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European Spine Journal

, Volume 27, Issue 7, pp 1644–1652 | Cite as

Comparative study of two spinous process (SP) osteotomy techniques for posterior decompression surgery in lumbar spinal stenosis: SP base versus splitting osteotomy

  • Gun Woo Lee
  • Myun-Whan Ahn
Original Article

Abstract

Purpose

To compare the postoperative clinical and radiological outcomes of the SP base osteotomy versus SP splitting techniques for PD for treating LSS.

Methods

Of 139 patients who underwent PD surgery for LSS, 97 who met the study criteria were enrolled in the study. Group A comprised 53 patients who underwent SP base osteotomy, and group B included 44 patients who underwent SP splitting osteotomy. The primary study endpoint was intensity of lower back pain (LBP) and pain radiation to the lower extremities measured with the visual analogue scale (VAS). Secondary endpoints included (1) clinical outcomes assessed using Oswestry disability index and 12-short health form questionnaire; (2) surgical outcomes; and (3) procedure-related complications.

Results

LBP was more or less greater in SP base osteotomy group than in SP splitting osteotomy group at postoperative 1 week and 1 year (P = 0.04 and 0.03), but radiating pain was no significant difference between the groups throughout the 1-year follow-up period. One year after the surgery, the fusion rate at the osteotomized site was significantly greater in SP splitting osteotomy group (77%) than in SP base osteotomy group (55%) (P = 0.03). Clinical outcomes, surgical outcomes, and complications did not differ significantly between groups during follow-up times.

Conclusions

The two SP osteotomy techniques offer excellent clinical and radiological outcomes at least for the first year after the surgery. In fusion rate at the osteotomized SP site, the SP splitting technique was superior to the SP base osteotomy technique.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

Keywords

Spinal stenosis Posterior decompression Spinous process Base osteotomy Splitting osteotomy 

Notes

Acknowledgements

This work was supported by the 2017 Yeungnam University Research Grant. Institutional Review Board (IRB) of Yeungnam University Medical Center (YUMC) approved this study (IRB No. 2016-09-007).

Funding

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Supplementary material

586_2018_5526_MOESM1_ESM.pptx (1.2 mb)
Supplementary material 1 (PPTX 1252 kb)

References

  1. 1.
    Benz RJ, Garfin SR (2001) Current techniques of decompression of the lumbar spine. Clin Orthop Relat Res 384:75–81CrossRefGoogle Scholar
  2. 2.
    Overdevest GM, Jacobs W, Vleggeert-Lankamp C, Thomé C, Gunzburg R, Peul W (2015) Effectiveness of posterior decompression techniques compared with conventional laminectomy for lumbar stenosis. In: The Cochrane Collaboration (ed) Cochrane database of systematic reviews. Wiley, ChichesterGoogle Scholar
  3. 3.
    Weiner BK, Walker M, Brower RS, McCulloch JA (1999) Microdecompression for lumbar spinal canal stenosis. Spine (Phila Pa 1976) 24:2268–2272CrossRefGoogle Scholar
  4. 4.
    Castro-Menéndez M, Bravo-Ricoy JA, Casal-Moro R, Hernández-Blanco M, Jorge-Barreiro FJ (2009) Midterm outcome after microendoscopic decompressive laminotomy for lumbar spinal stenosis: 4-year prospective study. Neurosurgery 65:100–110CrossRefPubMedGoogle Scholar
  5. 5.
    Takaso M, Nakazawa T, Imura T, Okada T, Fukushima K, Ueno M, Saito W, Shitani R, Sakagami H, Takahashi K, Yamazaki M, Ohtori S, Kotani T (2011) Less invasive and less technically demanding decompressive procedure for lumbar spinal stenosis—appropriate for general orthopaedic surgeons? Int Orthop 35:67–73CrossRefPubMedGoogle Scholar
  6. 6.
    Sihvonen T, Herno A, Paljärvi L, Airaksinen O, Partanen J, Tapaninaho A (1993) Local denervation atrophy of paraspinal muscles in postoperative failed back syndrome. Spine (Phila Pa 1976) 18:575–581CrossRefGoogle Scholar
  7. 7.
    Zoidl G, Grifka J, Boluki D, Willburger RE, Zoidl C, Krämer J, Dermietzel R, Faustmann PM (2003) Molecular evidence for local denervation of paraspinal muscles in failed-back surgery/postdiscotomy syndrome. Clin Neuropathol 22:71–77PubMedGoogle Scholar
  8. 8.
    Sienkiewicz PJ, Flatley TJ (1987) Postoperative spondylolisthesis. Clin Orthop Relat Res 221:172–180Google Scholar
  9. 9.
    Mikami Y, Nagae M, Ikeda T, Tonomura H, Fujiwara H, Kubo T (2013) Tubular surgery with the assistance of endoscopic surgery via midline approach for lumbar spinal canal stenosis: a technical note. Eur Spine J 22:2105–2112CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Chatani K (2016) A novel surgical approach to the lumbar spine involving hemilateral split-off of the spinous process to preserve the multifidus muscle: technical note. J Neurosurg Spine 24:694–699CrossRefPubMedGoogle Scholar
  11. 11.
    Watanabe K, Hosoya T, Shiraishi T, Matsumoto M, Chiba K, Toyama Y (2005) Lumbar spinous process-splitting laminectomy for lumbar canal stenosis. Technical note. J Neurosurg Spine 3:405–408CrossRefPubMedGoogle Scholar
  12. 12.
    Hatta Y, Shiraishi T, Sakamoto A, Yato Y, Harada T, Mikami Y, Hase H, Kubo T (2009) Muscle-preserving interlaminar decompression for the lumbar spine: a minimally invasive new procedure for lumbar spinal canal stenosis. Spine (Phila Pa 1976) 34:E276–E280CrossRefGoogle Scholar
  13. 13.
    Yong-Hing K, Kirkaldy-Willis WH (1978) Osteotomy of lumbar spinous process to increase surgical exposure. Clin Orthop Relat Res 134:218–220Google Scholar
  14. 14.
    Maruo K, Tachibana T, Inoue S, Arizumi F, Yoshiya S (2015) Prognostic factors of surgical outcome after spinous process-splitting laminectomy for lumbar spinal stenosis. Asian Spine J 9:705–712CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Fraser RD, Hall DJ (1993) Laminectomy combined with posterolateral stabilisation: a muscle-sparing approach to the lumbosacral spine. Eur Spine J 1:249–253CrossRefPubMedGoogle Scholar
  16. 16.
    Weiner BK, Fraser RD, Peterson M (1999) Spinous process osteotomies to facilitate lumbar decompressive surgery. Spine (Phila Pa 1976) 24:62–66CrossRefGoogle Scholar
  17. 17.
    Hermansen E, Moen G, Fenstad AM, Birketvedt R, Indrekvam K (2014) Spinous process osteotomy to facilitate the access to the spinal canal when decompressing the spinal canal in patients with lumbar spinal stenosis. Asian Spine J 8:138–144CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Baghdadi YM, Moussallem CD, Shuaib MA, Clarke MJ, Dekutoski MB, Nassr AN (2016) Lumbar spinous process-splitting laminoplasty: a novel technique for minimally invasive lumbar decompression. Orthopedics 39:e950–e956CrossRefPubMedGoogle Scholar
  19. 19.
    Machado GC, Ferreira PH, Yoo RI, Harris IA, Pinheiro MB, Koes BW, van Tulder MW, Rzewuska M, Maher CG, Ferreira ML (2016) Surgical options for lumbar spinal stenosis. Cochrane Database Syst Rev 11:CD012421PubMedGoogle Scholar
  20. 20.
    Hermansen E, Romild UK, Austevoll IM, Solberg T, Storheim K, Brox JI, Hellum C, Indrekvam K (2017) Does surgical technique influence clinical outcome after lumbar spinal stenosis decompression? A comparative effectiveness study from the Norwegian Registry for Spine Surgery. Eur Spine J 26:420–427CrossRefPubMedGoogle Scholar
  21. 21.
    Kim HJ, Chun HJ, Kang KT, Lee HM, Chang BS, Lee CK, Yeom JS (2015) Finite element analysis for comparison of spinous process osteotomies technique with conventional laminectomy as lumbar decompression procedure. Yonsei Med J 56:146–153CrossRefPubMedGoogle Scholar
  22. 22.
    Keller TS, Szpalski M, Gunzburg R, Spratt KF (2003) Assessment of trunk function in single and multi-level spinal stenosis: a prospective clinical trial. Clin Biomech (Bristol, Avon) 18:173–181CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic Surgery, Spine Center, Yeungnam University Medical CenterYeungnam University College of MedicineDaeguRepublic of Korea

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