A new surgery choice of bilateral laminoplasty for symptomatic three or more-level lumbar canal stenosis in patients over 60 years old: a two-year retrospective study

Multi-level lumbar canal stenosis (LCS) in patients over 60 years is common and frequently complicated by significant comorbidities, making surgical decisions complex. While posterior lumbar interbody fusion (PLIF) is often used, bilateral laminoplasty offers a potential motion-preserving alternative. This study compares outcomes of bilateral laminoplasty versus PLIF for multi-level LCS in this elderly population. This retrospective study included consecutive patients >60 years with ≥3-level LCS undergoing bilateral laminoplasty or PLIF at our center. Patients were followed for a mean of approximately 24 months. We first detailed the bilateral laminoplasty technique. Then, outcomes were assessed using Visual Analog Scale (VAS) for pain, Japanese Orthopaedic Association (JOA) score for neurological function, and Oswestry Disability Index (ODI) for quality of life. Perioperative parameters, complications, and comorbidities were analyzed. Fifty-one patients met inclusion criteria and surveyed (26 laminoplasty, 25 PLIF). Laminoplasty demonstrated significantly shorter operative time (1.8±0.4 vs. 3.2±0.7 hours) and reduced blood loss (102±38 vs. 318±204 ml) compared to PLIF. Transfusion rates were lower with laminoplasty (0% vs 52%). Both groups showed significant improvements in VAS, JOA, and ODI scores at final follow-up. Laminoplasty achieved significantly better final ODI scores. Comorbidity rates were high, but no serious complications were found. Bilateral laminoplasty is a safe and effective surgical option for patients over 60 years with multi-level LCS, offering comparable clinical improvements to PLIF while providing advantages of shorter operative time, significantly reduced blood loss and transfusion requirements. It represents a valuable motion-preserving alternative in this comorbid population.