BACKGROUND:
In 1981, we developed a technique of expansive lumbar laminoplasty to
alleviate the problems of conventional laminectomy in the treatment of spinal
stenosis. The purposes of this study were to assess the long-term outcome
following expansive lumbar laminoplasty and to investigate the postoperative
problems.
METHODS:
Fifty-four patients underwent expansive lumbar laminoplasty for the
treatment of spinal stenosis. There were forty-three men and eleven women with
a mean age of 52.6 years. The average length of follow-up was 5.5 years.
Preoperatively, twenty-five patients had degenerative stenosis; thirteen,
stenosis due to spondylolisthesis; twelve, combined stenosis (disc herniation
and stenosis); and six, hyperostotic stenosis. (Two patients with hyperostotic
stenosis and spondylolisthesis were included in both groups.) The clinical
results were assessed with use of the Japanese Orthopaedic Association score,
and the rate of recovery was calculated. Radiographic findings were analyzed
on the basis of the cross-sectional area of the spinal canal, kyphosis, range
of motion of the lumbar spine, and the rate of interlaminar fusion.
RESULTS:
The average recovery rate at the time of the last follow-up was 69.2% for
patients with degenerative stenosis, 66.5% for patients with combined
stenosis, 65.2% for those with hyperostotic stenosis, and 54.7% for those with
spondylolisthesis. The factors resulting in a poor recovery were an older age
and insufficient decompression of the lateral stenosis. During the follow-up
period, the Japanese Orthopaedic Association score became worse for seven
patients, six patients had lesions develop at the level adjacent to the
laminoplasty, and five patients had spondylolisthesis develop. Interlaminar
fusion was observed in twenty-two patients (41%).
CONCLUSIONS:
The satisfactory results of expansive lumbar laminoplasty were maintained
at an average of 5.5 years after surgery. The best indications for the lumbar
laminoplasty procedure were young and active patients with central spinal
stenosis.