Restoration of the Spinous Process Following Muscle-Preserving Posterior Lumbar Decompression via Sagittal Splitting of the Spinous Process

Wi, Seung Myung; Lee, Hui Jong; Chang, Sam Yeol; Kwon, Oh Hyo; Lee, Choon-Ki; Chang, Bong Soon; Kim, Hyoungmin

doi:10.4055/cios.2019.11.1.95

Cited by 7 publications

(11 citation statements)

References 26 publications

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“…Watanabe et al first described this technique in 2001 [17]. This technique is relatively largely used, especially in Japan, South Korea, and some centers in the US, Canada, and India, as described in the literature [18,11,10,16,5,7,9,3,6,1,8,4,19,13,14].…”

Section: Discussionmentioning

confidence: 99%

“…3 This technique is relatively largely used, especially in Japan, South Korea, and some centers in the United States, Canada, and India, as described in the literature. 1,[4][5][6][7][8][9][10][11][12][13][14][15][16][17] The target is to be the least invasive, respecting the natural anatomy, preserving the bone continuity between spinous process and lamina and the integrity of the paraspinal muscles.…”

Section: Discussionmentioning

confidence: 99%

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Lumbar Spinous Process–Splitting Technique for Ligamentum Flavum Cyst Removal

Tomasi

Umana

Scalia

et al. 2021

J Neurol Surg A Cent Eur Neurosurg

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Background Laminotomy for lumbar stenosis is a well-defined procedure and represents a routine in every neurosurgical department. It is a common experience that the mono- or bilateral paraspinal muscles detachment together with supra and interspinous ligaments injury can lead to postoperative pain. In literature has been reported the application at the level of the lumbar spine of a minimally invasive technique defined as lumbar spinous process-splitting technique (LSPST). Methods In the current study, we present a case series of 12 patients that underwent LSPSL from September 2019 to April 2020. Two patient suffering from ligamentum flavum cyst, 8 patients with single level lumbar canal stenosis (LCS) and two patients with two-level LCS. The approach was mini-open, with reduced soft tissue dissection and without paraspinal muscles injury. Moreover, a novel morphological classification of postoperative muscle atrophy is proposed as well as a volumetric analysis of the decompression achieved. Conclusion At our knowledge, this is the first description of this surgical technique and the first LSPSL case series in Europe. Furthermore, cases of ligamentum flavum cyst removal using this safe and effective technique are not yet reported. Abbreviations Lumbar canal stenosis (LCS), lumbar spinous process-splitting technique (LSPST), minimally invasive spine surgery (MISS)

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Lumbar Spinous Process–Splitting Technique for Ligamentum Flavum Cyst Removal

Tomasi

Umana

Scalia

et al. 2021

J Neurol Surg A Cent Eur Neurosurg

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“…The authors’ modified SPSD was performed as previously reported. 11) It was based on the technique introduced by Watanabe et al 7) and modified by Cho et al, 13) Nomura et al, 10) and Hatta et al 14) Under general anesthesia, a posterior midline approach was performed, and the supraspinous and interspinous ligaments were sharply divided using a #10 scalpel blade. The proximal SP at the level to be decompressed was then split vertically and equally into the base using an ultrasonic blade ( Fig.…”

Section: Methodsmentioning

confidence: 99%

“…There have been many favorable clinical outcomes using SPSD modified by other surgeons; however, these are limited to short-term follow-up. 10 11) Furthermore, few studies have reported the possibility of delayed instability, reoperation rate, and effects on the clinical outcomes of union status of the split SP after SPSD. The purpose of the present study was to report the clinical and radiological mid-term outcomes of SPSD for DLSS.…”

mentioning

confidence: 99%

Midterm Outcomes of Muscle-Preserving Posterior Lumbar Decompression via Sagittal Splitting of the Spinous Process: Minimum 5-Year Follow-up

Son,

Chang,

Chang

et al. 2023

Clin Orthop Surg

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Background To overcome several disadvantages of conventional laminectomy for degenerative lumbar spinal stenosis (DLSS), several types of minimally invasive surgery have been developed. The purpose of the present study was to report the clinical and radiological mid-term outcomes of spinous process-splitting decompression (SPSD) for DLSS. Methods Seventy-three consecutive patients underwent SPSD between September 2014 and March 2016. Of these, 42 (70 segments) who had at least 5 years of follow-up were analyzed retrospectively. The visual analog scale for back pain and leg pain, Oswestry disability index, and walking distance without resting were scored to assess clinical outcomes at the preoperative and final follow-up. A subgroup analysis was performed according to the union status of the split spinous processes (SPs). For radiological outcomes, slip in the neutral position as a static parameter, anterior flexion-neutral translation, and posterior extension-neutral translation as a dynamic parameter were measured before and at the final follow-up after surgery. Spinopelvic parameters were also measured. Reoperation rate at the index levels was investigated, and predictive risk factors for reoperation were evaluated using multivariate logistic regression. Survival analysis was performed with reoperation as the endpoint to estimate the longevity of the SPSD for DLSS. Results All clinical outcomes improved significantly at the final follow-up compared to those at the initial visit ( p < 0.05). The clinical outcomes did not differ according to the union status of the split SP. There were no cases of definite segmental instability and no significant changes in the static or dynamic parameters after surgery. Sacral slope and lumbar lordosis increased, and pelvic tilt decreased significantly at the follow-up ( p < 0.05), despite no significant change in the sagittal vertical axis. The mean longevity of the procedure before the reoperation was 82.9 months. Five patients (11.9%) underwent reoperation at a mean of 52.2 months after the SPSD. There were no significant risk factors for reoperation; however, the preoperative severity of foraminal stenosis had an odds ratio of 7.556 ( p = 0.064). Conclusions SPSD for DLSS showed favorable clinical and radiological outcomes at the mid-term follow-up. SPSD could be a good surgical option for treating DLSS.

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“…In this regard, this study aimed to investigate whether LBP as well as lower leg symptoms can also be improved in patients with CLSS by one-level lumbar decompression surgery, based upon the study results by other authors [18][19][20][21] that encroachment on the cauda equina itself can be a cause of LBP in CLSS.…”

Section: Introductionmentioning

confidence: 99%

The Effectiveness of Decompression Surgery on Low Back Pain in Patients with Central Lumbar Spinal Stenosis

Jae-Jun

Nam

2020

Preprint

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Background: Patients with central lumbar spinal stenosis (CLSS) complain of not only the lower leg symptoms but also low back pain (LBP) simultaneously in many cases. Therefore, patients who undergo decompressive surgery expect recovery from LBP as well as lower leg symptoms, and surgeons who perform decompression surgery are making efforts to improve both symptoms. The objective of this study is to investigate whether decompression surgery can improve low back pain and symptoms of lower limb pain in patients with one level central lumbar spinal stenosis.Methods: The present study included 39 patients who had findings of central lumbar spinal stenosis and underwent decompression surgery due to its corresponding claudication and lower leg radiating pain complaints from 2013 to 2018. Their pain (lower leg radiating pain and low back pain) and functional outcomes (Oswestry Disability Index (ODI), Roland–Morris Disability Questionnaire (RMDQ), and Short Form-36 (SF-36)) were evaluated before surgery and 6 and 12 months after surgery.Results: Mean lower leg radiating pain continuously showed statistically significant improvement (p < 0.05, p = 0.003); however, the clinical significance of differences above minimum clinically important difference (MCID) was up to 6 months. Mean low back pain was 4.72 ± 3.40 before surgery, 2.33 ± 2.27 at 6 months after surgery, and 2.21 ± 2.02 at 12 months after surgery, showing statistically and clinically significant improvement (p < 0.05) up to 6 months after surgery, after which there were no findings of improvement. Conclusion: Decompression surgery for patients with central lumbar spinal stenosis showed clinically significant improvements in lower leg radiating pain and low back pain up to 6 months after surgery and continuous improvements in lower leg radiating pain up to 12 months, but there was no continuous improvement in LBP.

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Restoration of the Spinous Process Following Muscle-Preserving Posterior Lumbar Decompression via Sagittal Splitting of the Spinous Process

Cited by 7 publications

References 26 publications

Lumbar Spinous Process–Splitting Technique for Ligamentum Flavum Cyst Removal

Lumbar Spinous Process–Splitting Technique for Ligamentum Flavum Cyst Removal

Midterm Outcomes of Muscle-Preserving Posterior Lumbar Decompression via Sagittal Splitting of the Spinous Process: Minimum 5-Year Follow-up

The Effectiveness of Decompression Surgery on Low Back Pain in Patients with Central Lumbar Spinal Stenosis

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