Spinous Process splitting Laminectomy: Clinical outcome and Radiological analysis of extent of decompression

Lee, Seungcheol; Srikantha, Umesh

doi:10.14444/2020

Cited by 14 publications

(15 citation statements)

References 25 publications

(50 reference statements)

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“…12 Facet-preserving decompression has the benefit of offering a less morbid alternative for patients with primarily leg symptoms and stenosis associated with spondylolisthesis or scoliosis. 8,12,14 Our study confirms that endoscopic decompression causes very little destruction to both the ipsilateral and contralateral facets. We do not have a comparison group to draw any conclusions about the benefit of this procedure over an open or tubular laminectomy in facet preservation.…”

Section: Discussionsupporting

confidence: 72%

Radiographic outcomes of endoscopic decompression for lumbar spinal stenosis

Khalsa

Kim

Singh

et al. 2019

Neurosurgical Focus

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OBJECTIVELumbar central stenosis can theoretically be decompressed with minimal bone removal via an endoscopic approach. Although multiple studies have demonstrated an adequate radiographic decompression, none has quantified the volume of bone removal after endoscopic decompression. The objective of this study was to quantify the 3D volume of bone removed from the lamina and facet joints during endoscopic decompression for lumbar central and lateral recess stenosis.METHODSThis retrospective study included adults with lumbar spinal stenosis who underwent endoscopic decompression of a single level or 2 noncontiguous lumbar levels. Central stenosis on MRI was graded preoperatively and postoperatively using the Schizas scale. A computer program was developed in MATLAB to semiautomatically perform a 3D volumetric analysis of preoperative and postoperative lumbar CT scans. The volumetric percentage of bone removed from the lamina and facet joints ipsilateral and contralateral to the side of approach was quantified.RESULTSNineteen patients with 21 treated lumbar levels were included in the study. Preoperatively, the number of levels with Schizas stenosis grades B, C, and D were 5, 12, and 4, respectively. Stenosis grades improved postoperatively to grades A, B, C, and D for 17, 3, 1, and 0 levels, respectively. All levels improved by at least 1 stenosis grade. The volumetric percentage of laminar bone removed was 15.5% (95% CI 11.2%–19.8%, p < 0.001) from the ipsilateral lamina and 8.8% (95% CI 5.7%–11.8%, p < 0.001) from the contralateral lamina. The percentage of facet joint resection was 5.3% (95% CI 4.2%–6.4%, p < 0.001) and 4.3% (95% CI 2.2%–6.4%, p < 0.001) for the ipsilateral and contralateral facet joints, respectively. Average pain scores, as measured by the visual analog scale, improved from 7.9 preoperatively to 2.2 by 3–10 months postoperatively (p < 0.001).CONCLUSIONSEndoscopic lumbar decompression achieves improvement in the radiographic grade of lumbar central stenosis with minimal bone removal from the lamina and facet joints. Future prospective studies are needed to validate the findings of this study with more comprehensive clinical outcomes.

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Section: Discussionsupporting

confidence: 72%

Radiographic outcomes of endoscopic decompression for lumbar spinal stenosis

Khalsa

Kim

Singh

et al. 2019

Neurosurgical Focus

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“…Our sample included patients who were unresponsive to non-operative conservative treatment for at least 12 weeks and who showed progressive symptoms despite continued non-operative treatment. The exclusion criteria included patients with marked neuroforaminal stenosis (treated by fusion or foraminal decompression at our institution, described elsewhere) [ 11 ], over three levels of stenosis (treated by spinous process splitting laminectomy at our institution, described elsewhere) [ 12 ], any prior spine surgery at any operative level in consideration of morphological changes, any prior lumbar fusion at any level to avoid adjacent disc disease, or requiring additional concurrent treatments. Patients with segmental instability, lytic spondylolisthesis, and degenerative spondylolisthesis over grade 2, with predominant lower-back pain were also excluded from the study.…”

Section: Methodsmentioning

confidence: 99%

Minimally Invasive Lumbar Spinal Decompression in Elderly Patients with Magnetic Resonance Imaging Morphological Analysis

Hong

Lee

2018

Asian Spine J

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Study DesignCase-control study.PurposeIn this study, we aimed to investigate clinical outcomes and morphological features in elderly patients with lumbar spinal stenosis (LSS) who were treated by minimally invasive surgery (MIS) unilateral laminectomy for bilateral decompression (ULBD) using a tubular retractor.Overview of LiteratureNumerous methods using imaging have been attempted to describe the severity of spinal stenosis. But the relationship between clinical symptoms and radiological features remains debatable.ObjectiveIn this study, we aimed to investigate clinical outcomes and morphological features in elderly patients with LSS who were treated by MIS-ULBD.MethodsWe methodically assessed 85 consecutive patients aged >65 years who were treated for LSS. The patients were retrospectively analyzed in two age groups: 66–75 years (group 1) and >75 years (group 2). Clinical outcomes were assessed using the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and the modified MacNab criteria. Outcome parameters were compared between the groups at the 1-year follow-up. Core radiologic parameters for central and lateral stenosis were analyzed and clinical findings of the groups were compared.ResultsAt the 1-year follow-up, patients in both groups 1 and 2 demonstrated significant improvement in their VAS and ODI scores. All clinical outcomes, except postoperative ODI, were not significantly difference between the groups. In addition, no significant difference was noted in the preoperative radiological parameters between the groups. There was no statistically significant correlation between radiological parameters and clinical symptoms or their outcomes. Moreover, no differences were noted in perioperative adverse events and in the need for repeat surgery at follow-ups between the groups.ConclusionsMIS-ULBD by tubular approach is a safe and effective treatment option for elderly patients with LSS. Clinical outcomes in patients with LSS and aged >75 years were comparable with those in patients with LSS and aged 66–75 years. Moreover, we did not find any correlation between radiological parameters and clinical outcomes in either of the two patient groups.

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“…A study conducted by Zhang et al 19 reported that the mean canal stenosis index after posterior indirect reduction and pedicle screw fixation without laminectomy was 84.8% ( sd 7.3%) compared with 32.9% ( sd 7.8%) before the operation, which indicated that there is a more than twofold increase of the mean canal stenosis index following the procedure. Other studies conducted by Lee et al 20 reported that the ratio increase of cross-sectional spinal canal area was 163.8%. According to the study conducted by Mlyavykh et al, 8 lengthening of less than 5 mm with pedicle-lengthening osteotomy could provide favourable clinical results and increase spinal canal volume by 65.2%.…”

Section: Discussionmentioning

confidence: 84%

Impact of pedicle-lengthening osteotomy on spinal canal volume and neural foramen size in three types of lumbar spinal stenosis

Qian

et al. 2016

Bone & Joint Research

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ObjectivesPedicle-lengthening osteotomy is a novel surgery for lumbar spinal stenosis (LSS), which achieves substantial enlargement of the spinal canal by expansion of the bilateral pedicle osteotomy sites. Few studies have evaluated the impact of this new surgery on spinal canal volume (SCV) and neural foramen dimension (NFD) in three different types of LSS patients.MethodsCT scans were performed on 36 LSS patients (12 central canal stenosis (CCS), 12 lateral recess stenosis (LRS), and 12 foraminal stenosis (FS)) at L4-L5, and on 12 normal (control) subjects. Mimics 14.01 workstation was used to reconstruct 3D models of the L4-L5 vertebrae and discs. SCV and NFD were measured after 1 mm, 2 mm, 3 mm, 4 mm, or 5 mm pedicle-lengthening osteotomies at L4 and/or L5. One-way analysis of variance was used to examine between-group differences.ResultsIn the intact state, SVC and NFD were significantly larger in the control group compared with the LSS groups (P<0.05). After lengthening at L4, the percentage increase in SCV (per millimetre) was LRS>CCS>FS>Control. After lengthening at L5 and L4-L5, the percentage increase in SCV (per millimetre) was LRS>FS>CCS>Control. After lengthening at L4 and L4-L5, the percentage increase in NFD (per millimetre) was FS>CCS>LRS>Control. After lengthening at L5, the percentage increase in NFD (per millimetre) was CCS>LRS>control>FS.ConclusionsLRS patients are the most suitable candidates for treatment with pedicle-lengthening osteotomy. Lengthening L4 pedicles produced larger percentage increases in NFD than lengthening L5 pedicles (p < 0.05). Lengthening L4 pedicles may be the most effective option for relieving foraminal compression in LSS patients.Cite this article: P. Li, L. Qian, W. D. Wu, C. F. Wu, J. Ouyang. Impact of pedicle-lengthening osteotomy on spinal canal volume and neural foramen size in three types of lumbar spinal stenosis. Bone Joint Res 2016;5:239–246. DOI: 10.1302/2046-3758.56.2000469.

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Spinous Process splitting Laminectomy: Clinical outcome and Radiological analysis of extent of decompression

Cited by 14 publications

References 25 publications

Radiographic outcomes of endoscopic decompression for lumbar spinal stenosis

Radiographic outcomes of endoscopic decompression for lumbar spinal stenosis

Minimally Invasive Lumbar Spinal Decompression in Elderly Patients with Magnetic Resonance Imaging Morphological Analysis

Impact of pedicle-lengthening osteotomy on spinal canal volume and neural foramen size in three types of lumbar spinal stenosis

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