The comparison study of laminectomy with unilateral and bilateral pedicle screws fixation and laminectomy alone without fusion interbody in young patients with lumbar spinal stenosis: A randomized clinical trial.

Background: There are many reports about the risk factors for recurrence after laminectomy surgery. Some surgeons use unilateral and bilateral fusion to provide sufficient stability to the lumbar spine. However, its strength, safety, and effectiveness in young patients are not widely known. Therefore, this study was conducted to compare surgical methods of laminectomy with unilateral and bilateral fixation and laminectomy alone without interbody fusion in young patients with lumbar spinal stenosis.

Methods: 90 patients eligible for lumbar spinal stenosis surgery were selected through convenience sampling and randomly divided into three groups: laminectomy without fixation (A), laminectomy with unilateral fixation (B), and bilateral fixation (C). Pain, functional disability, quality of life, recurrent disc, adjacent segment disease (ASD), and fusion rate were evaluated and compared among the three groups six months post-surgery. The data were analyzed using SPSS version 16.

Results: Six months after surgery, the mean score of functional disability in the bilateral group was significantly higher than the other groups (12.92 (3.30) vs 5.52 (1.91) and 4.30 (1.84), P < 0.05). Also, the highest mean score of pain after surgery was observed in the bilateral group (4.33 (0.70) vs 1.81(0.68) and 1.63(0.56), P < 0.05). The mean score of quality of life in the unilateral group was significantly higher than the other groups (87.81 (5.67) vs 68.58 (3.08) and 56.07 (4.04), P < 0.05). No significant difference was observed between the groups (P > 0.05) regarding fusion, recurrent disc herniation, and adjacent segment disease.

Conclusions: Unilateral fixation provides the same benefits as bilateral fixation but has the additional benefits of being less invasive and minimizing the disadvantages of other investigated techniques during and after surgery.