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Erschienen in: European Spine Journal 7/2018

21.02.2018 | Original Article

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

verfasst von: Gun Woo Lee, Myun-Whan Ahn

Erschienen in: European Spine Journal | Ausgabe 7/2018

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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.
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Literatur
1.
Zurück zum Zitat Benz RJ, Garfin SR (2001) Current techniques of decompression of the lumbar spine. Clin Orthop Relat Res 384:75–81CrossRef Benz RJ, Garfin SR (2001) Current techniques of decompression of the lumbar spine. Clin Orthop Relat Res 384:75–81CrossRef
2.
Zurück zum Zitat 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, Chichester 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, Chichester
3.
Zurück zum Zitat Weiner BK, Walker M, Brower RS, McCulloch JA (1999) Microdecompression for lumbar spinal canal stenosis. Spine (Phila Pa 1976) 24:2268–2272CrossRef Weiner BK, Walker M, Brower RS, McCulloch JA (1999) Microdecompression for lumbar spinal canal stenosis. Spine (Phila Pa 1976) 24:2268–2272CrossRef
4.
Zurück zum Zitat 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 65:100–110CrossRefPubMed 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 65:100–110CrossRefPubMed
5.
Zurück zum Zitat 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 35:67–73CrossRefPubMed 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 35:67–73CrossRefPubMed
6.
Zurück zum Zitat 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) 18:575–581CrossRef 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) 18:575–581CrossRef
7.
Zurück zum Zitat 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 22:71–77PubMed 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 22:71–77PubMed
8.
Zurück zum Zitat Sienkiewicz PJ, Flatley TJ (1987) Postoperative spondylolisthesis. Clin Orthop Relat Res 221:172–180 Sienkiewicz PJ, Flatley TJ (1987) Postoperative spondylolisthesis. Clin Orthop Relat Res 221:172–180
9.
Zurück zum Zitat 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 22:2105–2112CrossRefPubMedPubMedCentral 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 22:2105–2112CrossRefPubMedPubMedCentral
10.
Zurück zum Zitat 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 24:694–699CrossRefPubMed 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 24:694–699CrossRefPubMed
11.
Zurück zum Zitat 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 3:405–408CrossRefPubMed 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 3:405–408CrossRefPubMed
12.
Zurück zum Zitat 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–E280CrossRef 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–E280CrossRef
13.
Zurück zum Zitat Yong-Hing K, Kirkaldy-Willis WH (1978) Osteotomy of lumbar spinous process to increase surgical exposure. Clin Orthop Relat Res 134:218–220 Yong-Hing K, Kirkaldy-Willis WH (1978) Osteotomy of lumbar spinous process to increase surgical exposure. Clin Orthop Relat Res 134:218–220
14.
Zurück zum Zitat 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 9:705–712CrossRefPubMedPubMedCentral 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 9:705–712CrossRefPubMedPubMedCentral
15.
Zurück zum Zitat Fraser RD, Hall DJ (1993) Laminectomy combined with posterolateral stabilisation: a muscle-sparing approach to the lumbosacral spine. Eur Spine J 1:249–253CrossRefPubMed Fraser RD, Hall DJ (1993) Laminectomy combined with posterolateral stabilisation: a muscle-sparing approach to the lumbosacral spine. Eur Spine J 1:249–253CrossRefPubMed
16.
Zurück zum Zitat Weiner BK, Fraser RD, Peterson M (1999) Spinous process osteotomies to facilitate lumbar decompressive surgery. Spine (Phila Pa 1976) 24:62–66CrossRef Weiner BK, Fraser RD, Peterson M (1999) Spinous process osteotomies to facilitate lumbar decompressive surgery. Spine (Phila Pa 1976) 24:62–66CrossRef
17.
Zurück zum Zitat 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 8:138–144CrossRefPubMedPubMedCentral 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 8:138–144CrossRefPubMedPubMedCentral
18.
Zurück zum Zitat 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–e956CrossRefPubMed 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–e956CrossRefPubMed
19.
Zurück zum Zitat 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:CD012421PubMed 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:CD012421PubMed
20.
Zurück zum Zitat 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 26:420–427CrossRefPubMed 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 26:420–427CrossRefPubMed
21.
Zurück zum Zitat 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 56:146–153CrossRefPubMed 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 56:146–153CrossRefPubMed
22.
Zurück zum Zitat 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) 18:173–181CrossRef 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) 18:173–181CrossRef
Metadaten
Titel
Comparative study of two spinous process (SP) osteotomy techniques for posterior decompression surgery in lumbar spinal stenosis: SP base versus splitting osteotomy
verfasst von
Gun Woo Lee
Myun-Whan Ahn
Publikationsdatum
21.02.2018
Verlag
Springer Berlin Heidelberg
Erschienen in
European Spine Journal / Ausgabe 7/2018
Print ISSN: 0940-6719
Elektronische ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-018-5526-z

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