Unilateral laminotomy with bilateral decompression versus standard open bilateral decompression in patients with single-level lumbar spinal stenosis without instability: a single-center retrospective cohort study
- 1epartment of Neurosurgery and Spinal Surgery, University Hospital Olomouc, Olomouc, Czechia
Abstract
Background and purposeDegenerative lumbar spinal stenosis is commonly treated surgically. Standard open bilateral decompression (SOBD) is established, whereas unilateral laminotomy with bilateral decompression (ULBD, “over-the-top”) aims to preserve posterior midline structures and contralateral musculature. We compared 3-year outcomes after ULBD and SOBD in patients with single-level stenosis without instability.Patients and methodsIn this single-center retrospective cohort study, consecutive patients operated between 2017 and 2020 for MRI-confirmed single-level lumbar stenosis without radiological instability were included. The primary outcome was the Oswestry Disability Index (ODI) assessed preoperatively and at 12, 24, and 36 months. Secondary outcomes were operative time, hospital stay, and complications. Between-group comparisons were exploratory and used the Mann–Whitney U test or Fisher's exact test. Longitudinal ODI analysis was limited by substantial missing baseline ODI data.ResultsOf 65 operated patients, 63 were included in the functional outcome analysis: 14 underwent ULBD and 49 underwent SOBD. ULBD patients were older than SOBD patients (mean 59.9 vs. 51.2 years; p = 0.011), while BMI did not differ significantly. Preoperative ODI was available for only 3/14 ULBD and 12/49 SOBD patients. ULBD was associated with shorter operative time (median 60 vs. 80 min; p < 0.001) and shorter hospital stay (median 4 vs. 5 days; p = 0.035). ODI was lower after ULBD at 12 months (median 4 vs. 6; p = 0.049), but not at 24 or 36 months. Complication comparisons were limited by low event numbers.ConclusionIn this retrospective cohort, ULBD was associated with shorter operative time and hospital stay. Postoperative ODI was lower in the ULBD group at 12 months but not at 24 or 36 months. Because of non-randomized treatment allocation, substantial missing baseline ODI data, and the small ULBD cohort, comparative functional superiority cannot be established.
Related
- Clinical Outcomes and Feasibility of Unilateral Biportal Endoscopic Decompression for Thoracic Ossification of the Ligamentum Flavum: A Retrospective Single-Center Study
- Unilateral Biportal Endoscopy Versus Percutaneous Endoscopic Interlaminar Discectomy for Highly Migrated Lumbar Disc Herniation: A Retrospective Comparative Study With Quantitative MRI-Based Decompression Analysis.
- Comparison of unilateral biportal endoscopic decompression and percutaneous endoscopic lumbar decompression for single-segment degenerative lumbar spinal stenosis: a retrospective comparative study involving clinical efficacy and cost analysis
- Comparative clinical and molecular profiling of papillary thyroid carcinomas with unilateral and bilateral lateral lymph node metastasis: a retrospective cohort study.
- Changes in spinopelvic sagittal parameters and functional outcomes after unilateral microscopic decompression for lumbar spinal stenosis
BibTeX
@article{hampl2026unilateral,
title = {{Unilateral laminotomy with bilateral decompression versus standard open bilateral decompression in patients with single-level lumbar spinal stenosis without instability: a single-center retrospective cohort study}},
author = {Martin Hampl and Filip Blazek and Daniel Pohlodek and Matej Halaj and Lumir Hrabalek},
journal = {Frontiers in Surgery},
year = {2026},
month = nov,
doi = {10.3389/fsurg.2026.1928128},
url = {https://doi.org/10.3389/fsurg.2026.1928128},
note = {CC BY},
}
RIS
TY - JOUR
TI - Unilateral laminotomy with bilateral decompression versus standard open bilateral decompression in patients with single-level lumbar spinal stenosis without instability: a single-center retrospective cohort study
AU - Martin Hampl
AU - Filip Blazek
AU - Daniel Pohlodek
AU - Matej Halaj
AU - Lumir Hrabalek
PY - 2026
DA - 2026/11/02
JO - Frontiers in Surgery
DO - 10.3389/fsurg.2026.1928128
UR - https://doi.org/10.3389/fsurg.2026.1928128
AB - Background and purposeDegenerative lumbar spinal stenosis is commonly treated surgically. Standard open bilateral decompression (SOBD) is established, whereas unilateral laminotomy with bilateral decompression (ULBD, “over-the-top”) aims to preserve posterior midline structures and contralateral musculature. We compared 3-year outcomes after ULBD and SOBD in patients with single-level stenosis without instability.Patients and methodsIn this single-center retrospective cohort study, consecutive patients operated between 2017 and 2020 for MRI-confirmed single-level lumbar stenosis without radiological instability were included. The primary outcome was the Oswestry Disability Index (ODI) assessed preoperatively and at 12, 24, and 36 months. Secondary outcomes were operative time, hospital stay, and complications. Between-group comparisons were exploratory and used the Mann–Whitney U test or Fisher's exact test. Longitudinal ODI analysis was limited by substantial missing baseline ODI data.ResultsOf 65 operated patients, 63 were included in the functional outcome analysis: 14 underwent ULBD and 49 underwent SOBD. ULBD patients were older than SOBD patients (mean 59.9 vs. 51.2 years; p = 0.011), while BMI did not differ significantly. Preoperative ODI was available for only 3/14 ULBD and 12/49 SOBD patients. ULBD was associated with shorter operative time (median 60 vs. 80 min; p < 0.001) and shorter hospital stay (median 4 vs. 5 days; p = 0.035). ODI was lower after ULBD at 12 months (median 4 vs. 6; p = 0.049), but not at 24 or 36 months. Complication comparisons were limited by low event numbers.ConclusionIn this retrospective cohort, ULBD was associated with shorter operative time and hospital stay. Postoperative ODI was lower in the ULBD group at 12 months but not at 24 or 36 months. Because of non-randomized treatment allocation, substantial missing baseline ODI data, and the small ULBD cohort, comparative functional superiority cannot be established.
SN - 2296-875X
ER -