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

Abstract

Study DesignSeventy-five patients who had been treated for lumbar spinal stenosis (LSS) were reviewed retrospectively.PurposeInvasion 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 LiteratureThere are no other study has investigated the lumbar spinal instability after spinous process-splitting laminectomy.MethodsThis 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.ResultsJapanese 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.ConclusionsIn 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.

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.…”

“…However, reports of case series with long follow-up periods have shown lower rates of vertebral segment instability with the spinous process splitting technique. 2 The clinical parameters chosen for the preliminary evaluation of the group of patients studied were lumbar and lower limb pain, considering that these symptoms may be presented in different types of lumbar stenosis (central, lateral recess, or foraminal). 9 The use of specific questionnaires might better assess the function of operated patients, but because of the short evaluation period only lumbar and lower limb pain were selected.…”

“…Classically, decompression of the nerve structures has been accomplished by removal of the lamina, facet joints, ligamentum flavum, and osteophytes of the canal and vertebral foramen. 2,3 Laminoplasty has also been performed as an alternative for decompression of the nerve structures and to preserve the continuity of the posterior vertebral elements (spinous process and vertebral lamina). 4 Decompression has been classically performed by exposing the posterior vertebral elements.…”

“…This surgical approach promotes the detachment and retraction of the paravertebral muscles and the morbidity related to the injury to the paravertebral muscles caused by ischemia, denervation, and muscle detachment has motivated the development of less invasive surgical techniques. 2 Preservation of the paravertebral muscles has been the objective of several techniques that have been described for decompression of the vertebral canal. The technique of longitudinal splitting of the spinous process at the midline to preserve the paravertebral muscles during lumbar spine decompression was described by Watanabe et al in 2005.…”

Comparison of Three Different Paraspinous Unilateral Approaches to the Spinal Canal for Lumbar Decompression-Minimally 2-Year Postoperative Evaluation

“…Less invasive spinal procedures have come into wide use, and previous studies have found that less invasive surgeries have equal or superior outcomes compared to conventional open surgery [1][2][3][4][5][6][7][8]. The purpose of this retrospective case-control study was to determine whether the differences among 3 paraspinous unilateral approaches for lumbar decompression would suggest that less invasive procedures would have superior outcomes compared to conventional procedures for at least 2 years.…”