Split–spinous process laminotomy and discectomy for degenerative lumbar spinal stenosis: a preliminary report

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The authors evaluated a new minimally invasive spinal surgery technique to correct degenerative lumbar spinal stenosis involving a split–spinous process laminotomy and discectomy (also known as the “Marmot operation”).</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>This prospective study randomized 70 patients with lumbar stenosis to undergo either a Marmot operation (40 patients), or a conventional laminectomy (30 patients), with or without discectomy. Spinal anteroposteri-or diameter, cross-sectional area, lateral recess distance, spinal stability, postoperative back pain, functional outcomes, and muscular trauma were evaluated. The follow up ranged from 10 to 18 months, with a mean of 15.1 months for the Marmot operation group and 14.8 months for the conventional laminectomy group.</jats:p> <jats:p>Compared with patients in the conventional laminectomy group, patients who received a Marmot operation had a shorter mean postoperative duration until ambulation without assistance, a reduced mean duration of hospital stay, a lower mean creatine phosphokinase–muscular-type isoenzyme level, a lower visual analog scale score for back pain at 1-year follow up, and a better recovery rate. These patients also had a longer mean duration of operative time and a greater mean blood loss compared with the conventional group. Satisfactory neurological decompression and symptom relief were achieved in 93% of these patients. Most of the patients (66%) in this group needed discectomy for decompression. The postoperative mean lateral recess width, spinal anteroposterior diameter, and cross-sectional area were all significantly increased. There was no evidence of spinal instability in any patient. One patient with insufficient lateral recess decompression and recurrent disc herniation needed additional conventional laminectomy and discectomy, and one patient with mild superficial wound infection was successfully treated with antibiotics and frequent dressing changes.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>A Marmot operation may provide effective spinal decompression. Although this method requires more operative time than a conventional method, it may involve only minimal muscular trauma, spinal stability maintenance, and early mobilization; shorten the duration of hospital stay; reduce postoperative back pain; and provide satisfactory neurological and functional outcomes.</jats:p></jats:sec>

Effectiveness of posterior decompression techniques compared with conventional laminectomy for lumbar stenosis

“…Review of trial registries revealed no other ongoing or unpublished trials. We subdivided studies evaluating posterior decompressive techniques into unilateral laminotomy for bilateral decompression [4,24,25], bilateral laminotomy [2][3][4]26] and split-spinous process laminotomy [27][28][29][30] to ensure clinical homogeneity.…”

“…Decisive arguments were the inclusion of concomitant intertransverse arthrodesis (in 12 out of 67 participants) and concomitant discectomy (in 7 out of 67 participants) by Postacchini et al [3], and concomitant discectomy (in 44 out of 70 participants) by Cho et al [27]. Concomitant discectomy was not among the predefined exclusion criteria of this review, but the exceptionally high rate of concomitant discectomy by Cho et al compared with no …”

“…Two studies were excluded from the quantitative analysis as the result of clinical heterogeneity [3,27]. Decisive arguments were the inclusion of concomitant intertransverse arthrodesis (in 12 out of 67 participants) and concomitant discectomy (in 7 out of 67 participants) by Postacchini et al [3], and concomitant discectomy (in 44 out of 70 participants) by Cho et al [27].…”

“…Investigators used different disability questionnaires among the studies included in this review [2,4,[24][25][26][27][28][29][30]. Postacchini et al did not report a validated disability score [3].…”

“…Postacchini et al did not report a validated disability score [3]. None of these studies, except the study by Fu et al The quality of evidence had to be decreased because the estimate of the effect is insufficiently precise c Only one high-quality RCT was available for analysis [4] d Included studies have inconsistent findings e The quality of evidence had to be decreased because of the relatively high impact of one low-quality study [26] f The quality of evidence had to be decreased because of high risk of bias due to a non-standardised assessment of spinal instability g The quality of evidence had to be decreased because of the relatively high impact of one low-quality study [28] h Only one low-quality RCT was available for analysis [27] Eur Spine J (2015) 24:2244-2263 2255 MD -0.29, 95 % CI -0.41 to -0.17). The quality of evidence had to be decreased because of the relatively high impact of one low-quality study on the combined quantitative analysis [28].…”