Unilateral Laminectomy Bilateral Decompression as a minimally invasive spinal option for lumbar decompression surgery

1. ULBD: Unilateral
Laminectomy Bilateral
Decompression
 August 14, 2015
 Upper Chesapeake Medical Center

6. xter and Barr JBJS 1934
s the first description of
rniated discs causing
atica with surgery as a
ccessful treatment

7. Henk Verbiest
1909-1997
Dutch neurosurgeon
introduced the
concept of a
developmental spinal
stenosis 1940 due to
a small AP diameter
spinal canal

13. Red flag
 Nocturnal pain
 Pain at rest
 Progressive
neurological
deficit
 Suspicious for
cancer or
infection

14. High index of
suspicion
 H/O cancer
 Osteoporosis/steroids
/immunosuppression
 AS
 10/10
 Weight loss
 IVDA
 UTI/sepsis

16. Case 1 continued 81 year old man with long h/o L>R LE pain LBP PMH: prostate
seeds age 44, HTN SH: retired carpenter EXAM: 6’ 220lb neuro intact

25. Kleeman, T.J., Hiscoe, A.C., Berg, E.E.: “Patient Outcomes
Following Minimally Destabilizing
Lumbar Stenosis Decompression: The ‘Port Hole’ Technique”,
Spine, April 2000.

27. Toyoda et al. Clinical Outcome of Microsurgical Bilateral Decompression via Unilateral Approach
for Lumbar Canal Stenosis. Spine 2011; 36:410-415
Poletti CE. Central Lumbar Stenosis caused by ligamentum flavum unilateral laminectomy for
bilateral ligamentectomy. Neurosurgery 1995; 37: 343-347

32. Prone Position

33. OSI Jackson Table 1

39. Slide a
Ligamentum
flavum

40. Optimal anatomy

41. L5S1

42. L4L5

43. L3L4

44. L2L3

45. L1L2

46. T12L1

47. T11T12

48. 85 year old man
with LBP and
Bilateral sciatica
with ambulation that
Resolves with sitting

50. L5S1

51. L4L5

52. L4

53. L3L4

54. L3

55. L2L3

56. L2

58. 81 year old man with long h/o L>R LE pain LBP PMH: prostate seeds age 44,
HTN SH: retired carpenter EXAM: 6’ 220lb neuro intact
Case 1

59. 144 single level, korea, Trefoil canal stenosis patients were more difficult to
decompression due to angle of approach and patients had worse outcomes

62.  J Neurosurg Spine. 2014 Aug;21(2):179-86. doi: 10.3171/2014.4.SPINE13420. Epub
2014 May 30.
 Outcomes after decompressive laminectomy for lumbar spinal stenosis: comparison
between minimally invasive unilateral laminectomy for bilateral decompression and
open laminectomy: clinical article.
 Mobbs RJ1, Li J, Sivabalan P, Raley D, Rao PJ.
79 patients prospective 1:1 ULBD v. open laminectomy, oswestry disability and
Patient satisfaction were similar, ULBD had shorter stay 55 h v 100 h, shorter
time
To mobilize 15h v 33 h and more people not requiring opiates 51% v 15%

63. Neurosurgery. 2006 Dec;59(6):1264-9; discussion 1269-70.
Long-term results of microsurgical treatment of lumbar spinal stenosis by unilateral
laminotomy for bilateral decompression.
Oertel MF1, Ryang YM, Korinth MC, Gilsbach JM, Rohde V.
 133 patients mean fu 5.6 years up to 10
years
 Reoperation 11%, 2 instability, 7
restenosis
 85% excellent to fair long term results
Dr M F Oertel Department of Neurosurgery, University Hospital, School of
Medicine, Aachen University, Pauwelsstrasse 30, 52057 Aachen, Germany

64. ULBD pitfalls complications
 Restenosis( contralateral side)
 Dural tear
 Nerve injury
 Instability
 Persistent pain from facet
 Pars fracture
 Inadequate decompression

65. Normal?
 Boden article: JBJS Vol. 72-A,
No. 8, Sept 1990
<40 years
N=167
<40 years >40 years
N=97
>40 years
MAJOR MINOR
Herniated
disc
3% 4% 1% 4%
Bulging disc 0 5% 1% 5%
Foraminal
stenosis
3% 4% 9% 14%
Disc space
narrowing
2% 11% 16% 22%
Degenerative
disc
8% 37%
Spurs 3% 14% 6% 34%
Abnormal
cord
9% 9% 1% 18%

66. FEATURE CASE:
77 year old woman cc L leg
pain LBP s/p previous
decompression 2 years ago

71. Short pedicles developmental/congenital stenosis

72. Case 2 58 year old man L>R LE pain s/p L
L5S1 disc years ago

73. Case 2 58 year old man L>R LE pain s/p L
L5S1 disc years ago

74. Case 2 58 year old man L>R LE pain s/p L
L5S1 disc years ago

75. Case 2 58 year old man L>R LE pain s/p L
L5S1 disc years ago

76. Case 2 58 year old man L>R LE pain s/p L
L5S1 disc years ago

77. Case 2 58 year old man L>R LE pain s/p L
L5S1 disc years ago

79. Case 3: 84 year old woman with L sciatica

80. Case 3: 84 year old woman with L sciatica

81. Case 3: 84 year old woman with L sciatica

83. Case 3: 84 year old woman with improved LBP
postoperatively but worsened L sciatica

86. Thanks!