Comparison of bilateral decompression by total laminectomy and fusion with microscopic unilateral approach

Objective: This study aimed to compare the outcomes of microscopic unilateral laminotomy for bilateral decompression (ULYBD) and laminectomy with posterior fusion in patients with lumbar spinal stenosis (LSS). Methods: A retrospective analysis of 123 patients diagnosed with LSS between 2015 and 2022 was conducted. Patients were divided into two groups: Group 1 underwent ULYBD, and Group 2 underwent conventional laminectomy with fusion. Demographic data, surgical parameters (duration, blood loss, transfusion needs), hospital stay, and postoperative outcomes, including Visual Analog Scale (VAS) and Odom's scores, were evaluated. Results: Group 1 had significantly shorter surgical time (134.86 ± 30.99 vs. 225.44 ± 70.22 minutes, p <0.01) and lower blood loss (347.8 ± 141.1 vs. 496.5 ± 254.8 mL, p <0.01) compared to Group 2. Hospital stay and drain retention duration were also significantly reduced in Group 1 (p <0.01). Postoperative VAS and Odom's scores showed significant improvements in both groups (p <0.01); however, no statistically significant differences were observed between the groups in terms of these outcomes at the 12-month follow-up (p> 0.05). Group 1 demonstrated lower transfusion rates and earlier recovery with fewer complications compared to Group 2. Conclusion: ULYBD is a safe and effective alternative to conventional laminectomy with fusion for LSS, offering shorter surgical time, reduced blood loss, and faster recovery. These findings highlight the advantages of minimally invasive techniques in spine surgery. Further prospective studies are warranted to confirm long-term outcomes.