Clinical comparison between patients operated for unilateral radiculopathy via a contralateral (facet-sparing) and ipsilateral side approach

Abstract

Aim: To compare clinical outcomes of the patients operated from the contralateral or ipsilateral side for unilateral radiculopathy in spinal stenosis. Material and Methods: This was a retrospective study. Twenty patients were listed as Group 1 (Contralateral) with unilateral radiculopathy and spinal stenosis with/without lateral recess syndrome or foraminal stenosis. Decompression from opposite side of radiculopathy was performed to Group 1 patients. Decompression from the radiculopathy side was performed to the patients in Group 2 (Ipsilateral). Twenty eight patients were listed as Group 2. Back pain visual analogue scale (VAS) score and leg pain VAS score were assessed at preoperative, postoperative 1st month and postoperative 12th month. The results were compared statistically. Results: Two patients were excluded because of reoperation at the 2nd month from the Group 2 to assessment 12th month VAS score. There was no significant difference between two groups at 1st month back pain VAS and leg pain VAS scores. There was no significant difference between two groups at 12th month back pain VAS and leg pain VAS scores. Dynamic stabilization was performed at 2nd month to two patients after the first operations for instability. So, there was no difference in clinical outcomes between the patients treated by contralateral approach and ipsilateral approach when instability did not occur. However, there is a risk of instability of the same side approach and surgery owing to shaving of the facet joint. Conclusion: In the contralateral approach, the recess of the contralateral side and foramen can be better seen than in the ipsilateral approach. So, this is a facet-sparing approach to spinal stenosis with/without lateral recess syndrome or foraminal stenosis with unilateral radiculopathy. The contralateral approach to unilateral radicular complaints is quite effective. With this approach, facet joints are protected from possible instability.