1.1 Inclusion criteria

Analyses included patients who underwent lumbar laminotomy and foraminotomy surgery for the treatment of LSS during an 8-month period, who have not had previous lumbar surgery, did not have more than one moderate or severe level of LSS, over the age of 18, had complete preoperative and postoperative data, had a BMI ≥ 30.0, and were not classified as a worker's compensation case.

After implementing the inclusion criteria, 41 patients were eligible for participation in the study. The eligible sample consisted of adults between the ages of 20 and 72 years (M = 55.10, SD = 12.31). The sample was mostly male (68.3%) and Caucasian (92.7%). See Table 1 for demographic statistics.

1.2 Outcome measures

In past spine surgery studies, the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) have been frequently used.^9,10 In this study, the VAS was used to measure pain intensity. Patients were asked to rate their current level of pain ranging from 0 to 10 with 0 indicating no pain and 10 indicating the worst pain they can imagine. The ODI was used to measure patients' level of disability. For this measure, scores range from 0 to 100. Lower scores on the VAS and ODI indicate a lesser amount of pain and disability respectively.

1.3 Operative variables

Data pertaining to estimated blood loss (EBL), number of intraoperative and postoperative complications up to 30-days out (NOC), and length of surgery (LOS) were retrieved from patients' medical records.

1.4 Procedure

Patients who underwent a single-level laminotomy and foraminotomy for the treatment of LSS completed a VAS and ODI both preoperatively and 12-months postoperatively. Informed consent was obtained from all patients included in this study.

1.5 Surgical procedure

In brief, a scalpel was used to make a stab wound through which a guide-wire was inserted down to the facet region of the vertebral body. Over this guide-wire, the tissues were dilated with the use of a series of increasing diameter dilating tubes to approximately 18 mm. A drill bit was used to create a window into the lamina. This was confirmed through the use of fluoroscopy to determine the depth of penetration of the drill unit. Electrocautery and holmium lasers were used for hemocoagulation and soft tissue removal. Once this was accomplished, a standard mechanical burr system was utilized to grind away the lamina of the vertebral body and widen the opening that was created with the bit. Kerrison and pituitaries rongeurs were utilized during the entire process to assist in bone removal and for general debulking of soft tissues and loose bone fragments. Once the region of the lamina and foraminal canal was properly opened and decompressed, the tube was removed and the procedure was completed. All surgeries were performed in an outpatient setting.

2.1 Missing data

Patients with missing data on the outcome measures were excluded from analyses. There was one missing data point for the EBL and NOC variables. There were no missing data points for the VAS, ODI, or LOS.

2.2 Outcome measures

An alpha level of 0.05 or below was considered statistically significant for all analyses. A significant decrease in VAS (p-value < 0.001) and ODI scores (p-value < 0.001) between preoperative and postoperative was observed. Descriptive statistics for the outcome measures are reported in Table 2. The average EBL was 59.00 mL and the LOS averaged at 78.46 min. There were no reported intraoperative or postoperative complications. See Table 3 for descriptive statistics and Figs. 1 and 2 for the frequency distribution of the surgical variables.

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Fig. 1 Estimated blood loss.

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Fig. 2 Length of surgery.

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