Bilateral laminotomy and discectomy for segmental lumbar disc disease. Decompression with stability.

A type of bilateral laminotomy with discectomy for segmental lumbar discogenic disease is presented. The procedure includes wide bilateral decompressive laminotomies and radical partial discectomies, partial V-ostectomy of the adjacent spinous processes, partial facetectomies of the inferior and superior articular processes, and foraminotomies as indicated. One hundred patients who underwent this procedure were evaluated by an independent examiner in follow-up an average of six years postoperatively. The patients were evaluated by utilizing a scale which included back and leg pain relief, restriction of physical activities, analgesic use, and return to work. Seventy patients were graded as good, 12 as fair, and 18 as poor. Preoperative factors which were highly significantly correlated with a good postoperative result included occupation other than heavy labor, present employment or less than 12 months of unemployment, unilateral subjective paresthesias, symptoms of spinal claudication, unilateral restriction of straight leg raising, a positive Cram or bowstring test, the severity of the myelographic defect, elevation of spinal fluid protein, and the severity of the disc pathology noted at surgery. Several other preoperative factors were noted to be of somewhat lesser significance and were correlated with a poor surgical outcome, including job-related injury, compensation or litigation, previous unsuccessful surgery, subjective weakness, calf atrophy, and sensory deficit.