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. 2014 Dec;8(6):768-76.
doi: 10.4184/asj.2014.8.6.768. Epub 2014 Dec 17.

Comparison of Spinous Process-Splitting Laminectomy versus Conventional Laminectomy for Lumbar Spinal Stenosis

Masashi Uehara  1 , Jun Takahashi  2 , Hiroyuki Hashidate  3 , Keijiro Mukaiyama  2 , Shugo Kuraishi  2 , Masayuki Shimizu  2 , Shota Ikegami  2 , Toshimasa Futatsugi  2 , Nobuhide Ogihara  4 , Hiroki Hirabayashi  5 , Hiroyuki Kato  2
Affiliations

Comparison of Spinous Process-Splitting Laminectomy versus Conventional Laminectomy for Lumbar Spinal Stenosis

Masashi Uehara et al. Asian Spine J. 2014 Dec.

Abstract

Study design: Seventy-five patients who had been treated for lumbar spinal stenosis (LSS) were reviewed retrospectively.

Purpose: Invasion into the paravertebral muscle can cause major problems after laminectomy for LSS. To address these problems, we performed spinous process-splitting laminectomy. We present a comparative study of decompression of LSS using 2 approaches.

Overview of literature: There are no other study has investigated the lumbar spinal instability after spinous process-splitting laminectomy.

Methods: This study included 75 patients who underwent laminectomy for the treatment of LSS and who were observed through follow-ups for more than 2 years. Fifty-five patients underwent spinous process-splitting laminectomy (splitting group) and 20 patients underwent conventional laminectomy (conventional group). We evaluated the clinical and radiographic results of each surgical procedure.

Results: Japanese Orthopaedic Association score improved significantly in both groups two years postoperatively. The following values were all significantly lower, as shown with p-values, in the splitting group compared to the conventional group: average operating time (p=0.002), postoperative C-reactive protein level (p=0.006), the mean postoperative number of days until returning to normal body temperature (p=0.047), and the mean change in angulation 2 years postoperatively (p=0.007). The adjacent segment degeneration occurred in 6 patients (10.9%) in the splitting group and 11 patients (55.0%) in the conventional group.

Conclusions: In this study, the spinous process-splitting laminectomy was shown to be less invasive and more stable for patients with LSS, compared to the conventional laminectomy.

Keywords: Lumbar spinal stenosis; Paravertebral muscle, posterior approach; Postoperative low back pain; Spinous process-splitting laminectomy.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Preoperative radiographs.
Fig. 2
Fig. 2
Radiographs 2 years after the surgery. Spinous process-splitting laminectomy from L3 to L5 was performed. There was no spinal instability 2 years after the surgery. The Japanese Orthopaedic Association score improved from 9 to 22 points.
Fig. 3
Fig. 3
Postoperative computed tomography and magnetic resonance images of a patient in the splitting group. The spinous process was split and sutured, and the paravertebral muscle showed little damage at 3 months after the surgery.
Fig. 4
Fig. 4
Postoperative magnetic resonance image of a patient in the conventional group. The spinous process was excised and high signal change was observed in the paravertebral muscle, 3 months after surgery.
Fig. 5
Fig. 5
Preoperativ and postoperative Japanese Orthopaedic Association (JOA) scores. In the splitting group, the mean preoperative and 2-year postoperative JOA scores were 12.8 points and 22.6 points, respectively; the score improved significantly. In the conventional group, the mean preoperative and 2-year postoperative JOA scores were 14.3 points and 20.5 points, respectively; the score improved significantly.
See this image and copyright information in PMC

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