Two Different Minimally Invasive Approaches for Management of Thoracolumbar Fractures

Abstract Objective To compare the clinical effect and safety of pedicle screw fixation via percutaneous approach and Wiltse paraspinal approach for thoracolumbar fractures without neurological deficit.Methods 98 cases who suffered from single level thoracolumbar fracture without nerve injury were treated by pedicle screws fixation via either percutaneous approach (percutaneous group) and Wiltse paraspinal approach(paraspinal group). Perioperative indexes, imaging parameters and functional and symptom results of the two groups were recorded and compared. Results All patients were followed for more than 12 months, and the incision length and postoperative hospital stay in the percutaneous group were significantly shorter than those in the paraspinal group (P<0.05), intraoperative blood loss was less than that of the paraspinal group (P<0.05), operative and postoperative costs and the number of fluoroscopy were significantly higher than those of the paraspinal group (P<0.05). There was no significant difference in operative time between the two groups (P > 0.05). The anterior edge height percentage of the injured vertebrae and kyphosis Cobb Angle were significantly improved 1 week and 1 year postoperatively in each group (P<0.05), there was no statistical difference between the two groups (P<0.05). As for Visual Analog Scale (VAS) scores, in each group there were continuous decreases 3 days, 6 months, and 1 year postoperatively (P<0.05); There were no statistically significant differences between the two groups before operation, 6 months and 1 year postoperatively (P<0.05), but a significant difference 3 days postoperatively (P<0.05). In terms of Oswestry disability index (ODI), in each group there was continuous decreases 6 months and 1 year postoperatively (P<0.05); and there was no significant difference between the two groups (P<0.05).There was no significant difference in the accuracy of implant between the two groups (P<0.05). In the percutaneous group, there were 2 cases of incision fat liquefaction, 1 case of guidewire fracture and 1 case of the anterior wall of the vertebra penetrated by guide wire rupture. 1 diabetic case of superficial incision infection and 2 cases of skin edge necrosis were found in the paraspinal group.Conclusion In the treatment of thoracolumbar fractures without neurological defect, pedicle screw fixations via Wiltse paraspinal and percutaneous approach both can obtain minimally invasive and reliable effect, but the percutaneous approach bring smaller trauma, less blood loss, longer operation time, more fluroscopy, higher surgery and postoperative costs, with its own unique complications especially in early learning curve.

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Is It Necessary to Reduce Thoracolumbar Compression Fractures with Intermediate Screws in the Fractured Vertebra?

10.21203/rs.3.rs-542387/v1 ◽

2021 ◽

Author(s):

ZeJun Xing ◽

Shuai Hao ◽

XiaoFei Wu

Keyword(s):

Blood Loss ◽

Body Height ◽

Pedicle Screws ◽

Operation Time ◽

Short Segment ◽

Compression Fractures ◽

Significant Difference ◽

Before And After ◽

Screw Group

Abstract PurposeTo compare the efficacy and safety of percutaneous short-segment pedicle screws fixation (PPSF) with or without intermediate screws (IS) for the treatment of thoracolumbar compression fractures.MethodsFrom January 2016 to March 2019, a retrospective study of 38 patients with thoracolumbar compression fractures conducted. The patients were divided into a 4-screw group (without IS) and a 6-screw group (with IS) according to whether pedicle screws were placed in the fractured vertebrae. Combined positional reduction effects with the technique of pre-contoured lordotic rods were used to reduce the fracture by lengthening the anterior column of the fractured vertebrae. The posterior structure of the fractured vertebrae was undertaken as the fulcrum point for both groups. The operation time, intra-operative blood loss, visual analogue scale (VAS), anterior vertebral body height (AVBH), segment kyphosis（SK）before and after operation and complications were recorded.ResultsAlthough the operation time and blood loss in the 6-screw group were higher than in the 4-screw group, difference was not significant (P＞0.05). There was no significant difference in VAS, AVBH and SK between the two groups (P＞0.05). Nevertheless, these results were significant differences between the preoperative and the immediate postoperative, between preoperative and follow-up groups (P < 0.001). No neurologic injury was observed in either groups. ConclusionsIn the treatment of thoracolumbar compression fractures, percutaneous short-segment pedicle screws fixation without intermediate screws in the 4-screw construct may obtain the same clinical effect as that in the 6-screw construct.

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Which of MIS-TLIF and TLIF Can Leads to Better Pedicle Screws Placement Accuracy and Clinical Outcomes with Navigation Guidance?

10.21203/rs.3.rs-558088/v1 ◽

2021 ◽

Author(s):

JiaBin Liu ◽

JunLong Wu ◽

Rui Zuo ◽

ChangQing Li ◽

Chao Zhang ◽

...

Keyword(s):

Minimally Invasive ◽

Pedicle Screw ◽

Pedicle Screws ◽

Entry Point ◽

Screw Placement ◽

Transfusion Rate ◽

Pedicle Screw Placement ◽

Multifidus Muscle ◽

Lower Accuracy ◽

Significant Difference

Abstract Background Although previous studies have suggested that navigation can improve the accuracy of pedicle screw placement, there are still few studies comparing navigation-assisted transforaminal lumbar interbody fusion (TLIF) and navigation-assisted minimally-invasive TLIF (MIS-TLIF). The pedicle screw insertion entry point of navigation-assisted MIS-TLIF may be deflected from the planned entry point due to uneven bone-surface, which may result in misplacement. The purpose of this study was to explore the pedicle screws accuracy and clinical consequences of MIS-TLIF and TLIF both under O-arm navigation to determine which surgical method is better.MethodsA retrospective study of 54 patients who underwent single-segment navigation-assisted MIS-TLIF (NM-TLIF) or navigation-assisted TLIF (N-TLIF) was conducted. In addition to the patient's demographic characteristics, intraoperative indicators and complications, the ODI and VAS scores were recorded and analyzed preoperatively, at 1, 6, 12 months and at the final follow-up postoperatively. The clinical accuracy and absolute accuracy of pedicle screw placement was assessed by postoperative CT. Multifidus muscle injury were evaluated by T2-weighted MRI.ResultsCompared with N-TLIF, NM-TLIF was more advantageous in the incision length, intraoperative blood loss, drainage volume, time before ambulation, length of hospital stays, blood transfusion rate and analgesia rate (p<0.05). The ODI and VAS for low back pain scores were better than those of N-TLIF at 1 month and 6 months after surgery (p<0.05). There was no significant difference in the screw clinical qualitative accuracy (97.3% vs. 96.2%, p>0.05). The absolute quantitative accuracy results show that the axial translational error, sagittal translational error and sagittal angle error of NM-TLIF group are significantly greater than that in N-TLIF group (P<0.05). The mean T2-weighted signal intensity of multifidus muscle in the NM-TLIF group was significantly lower than that in the N-TLIF group (P<0.05)ConclusionsCompared with N-TLIF, NM-TLIF has more minimally invasive advantages, it does not yield a lower accuracy of screw placement and can achieve better symptom relief in the middle stage of postoperative recovery. However，more attention on real-time adjustment should be paid to pedicle insertion in NM-TLIF, rather than just following the entry point and trajectory of the intraoperative plan.

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Placement of percutaneous pedicle screws without imaging guidance

Neurosurgical FOCUS ◽

10.3171/foc.2006.20.3.4 ◽

2006 ◽

Vol 20 (3) ◽

pp. 1-6 ◽

Cited By ~ 29

Author(s):

Ciaran J. Powers ◽

Vinod K. Podichetty ◽

Robert E. Isaacs

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Pedicle Screw ◽

Spine Surgery ◽

Spinal Canal ◽

Pedicle Screws ◽

Degenerative Disease ◽

Imaging Guidance ◽

Intraoperative Fluoroscopy ◽

Minimally Invasive Spine

✓ Pedicle screw (PS) instrumentation provides an exceptionally rigid construct to promote fusion in cases of spinal trauma and degenerative disease. Although the safety of traditional open techniques for PS placement has been well documented, there are no large series in the literature in which the safety of percutaneously placed PSs has been examined. Because the advantages of minimally invasive spine surgery are becoming more widely recognized, especially in regard to the lessening of morbidity caused by pain and blood loss, there will be a greater demand for spine surgeons to place PSs percutaneously. During a 2-year period, the authors placed 287 PSs percutaneously with the aid of intraoperative fluoroscopy. Only one of these screws was later found to have breached the spinal canal, yielding a breach rate of 0.35% for percutaneously placed PSs (one of 287).

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Minimally invasive lateral corpectomy for thoracolumbar traumatic burst fractures

Neurosurgical FOCUS ◽

10.3171/2020.6.focus20366 ◽

2020 ◽

Vol 49 (3) ◽

pp. E12

Author(s):

Adam G. Podet ◽

Kevin D. Morrow ◽

Jared M. Robichaux ◽

Jessica A. Shields ◽

Anthony M. DiGiorgio ◽

...

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Operative Time ◽

Thoracolumbar Spine ◽

Tube Placement ◽

Control Group ◽

Thoracolumbar Fractures ◽

Burst Fractures ◽

Estimated Blood Loss ◽

Significant Difference

OBJECTIVEThe need for anterior column reconstruction after thoracolumbar burst fractures remains controversial. Here, the authors present their experience with minimally invasive lateral thoracolumbar corpectomies for traumatic fractures.METHODSBetween 2012 and 2019, 59 patients with 65 thoracolumbar fractures underwent 65 minimally invasive lateral corpectomies (MIS group). This group was compared to 16 patients with single-level thoracolumbar fractures who had undergone open lateral corpectomies with the assistance of general surgery between 2007 and 2011 (open control group). Comparisons of the two groups were made with regard to operative time, estimated blood loss, time to ambulation, and fusion rates at 1 year postoperatively. The authors further analyzed the MIS group with regard to injury mechanism, fracture characteristics, neurological outcome, and complications.RESULTSPatients in the MIS group had a significantly shorter mean operative time (228.3 ± 27.9 vs 255.6 ± 34.1 minutes, p = 0.001) and significantly shorter mean time to ambulation after surgery (1.8 ± 1.1 vs 5.0 ± 0.8 days, p < 0.001) than the open corpectomy group. Mean estimated blood loss did not differ significantly between the two groups, though the MIS group did trend toward a lower mean blood loss. There was no significant difference in fusion status at 1 year between the MIS and open groups; however, this comparison was limited by poor follow-up, with only 32 of 59 patients (54.2%) in the MIS group and 8 of 16 (50%) in the open group having available imaging at 1 year. Complications in the MIS group included 1 screw misplacement requiring revision, 2 postoperative femoral neuropathies (one of which improved), 1 return to surgery for inadequate posterior decompression, 4 pneumothoraces requiring chest tube placement, and 1 posterior wound infection. The rate of revision surgery for the failure of fusion in the MIS group was 1.7% (1 of 59 patients).CONCLUSIONSThe minimally invasive lateral thoracolumbar corpectomy approach for traumatic fractures appears to be relatively safe and may result in shorter operative times and quicker mobilization as compared to those with open techniques. This should be considered as a treatment option for thoracolumbar spine fractures.

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Comparison of unilateral and bilateral polymethylmethacrylate-augmented cannulated pedicle screw fixation for the management of lumbar spondylolisthesis with osteoporosis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01975-1 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Yao-yao Liu ◽

Jun Xiao ◽

Huai-jian Jin ◽

Zhong Wang ◽

Xiang Yin ◽

...

Keyword(s):

Blood Loss ◽

Pedicle Screw ◽

Pedicle Screws ◽

Operation Time ◽

Cerebrospinal Fluid Leakage ◽

Posterior Fixation ◽

Screw Loosening ◽

Superficial Infection ◽

Lumbar Degenerative Disease ◽

Lumbar Spondylolisthesis

Abstract Background Cannulated pedicle screw (CPS) augmented by polymethylmethacrylate (PMMA) can achieve satisfactory clinical efficacy in the treatment of lumbar spondylolisthesis with osteoporosis. However, accurate application of CPSs will help to avoid the difficulty of screw revision and reduce the incidence of PMMA-related complications. This study aimed to investigate the mid-term efficacy of CPS compared to unilateral and bilateral applications in this common lumbar degenerative disease. Methods May 2011 and May 2018, 50 patients with lumbar spondylolisthesis with osteoporosis who underwent posterior fixation and fusion using traditional pedicle screws or CPSs were included in the study. Patients were divided into two groups based on the application: the unilateral PMMA-augmented CPS group (UC, n = 29) and the bilateral PMMA-augmented CPS group (BC, n = 21). Operation time, blood loss, average hospitalization time, PMMA leakage, and other complications were recorded. The visual analog scale (VAS) and Oswestry disability index (ODI) scores were used to evaluate symptom recovery. Radiographic results were compared for intervertebral fusion and screw loosening. Results There were no significant differences in the baseline data of the two groups. The VAS and ODI scores improved significantly after surgery (P < 0.05), with no significant differences between the groups (P > 0.05). The operation time and blood loss in the UC group were significantly lower than those in the BC group (P < 0.05). However, the loss of intervertebral disk height and Taillard index did not differ significantly between the groups. The rates of PMMA leakage in the UC and BC groups were 7.0% and 11.9%, respectively (P < 0.05). Bony fusion was achieved in all groups without screw loosening at the last follow-up. Only one patient experienced superficial infection in both groups, while cerebrospinal fluid leakage was observed in two patients in the BC group. Conclusions Unilateral application of PMMA-augmented CPS may provide adequate clinical safety and effectiveness in the surgical treatment of lumbar spondylolisthesis with osteoporosis.

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Comparison of posterior open screw fixation with percutaneous fixation among traumatic thoracolumbar fracture patients.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.07.4466 ◽

2020 ◽

Vol 27 (07) ◽

pp. 1482-1487

Author(s):

Muhammad Adnan ◽

Muhammad Jahangir Khan ◽

Attique ur Rehman ◽

Hassaan Zahid ◽

Rakhshanda Jabbar ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Pedicle Screw ◽

Screw Fixation ◽

Operation Time ◽

Pedicle Screw Fixation ◽

Percutaneous Fixation ◽

Thoracolumbar Fractures ◽

Screw Malpositioning ◽

Hospital Stay Duration

Objectives: To compare outcome and adverse events of open posterior pedicle screw fixation with percutaneous posterior pedicle screw fixation among patients suffering traumatic thoracolumbar fractures in our population. Study Design: Retrospectively Analyzed. Setting: Department of Neurosurgery, DHQ Teaching hospital, Gujranwala. Period: June 2015 to May 2019. Material & Methods: The patients who underwent open pedicle screw fixation (group 1) and percutaneous fixation (group 2) for traumatic thoracolumbar fractures information’s collected included patient’s age, gender, operation time, intra-operative blood loss, duration of radiation exposure during surgery, hospital stay duration, non-union at 6months and post-operative screw malpositioning and infection. Statistical analysis was done using SPSS version 25. Independent sample T test and Chi-square test for independence were used for quantitative and qualitative variables respectively to determine their significant association with type of surgery. The p values were statistically significant if < 0.05. Results: Out of 82 patients, 60.9 (n=50) underwent open pedicle screw surgery and 39.1% (n=32) underwent percutaneous fixation. Both cohorts had similar preoperative data including age (p=0.54) and gender (p=0.505). In comparison to open surgery group, the patients who underwent percutaneous fixation had significantly lesser operation time (46.63 + 6.25 minutes vs 89.88 + 9.05 minutes, p<0.01), lesser intraoperative blood loss (78.75 + 23.93 ml vs 330.40 + 101.87ml, p<0.01), greater intraoperative fluoroscopic exposure time (400.19 + 31.22 seconds vs 190.06 + 30.28 seconds, p<0.01), and lesser hospital stay time (3.13 + 0.871 days vs 5.08 + 1.209days, p<0.01). The incidence of post-surgery complications like screw malpositioning (p=0.621) and infection (p=0.733) was similar in both cohorts. The fracture union rates were also comparable in both cohorts (p=0.664). Conclusion: Minimally inavsive percutaneous posterior pedicle screw fixation had lesser operation time, blood loss, and hospital stay duration and greater fluoroscopic exposure than conventional open posterior pedicle screw fixation among patients with traumatic thoracolumbar fractures in our studied population. It also had a similar radilogic outcome and post-operative adverse events like screw malpositioning and local infection, showing the non-inferiority as compared to conventional open instrumentation. Prospective trials with large sample size are required to find superiority if any of one modality over other exists in our people.

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Comparison of Hidden Blood Loss Between Cortical Bone Trajectory Screw Fixation and Traditional Pedicle Screw Fixation

10.21203/rs.3.rs-422796/v1 ◽

2021 ◽

Author(s):

Xinli Hu ◽

Chenyu Wu ◽

Cong Xu ◽

Kailiang Zhou ◽

Xiaobin Li ◽

...

Keyword(s):

Blood Loss ◽

Pedicle Screw ◽

Screw Fixation ◽

Lumbar Fusion ◽

Operation Time ◽

Total Blood ◽

Fusion Surgery ◽

Lumbar Fusion Surgery ◽

Hidden Blood Loss ◽

Significant Difference

Abstract Objective: This research aimed at examining the volume of hidden blood loss (HBL) in lumbar fusion surgery with two kinds of screw implanting techniques and evaluating HBL-related factors in the patient population receiving lumbar fusion surgeryMethods: A retrospective study was conducted targeting 104 patients with lumbar degenerative diseases and treated with TLIF from January 2017 to December 2018, and the CBT (cortical bone trajectory) technique and conventional PS (pedicle screw) technique were applied to 45 and 59 patients, respectively. The collected data covered patients’ weight, height, BMI index, and operation time. It was followed by the recording of preoperative and postoperative hematocrit (HCT) of patients, based on which the blood loss was calculated by Gross’s formula. Results: The CBT and PS groups presented no significant difference in demographic characteristics (p > 0. 05), but the average HBL of 280±227 mL and 298±232 mL as well as the average TBL of 603±232 mL and 728±321 mL, respectively. It indicated the difference of the two groups in TBL, but no significant difference in HBL. In addition, an association of HBL of two screw techniques with operation time, concomitant disease and age was found from the data analysis.Conclusion: Large total blood loss incurred in lumbar fusion surgery, specifically with a lower value by the CBT technique than by the PS technique. Nonetheless, HBL occupied a large part of the total blood loss and it was identified in both groups. Thus, a good understanding of HBL will improve postoperative rehabilitation and guarantee patients’ safety.

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Comparison of unilateral and bilateral polymethylmethacrylate-augmented cannulated pedicle screw fixation for the management of lumbar spondylolisthesis with osteoporosis

10.21203/rs.3.rs-46176/v2 ◽

2020 ◽

Author(s):

Yao-yao Liu ◽

Jun Xiao ◽

Huai-jian Jin ◽

Zhong Wang ◽

Xiang Yin ◽

...

Keyword(s):

Blood Loss ◽

Pedicle Screw ◽

Pedicle Screws ◽

Operation Time ◽

Cerebrospinal Fluid Leakage ◽

Posterior Fixation ◽

Screw Loosening ◽

Superficial Infection ◽

Intervertebral Disc Height ◽

Lumbar Spondylolisthesis

Abstract Background: Cannulated pedicle screw (CPS) augmented by polymethylmethacrylate (PMMA) can achieve satisfactory clinical efficacy in the treatment of lumbar spondylolisthesis with osteoporosis. However, accurate application of CPSs will help to avoid the difficulty of screw revision and reduce the incidence of PMMA-related complications. This study aimed to investigate the mid-term efficacy of CPS compared to unilateral and bilateral applications in this common lumbar degenerative disease.Methods: Between May 2011 and May 2018, 50 patients with lumbar spondylolisthesis with osteoporosis who underwent posterior fixation and fusion using traditional pedicle screws or CPSs were included in the study. Patients were divided into two groups based on the application: the unilateral PMMA-augmented CPS group (UC, n = 29) and the bilateral PMMA-augmented CPS group (BC, n = 21). Operation time, blood loss, average hospitalization time, PMMA leakage, and other complications were recorded. The Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores were used to evaluate symptom recovery. Radiographic results were compared for intervertebral fusion and screw loosening.Results: There were no significant differences in the baseline data of the two groups.The VAS and ODI scores improved significantly after surgery (P < 0.05), with no significant differences between the groups (P > 0.05). The operation time and blood loss in the UC group were significantly lower than those in the BC group (P < 0.05). However, the loss of intervertebral disc height and Taillard index did not differ significantly between the groups. The rates of PMMA leakage in the UC and BC groups were 7.0% and 11.9%, respectively (P < 0.05). Bony fusion was achieved in all groups without screw loosening at the last follow-up. Only one patient experienced superficial infection in both groups, while cerebrospinal fluid leakage was observed in two patients in the BC group.Conclusions: Unilateral application of PMMA-augmented CPS may provide adequate clinical safety and effectiveness in the surgical treatment of lumbar spondylolisthesis with osteoporosis.

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Efficacy evaluation of three-dimensional printing assisted osteotomy guide plate in accurate osteotomy of adolescent cubitus varus deformity

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1403-7 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 3

Author(s):

Yuan-Wei Zhang ◽

Xin Xiao ◽

Wen-Cheng Gao ◽

Yan Xiao ◽

Su-Li Zhang ◽

...

Keyword(s):

3D Printing ◽

Blood Loss ◽

Three Dimensional ◽

Operation Time ◽

Varus Deformity ◽

Conventional Group ◽

Intraoperative Blood Loss ◽

Cubitus Varus ◽

Guide Plate ◽

Significant Difference

Abstract Background This present study is aimed to retrospectively assess the efficacy of three-dimensional (3D) printing assisted osteotomy guide plate in accurate osteotomy of adolescent cubitus varus deformity. Material and methods Twenty-five patients (15 males and 10 females) with the cubitus varus deformity from June 2014 to December 2017 were included in this study and were enrolled into the conventional group (n = 11) and 3D printing group (n = 14) according to the different surgical approaches. The operation time, intraoperative blood loss, osteotomy degrees, osteotomy end union time, and postoperative complications between the two groups were observed and recorded. Results Compared with the conventional group, the 3D printing group has the advantages of shorter operation time, less intraoperative blood loss, higher rate of excellent correction, and higher rate of the parents’ excellent satisfaction with appearance after deformity correction (P < 0.001, P < 0.001, P = 0.019, P = 0.023). Nevertheless, no significant difference was presented in postoperative carrying angle of the deformed side and total complication rate between the two groups (P = 0.626, P = 0.371). Conclusions The operation assisted by 3D printing osteotomy guide plate to correct the adolescent cubitus varus deformity is feasible and effective, which might be an optional approach to promote the accurate osteotomy and optimize the efficacy.

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Microsurgical unilateral laminotomy for bilateral decompression of degenerative lumbar canal stenosis: a comparative study

The Egyptian Journal of Neurology Psychiatry and Neurosurgery ◽

10.1186/s41983-019-0125-4 ◽

2019 ◽

Vol 55 (1) ◽

Author(s):

Mohamed I. Refaat ◽

Amr K. Elsamman ◽

Adham Rabea ◽

Mohamed I. A. Hewaidy

Keyword(s):

Patient Satisfaction ◽

Blood Loss ◽

Minimally Invasive ◽

Invasive Technique ◽

Decompression Surgery ◽

Microsurgical Decompression ◽

Significant Difference ◽

Duration Of Surgery ◽

Group A ◽

Group B

Abstract Background The quest for better patient outcomes is driving to the development of minimally invasive spine surgical techniques. There are several evidences on the use of microsurgical decompression surgery for degenerative lumbar spine stenosis; however, few of these studies compared their outcomes with the traditional laminectomy technique. Objectives The aim of our study was to compare outcomes following microsurgical decompression via unilateral laminotomy for bilateral decompression (ULBD) of the spinal canal to the standard open laminectomy for cases with lumbar spinal stenosis. Subjects and methods Cases were divided in two groups. Group (A) cases were operated by conventional full laminectomy; Group (B) cases were operated by (ULBD) technique. Results from both groups were compared regarding duration of surgery, blood loss, perioperative complication, and postoperative outcome and patient satisfaction. Results There was no statistically significant difference between both groups regarding the improvement of visual pain analogue, while improvement of neurogenic claudication outcome score was significant in group (B) than group (A). Seventy-three percent of group (A) cases and 80% of group (B) stated that surgery met their expectations and were satisfied from the outcome. Conclusion Comparing ULBD with traditional laminectomy showed the efficacy of the minimally invasive technique in obtaining good surgical outcome and patient satisfaction. There was no statistically significant difference between both groups regarding the occurrence of complications The ULBD technique was found to respect the posterior spinal integrity and musculature, accompanied with less blood loss, shorter hospital stays, and shorter recovery periods than the open laminectomy technique.

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