Comparison of Three Surgical Approaches for the Treatment of Lumbar Spinal Stenosis: Total Laminectomy, Unilateral Approach for Bilateral Decompression, and Total Laminectomy with Posterior Transpedicular Screw Fixation

Introduction: Lumbar spinal stenosis (LSS) is one of the most common diseases for spinal surgery and many surgical techniques are used for treatment. Objective: The aim of this retrospective study was to observe the clinical and radiological results of total laminectomy (TL), unilateral approach for bilateral decompression, and posterior transpedicular fixation-interbody fusion with TL. Materials and Methods: The data of 112 patients who underwent surgical treatment for LSS with different surgical techniques were reviewed retrospectively. The patients were divided into 3 groups according to the surgical technique. In the first group, patients underwent TL, in the second group, patients underwent bilateral decompression via unilateral hemilaminectomy, and in the third group, patients underwent posterior transpedicular fixation-interbody fusion with TL. Preoperative and postoperative evaluations were done by visual analog scale (VAS) and functional back pain scales (FBPSs). Furthermore, three groups were compared in respect of operation time, bleeding, and complications. Results: The difference between preoperative and postoperative VAS and FBPS scores were statistically significant in all groups. Operation time, bleeding, and hospital stay were greater in fusion group than decompression-alone groups. The VAS improvement rate was 66%, 70%, and 62% in Group 1, Group 2, and Group 3, respectively. In addition, improvement of FBPS scores between preoperative and postoperative period was statistically significant for the three groups (P < 0.05). Conclusion: Decompression with fusion surgery had no significant difference compared with decompression alone in patient's clinical outcome and safety.