engleski

Laminectomy with Augmented Fusion vs.Young Laminoplasty for the Treatment of Degenerative Spinal Stenosis

Variety of less invasive surgical techniques has almost totally replaced laminectomy with augmented fusion due to invasiveness, cost and x-ray exposure. Our aim was comparison between long-term outcomes of Young laminoplasty (YL) as one of the less invasive techniques and laminectomy with posterolateral fusion (LF) augmented with free hand pedicle screw fixation. Patients with neurogenic claudication and lumbar stenosis (LF and YL mean +/- SD dural sac area (mm2) = 53, 96 +/- 8, 39 ; 54, 26 +/- 10, 11 ; p=0, 914) were surgically treated from February 2000 to September 2002 in General Hospital Pula. Outcome was measured as difference in the Oswestry Disability Index (ODI) at 1-year and 7-year follow-up examinations. Duration of surgery, blood loss, incision length, hospital stay and cost were measured. 44 patients out of 56 patients were enrolled. Twenty-six patients were randomized in LF (No=13) and YL (No=13) groups while 18 were allocated in observational LF (No=13) and YL (No=5) cohorts. Significant improvement on 1-year and 7-year follow-up was noticed in LF and YL groups (26, 65, p<0, 001 ; 30, 25, p<0, 001 ; and 16, 05, p<0, 001 ; 28, 78, p<0, 001, respectively). LF ODI was significantly better compared to YL at 7-year follow-up (27, 82 +/- 1, 918 vs. 40, 74 +/- 2, 163 ; p<0, 001). No significant difference was found between the randomized and observational cohorts. There were two dura lacerations in YL group and no revision surgeries in FL group for correction of malpositioned screw. LF is a more invasive and expensive technique but with significantly better long-term outcome. Incremented cost- effectiveness ratio was $153 per one 7-year follow-up ODI grade.

laminectomy; degenerative spinal stenosis; minimally invasive surgery

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