Surgery of Spinal Stenosis in Elderly Patients: Bilateral Canal Widening through Unilateral Approach.

Cho, Jin Mo; Yoon, Seung Hwan; Park, Hyung Chun; Park, Hyeon Seon; Kim, Eun Young; Ha, Yoon

Original Article

Journal of Korean Neurosurgical Society 2004;35(5): 492-497.

Jin Mo Cho, Seung Hwan Yoon, Hyung Chun Park, Hyeon Seon Park, Eun Young Kim, Yoon Ha

Department of Neurosurgery, Inha University Hospital, Inha University, Medical College, Incheon, Korea.

ABSTRACT

OBJECTIVE
We report an outcome of surgical treatment of the elderly patients with spinal stenosis, managed by a bilateral narrowed spinal canal widening technique through unilateral approach. METHODS: The operations were performed in 16 patients who diagnosed with spinal stenosis. All individuals had been presented with low-back pain, neurogenic claudication or radiculopathy and unresponsive to conservative treatment over six months. We perfomed hemi-laminectomy at the appropriate levels on the most symptomatic side preserving the facet joint. And the ligamentum flavum, as well as the cortical bone on the ventral surface of the contralateral laminae were removed. The spinous process was left as possible as we can, and the contralateral side of the spinal canal was decompressed completely. RESULTS: The mean age of the patients was 71 years. The mean operation time was 73 minutes. Despite of old age, the patients were able to walk in three days after the surgery. The significant pain scale improvement(7.73 to 2.68) and widening of the spinal canal diameter(7.60+/-1.75 to 17.77+/-1.47mm) were noted after the operation. No patient was presented spinal instability on their follow-up period over 24 months. CONCLUSION: The bilateral canal widening technique through the unilateral approach, minimizes the damage to the inter-spinous ligament and the inter-spinous muscle, and saves the operation time because it is not necessary to use the instruments which prevent spinal instability, despite spinal canal was sufficiently enlarged.

Key Words: Spinal stenosis; Neurogenic claudication; Radiculopathy; Spinal instability; Bilateral canal widening technique