Surgical outcomes of modified lumbar spinous process–splitting laminectomy for lumbar spinal stenosis

Abstract

<jats:p>The lumbar spinous process–splitting laminectomy (LSPSL) procedure was developed as an alternative to lumbar laminectomy. In the LSPSL procedure, the spinous process is evenly split longitudinally and then divided at its base from the posterior arch, leaving the bilateral paravertebral muscle attached to the lateral aspects. This procedure allows for better exposure of intraspinal nerve tissues, comparable to that achieved by conventional laminectomy while minimizing damage to posterior supporting structures. In this study, the authors make some modifications to the original LSPSL procedure (modified LSPSL), in which laminoplasty is performed instead of laminectomy. The purpose of this study was to compare postoperative outcomes in modified LSPSL with those in conventional laminectomy (CL) and to evaluate bone unions between the split spinous process and residual laminae following modified LSPSL.</jats:p> <jats:p>Forty-seven patients with lumbar spinal stenosis were enrolled in this study. Twenty-six patients underwent modified LSPSL and 21 patients underwent CL. Intraoperative blood loss and surgical duration were evaluated. The Japanese Orthopaedic Association (JOA) scale scores were used to assess parameters before surgery and 12 months after surgery. The recovery rates were also evaluated. Postoperative paravertebral muscle atrophy was assessed using MRI. Bone union rates between the split spinous process and residual laminae were also examined.</jats:p> <jats:p>The mean surgical time and intraoperative blood loss were 25.7 minutes and 42.4 ml per 1 level in modified LSPSL, respectively, and 22.7 minutes and 29.5 ml in CL, respectively. The recovery rate of the JOA score was 64.2% in modified LSPSL and 68.7% in CL. The degree of paravertebral muscle atrophy was 7.8% in modified LSPSL and 22.2% in CL at 12 months after surgery (p &lt; 0.05). The fusion rates of the spinous process with the arcus vertebrae at 6 and 12 months in modified LSPSL were 56.3% and 81.3%, respectively.</jats:p> <jats:p>The modified LSPSL procedure was less invasive to the paravertebral muscles and could be a laminoplasty; therefore, the modified LSPSL procedure presents an effective alternative to lumbar laminectomy.</jats:p>

Preliminary Results of Vertebral Canal Decompression by Spinous Process Splitting

“…We do not have long-term follow-up information, but the results reported in the literature have been very favorable and stimulated the introduction of this technique into our field of activity. 2,3,7,8 The efficacy of the surgical treatment of lumbar canal stenosis has been well-evidenced in prospective, randomized studies 9,10 and it has been established that decompression of the vertebral canal, lateral recess, and vertebral foramen promote the improvement of symptoms. However, there are potential risks arising from the conventional surgical procedure involving open dissection with displacement and retraction of the paravertebral muscles, resection of the vertebral lamina, facet joints, spinous process, and injury to the posterior ligament structures.…”

“…4,6 Performing less invasive surgeries with lower morbidity has been one of the goals of modern spine surgery and the spinous process splitting technique has been highlighted for its technical simplicity and reports of good results from its application. 3,7 The objective of this study was to observe the preliminary clinical and radiographical results from the use of the technique of spinal canal decompression by means of the approach using longitudinal splitting of the spinous process in patients with spinal canal stenosis.…”

Lumbar Spinous Process–Splitting Laminoplasty: A Novel Technique for Minimally Invasive Lumbar Decompression

“…These have included a brief description of the technique and reports on the clinical outcomes in patients with lumbar canal stenosis. [14][15][16][17][18][19][20][21][22][23][24][25] Watanabe et al 14 compared the clinical outcomes at a minimum of 2 years between 18 patients treated with spinous process-splitting laminectomy and 20 patients treated with conventional laminectomy for lumbar canal stenosis. They concluded that comparable clinical results can be achieved for both techniques based on the Japanese Orthopaedic Association (JOA) score.…”

“…Preliminary results suggested excellent decompression with less muscular damage than both traditional and other tubular techniques to decompress the lumbar spine. [14][15][16][17][18][19][20][21][22][23][24][25] The current authors theorized that this would be similar in a group of North American patients and therefore set out to analyze the results of a cohort of patients undergoing this procedure at their institution. The central hypothesis of this study was that spinous process-splitting laminoplasty is effective for the treatment of lumbar canal stenosis.…”

Long-Term Outcome of Patients Undergoing Microscopic Lumbar Spinous Process-Splitting Laminectomy

“…It is associated with compression of the dural tube and spinal nerve root, and degenerative alteration in the lumbar spine. Various minimally invasive laminectomies have recently been introduced in patients with LSS, including bilateral decompression via the unilateral approach using a microendoscope and tubular retractor [1][2][3], lumbar muscle-preserving interlaminar decompression [4], and lumbar spinous process-splitting laminectomy (LSPSL) [5][6][7].…”