Unilateral and bilateral decompression for lumbar bilateral nerve root canal stenosis with unilateral symptoms: a prospective study

English Keywords:Posterior oblique lumbar arthrodesis  Lumbar spinal stenosis  Decompessive surgery

English Abstract:

  【Abstract】 Objectives: To prospectively assess the outcome of unilateral decompression alone vs bilateral decompression for bilateral nerve root canal stenosis and with unilateral symptoms. Methods: Eighty cases with lumbar bilateral nerve root canal stenosis with unilateral symptoms undergoing posterior oblique lumbar arthrodesis(POLAr) were randomized into a unilateral decompression(group A) or a bilateral decompression group(group B). Both groups were performed POLAr surgery and evaluated by visual analogue scale(VAS) scores at pre-operation and post-operation. Operation time was recorded. The clinical outcomes and complications were evaluated afterwards. Results: All patients received 11 to 30 months′ follow-up, with an average of 18 months. Both groups showed significant improvement on low back pain and leg pain VAS scores at 1, 3, 6 months after the operation and the final follow-up(P<0.05). The rate of satisfactory clinical results was 77.5％ for group A and 92.5％ for group B(P<0.05). There was no incision infection and deep infection in both groups. Five patients in group A suffered from lower limb radicular pain on the contralateral side. One in group A suffered from transient segmental numbness and weakness on the ipsilateral side and recovered by correspondent treatment and neurotrophic therapy for 3 weeks. Four of them relived with epidural blockade on the contralateral side. One of them failed from epidural blockade and recovered after contralateral decompression. Only one patient in group B showed transient segmental numbness and weakness on the ipsilateral side and recovered by correspondent treatment and neurotrophic therapy for 2 weeks after the surgery. The incidence rate of complications was 15.0% for group A and 2.5% for group B(P<0.05). Conclusions: Campared with unilateral decompression of lumbar bilateral nerve root canal stenosis with unilateral symptoms, bilateral decompression is less likely to develop nerve root pain, which has better excellent to good results despite of longer surgical time.