Lumbar Canal Stenosis Decompression Using Bilateral Interlaminar Versus Classic Laminectomy Technique


  • Ehtisham Ahmed Khan Afridi Department of Neurosurgery, Ayub Teaching Hospital, Abbottabad
  • Gohar Ali
  • Mohammad Wasim
  • Aqsa Shahzadi
  • Sidra Asghar



Objective:  The study compared the postoperative back pain VAS score in bilateral interlaminar and classic laminectomy techniques in patients with lumbar canal stenosis.

Material and Methods:  This randomized controlled experiment was carried out at Ayub Teaching Hospital's Neurosurgery Department. 30 patients were in the bilateral interlaminar (BIL) group (A) and 30 were in the traditional laminectomy group (B). The bilateral interlaminar decompression technique was carried out utilizing the operating microscope. Both groups employed facet joint undercutting to reduce the 61-facet joint excision. All patients had postoperative CT scans to assess how well the decompression went. Postoperative VAS score was stratified to age, gender, duration of complaints, and duration of the procedure.

Results:  In group A, the mean age of patients was 51.10 years while in group B, the mean age was 54.500 years. There was a male dominance of male patients in both groups. The baseline mean VAS score was 7.9 in group A and group B both. The duration of the procedure was 71.2 minutes in group A, and 104.7 minutes in group B. Mean postoperative VAS score was 5.4 in group A and 3.3 in group B. There existed a significant difference in mean postoperative VAS scores between groups concerning gender, the duration of complaints, and procedures.

Conclusion:  In patients with lumbar canal stenosis, bilateral interlaminar allows for safe and adequate spinal canal decompression.

Keywords:  Lumbar canal stenosis (LCS), Bilateral Interlaminar (BIL), Classic Laminectomy, Visual Analog Scale (VAS).


Tang C, Moser FG, Reveille J, Bruckel J, Weisman MH. Cauda equina syndrome in ankylosing spondylitis: challenges in diagnosis, management, and pathogenesis. J Rheumatol. 2019;46(12):1582-8.

Glassman DM, Magnusson E, Agel J, Bellabarba C, Bransford RJ. The impact of stenosis and translation on spinal cord injuries in traumatic cervical facet dislocations. Spine J. 2019;19(4):687-94.

Bindal S, Bindal SK, Bindal M, Bindal AK. Noninstrumented lumbar fusion with bone morphogenetic proteins for spinal stenosis with spondylolisthesis in the elderly. World Neurosurg. 2019;126:e1427-35.

Messiah S, Tharian AR, Candido KD, Knezevic NN. Neurogenic claudication: a review of current understanding and treatment options. Curr Pain Headache Rep. 2019;23(5):32.

Urits I, Burshtein A, Sharma M, Testa L, Gold PA, Orhurhu V, et al. Low back pain, a comprehensive review: pathophysiology, diagnosis, and treatment. Curr Pain Headache Rep. 2019;23(3):23.

Bagley C, MacAllister M, Dosselman L, Moreno J, Aoun SG, El Ahmadieh TY. Current concepts and recent advances in understanding and managing lumbar spine stenosis. F1000Res. 2019;8. 79.

Zaina F, Tomkins-Lane C, Carragee E, Negrini S. Surgical versus nonsurgical treatment for lumbar spinal stenosis. Spine. 2016;41(14):E857-68.

Lurie J, Tomkins-Lane C. Management of lumbar spinal stenosis. BMJ. 2016;352:h6234.

Aldahshory AR, Mashaly H, El Molla ST, Ismaiel IA, Saoud K. Comparative study of minimally invasive lumbar decompression versus decompressive laminectomy with posterolateral transpedicular fixation for the treatment of degenerative lumbar canal stenosis. Asian J Neurosurg. 2020;15(2):293-301.

Soliman MAR, Ali A. Decompression of lumbar canal stenosis with a bilateral interlaminar versus classic laminectomy technique: a prospective randomized study. Neurosurg Focus. 2019;46(5):E3.

Watanabe K, Matsumoto M, Ikegami T, Nishiwaki Y, Tsuji T, Ishii K, et al: Reduced postoperative wound pain after lumbar spinous process- splitting laminectomy for lumbar canal stenosis: a randomized controlled study. J Neurosurg Spine. 2011; 14:51–58.

Jayarao M, Chin LS: Results after lumbar decompression with and without discectomy: comparison of the transspinous and conventional approaches. Neurosurgery 66 (3 Suppl Operative). 2010;152–160.

Thomé C, Zevgaridis D, Leheta O, Bäzner H, Pöckler-Schöniger C, Wöhrle J, et al: Outcome after less-invasive decompression of lumbar spinal stenosis: a randomized comparison of unilateral laminotomy, bilateral laminotomy, and laminectomy. J Neurosurg Spine. 2005; 3:129–141.

Tsai RY, Yang RS, Bray RS Jr: Microscopic laminotomies for degenerative lumbar spinal stenosis. J Spinal Disord. 1998;11:389–394.

Postacchini F, Cinotti G, Perugia D, Gumina S: The surgical treatment of central lumbar stenosis. Multiple laminotomy compared with total laminectomy. J Bone Joint Surg Br. 1993; 75:386–392.

Verbiest H: A radicular syndrome from developmental narrowing of the lumbar vertebral canal. J Bone Joint Surg Br. 1954; 36-B:230–237.

Johnsson KE, Redlund-Johnell I, Udén A, Willner S: Preoperative and postoperative instability in lumbar spinal stenosis. Spine (Phila Pa 1976). 1989; 14:591–593.

Abumi K, Panjabi MM, Kramer KM, Duranceau J, Oxland T, Crisco JJ: Biomechanical evaluation of lumbar spinal stability after graded facetectomies. Spine (Phila Pa 1976). 1990; 15:1142–1147.

Lee CK: Lumbar spinal instability (olisthesis) after extensive posterior spinal decompression. Spine (Phila Pa 1976) 8:429–433, 1983.

Natelson SE: The injudicious laminectomy. Spine (Phila Pa 1976). 1986; 11:966–969.

21. Oertel MF, Ryang YM, Korinth MC, Gilsbach JM, Rohde V: Longterm results of microsurgical treatment of lumbar spinal stenosis by unilateral laminotomy for bilateral decompression. Neurosurg. 2006;59:1264– 1270.

Weiner BK, Walker M, Brower RS, McCulloch JA: Microdecompression for lumbar spinal canal stenosis. Spine (Phila Pa 1976). 1999; 24:2268–2272.

Henky J, Yasuda M, Arifin MZ, Takayasu M, Faried A: Trumpet laminectomy microdecompression for lumbal canal stenosis. Asian Spine J. 2014; 8:667–674.

Lin PM: Internal decompression for multiple levels of lumbar spinal stenosis: a technical note. Neurosurgery 11:546–549, 1982 175. Aryanpur J, Ducker T: Multilevel lumbar laminotomies: an alternative to laminectomy in the treatment of lumbar stenosis. Neurosurg. 1990; 26:429– 433.

Nakai O, Ookawa A, Yamaura I: Long-term roentgenographic and functional changes in patients who were treated with wide fenestration for central lumbar stenosis. J Bone Joint Surg Am. 1991; 73:1184–1191.

Grob D, Humke T, Dvorak J: Degenerative lumbar spinal stenosis. Decompression with and without arthrodesis. J Bone Joint Surg Am. 1995; 77:1036–1041.

Yone K, Sakou T: Usefulness of Posner’s definition of spinal instability for selection of surgical treatment for lumbar spinal stenosis. J Spinal Disord. 1999;12:40–44, 1999.

Askar Z, Wardlaw D, Choudhary S, Rege A: A ligamentum flavum- preserving approach to the lumbar spinal canal. Spine (Phila Pa 1976). 2003; 28:E385–E390.

Detwiler PW, Spetzler CB, Taylor SB, Crawford NR, Porter RW, Sonntag VK: Biomechanical comparison of facet-sparing laminectomy and Christmas tree laminectomy. J Neurosurg. 2003; 99 (2 Suppl):214–220.

Kleeman TJ, Hiscoe AC, Berg EE: Patient outcomes after minimally destabilizing lumbar stenosis decompression: the “Port-Hole” technique. Spine (Phila Pa 1976). 2000; 25:865–870.

Postacchini F, Cinotti G, Perugia D, Gumina S: The surgical treatment of central lumbar stenosis. Multiple laminotomy compared with total laminectomy. J Bone Joint Surg Br. 1993; 75:386–392.

Khoo LT, Fessler RG: Microendoscopic decompressive laminotomy for the treatment of lumbar stenosis. Neurosurgery. 2002; 51 (5 Suppl): S146– S154.

Fredman B, Arinzon Z, Zohar E, Shabat S, Jedeikin R, Fidelman ZG, et al: Observations on the safety and efficacy of surgical decompression for lumbar spinal stenosis in geriatric patients. Eur Spine J. 2002; 11:571–574.

Palmer S, Turner R, Palmer R: Bilateral decompression of lumbar spinal stenosis involving a unilateral approach with microscope and tubular retractor system. J Neurosurg. 2002;97 (2 Suppl):213–217.

Amundsen T, Weber H, Lilleås F, Nordal HJ, Abdelnoor M, Magnaes B: Lumbar spinal stenosis. Clinical and radiologic features. Spine (Phila Pa 1976). 1995; 20:1178–1186.

Verbiest H: Results of surgical treatment of idiopathic developmental stenosis of the lumbar vertebral canal. A review of twenty-seven years’ experience. J Bone Joint Surg Br. 1997; 59:181–188.

Silvers HR, Lewis PJ, Asch HL: Decompressive lumbar laminectomy for spinal stenosis. J Neurosurg. 1993; 78:695–701.

Wang JC, Bohlman HH, Riew KD: Dural tears secondary to operations on the lumbar spine. Management and results after a two-year- minimum follow-up of eighty-eight patients. J Bone Joint Surg Am. 1998; 80:1728–1732.

Iguchi T, Kurihara A, Nakayama J, Sato K, Kurosaka M, Yamasaki K: Minimum 10-year outcome of decompressive laminectomy for degenerative lumbar spinal stenosis. Spine (Phila Pa 1976). 2000; 25:1754– 1759.

Young S, Veerapen R, O’Laoire SA: Relief of lumbar canal stenosis using multilevel subarticular fenestrations as an alternative to wide laminectomy: preliminary report. Neurosurg. 1988; 23:628–633.






Original Articles