Is bilateral laminectomy and fusion superior to total laminectomy and fusion in two-level lumbar spinal stenosis?

BACKGROUND

This study aims to compare the clinical outcomes of bilateral laminectomy fusion (BLF) with total laminectomy and fusion (TLF) surgeries for patients with two-level lumbar spinal stenosis (LSS).

METHODS

A total of 124 eligible patients with lumbar spinal stenosis treated either with BLF or TLF between January 2023 and October 2025 at our hospital were enrolled in this study. Patients were divided into two groups according to their operation methods (BLF group and TLF group). All data were collected from their medical records. Data on clinically related factors, such as the Visual Analog Scale (VAS) score, Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) score for low back pain, and MacNab criteria, and operation-related factors such as hospital stay, operation time, blood loss, and day to walk, as well as complications, were collected and compared.

RESULTS

There were no significant differences in terms of age, gender, pain side and operation level, preoperative VAS score, NDI, and JOA score between the two groups of patients (P > 0.05). Patients in the BLF group showed a significantly reduced hospital stay, blood loss, and day to walk. Moreover, patients in the BLF group showed significantly better improvement in clinical factors such as the ODI, VAS score, and JOA score at each follow-up visit point than the TLF group (P < 0.05). The excellent/good rates (MacNab criteria) were 95% (57/60) in the BLF group and 91% (58/64) in the TLF group. With regard to complications, three patients suffered from nerve root irritation symptoms and two patients had mild spinal epidural tear in the TLF group, while nerve root irritation symptoms occurred in only one patient in the BLF group.

CONCLUSIONS

BLF may provide better clinical outcomes than TLF in patients with LSS. Also, more studies are needed to further investigate the efficacy of BLF.