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Spinous process-splitting open pedicle screw fusion provides favorable results in patients with low back discomfort and pain compared to conventional open pedicle screw fixation over 1 year after surgery

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Abstract

Introduction

The conventional open pedicle screw fusion (PSF) requires an extensive detachment of the paraspinal muscle from the posterior aspect of the lumbar spine, which can cause muscle injury and subsequently lead to “approach-related morbidity”. The spinous process-splitting (SPS) approach for decompression, unilateral laminotomy for bilateral decompression, and the Wiltse approach for pedicle screw insertion are considered to be less invasive to the paraspinal musculature. We investigated whether SPS open PSF combined with the abovementioned techniques attenuates the paraspinal muscle damage and yields favorable clinical results, including alleviation in the low back discomfort, in comparison to the conventional open PSF.

Methods

We studied 53 patients who underwent single-level PSF for the treatment of degenerative spondylolisthesis (27 patients underwent SPS open PSF and the other 26 underwent the conventional open PSF). The clinical outcomes were assessed using the Japanese Orthopedic Association (JOA) score, the Roland–Morris disability questionnaire (RDQ), and the visual analog scale (VAS) for low back pain and low back discomfort (heavy feeling or stiffness). Postoperative multifidus (MF) atrophy was evaluated using MRI. Follow-up examinations were performed at 1 and 3 years after the surgery.

Results

Although there was no significant difference in the JOA and RDQ score between the two groups, the VAS score for low back pain and discomfort after the surgery were significantly lower in the SPS open PSF group than in the conventional open PSF group. The extent of MF atrophy after SPS open PSF was reduced more significantly than after the conventional open PSF during the follow-up. The MF atrophy ratio was found to correlate with low back discomfort at the 1-year follow-up examination.

Conclusion

In conclusion, SPS open PSF was less damaging to the paraspinal muscle than the conventional open PSF and had a significant clinical effect, reducing low back discomfort over 1 year after the surgery.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Spinal Injuries Center, 550-4 Igisu, Iizuka, Fukuoka, 820-8508, Japan

    Eiji Mori, Takayoshi Ueta, Yugue Itaru, Takeshi Maeda, Osamu Kawano & Keiichiro Shiba

  2. Department of Orthopaedic Surgery, Kyushu University, Graduate School of Medicine, 3-1-1 Maedashi Higashi-ku, Fukuoka, 812-8582, Japan

    Seiji Okada

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  1. Eiji Mori
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  2. Seiji Okada
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  3. Takayoshi Ueta
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  4. Yugue Itaru
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  5. Takeshi Maeda
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  6. Osamu Kawano
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  7. Keiichiro Shiba
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Correspondence to Eiji Mori.

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Mori, E., Okada, S., Ueta, T. et al. Spinous process-splitting open pedicle screw fusion provides favorable results in patients with low back discomfort and pain compared to conventional open pedicle screw fixation over 1 year after surgery. Eur Spine J 21, 745–753 (2012). https://doi.org/10.1007/s00586-011-2146-2

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  • DOI: https://doi.org/10.1007/s00586-011-2146-2

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