARED WITH TOTAL LAMINECTOMY

We assigned 67 patients with central lumbar stenosis alternately to ei ther multiple laminotomy or total laminectomy. The protocol, however, allowed multiple laminotomy to be changed to total laminectomy if it w as thought that the former procedure might not give adequate neural de compression. There were therefore three treatment groups: group I cons isting of 26 patients submitted to multiple laminotomy; group II, 9 pa tients scheduled for laminotomy but submitted to laminectomy; and grou p III, 32 patients scheduled for, and submitted to, laminectomy. The m ean follow-up was 3.7 years. Bilateral laminotomy at two or three leve ls required a longer mean operating time than total laminectomy at an equal number of levels. The mean blood loss at surgery and the clinica l results did not differ in the three groups. The mean subjective impr ovement score for low back pain was higher in group I but there was al so a higher incidence of neural complications in this group. No patien t in group I had postoperative vertebral instability, whereas this occ urred in three patients in groups II and III, who had lumbar scoliosis or degenerative spondylolisthesis preoperatively. Multiple laminotomy is recommended for all patients with developmental stenosis and for t hose with mild to moderate degenerative stenosis or degenerative spond ylolisthesis. Total laminectomy is to be preferred for patients with s evere degenerative stenosis or marked degenerative spondylolisthesis.