Bharath R*, Shaival C, Sharan P and Purushotam L

Department of Orthopaedics, Mithra Multispeciality Hospital, India

*Corresponding Author: Bharath R, Department of Orthopaedics, Mithra Multispeciality Hospital, India.

Received: August 11, 2022; Published: August 26, 2022

Abstract

Aim of Study: The functional outcome following decompression surgery using the spinous process splitting approach, to assess the integrity of the paraspinal muscles after surgery and assess the fusion of the split spinous processes after they are sutured together

Material and Methodology

Preoperative plan: History was taken followed by clinical examination. Pre- operative scores were assessed Oswestry Disability Index(ODI), Japanese Orthopaedic Association(JOA) scoring system and Visual Analog Scale(VAS). Tests such as Tread mill test and electromyography studies of the involved segment were done. Radiographs of lumbosacral spine AP/lateral/flexion and extension views and MRI of spine were performed. Blood parameters CPK levels were done. Informed consent taken

Surgical Procedure: With the patient prone, the level of decompression is marked. The spinous process is split longitudinally in the middle and divided at its base from the posterior arch, leaving the bilateral paraspinal muscles attached to the lateral aspects. Ample working space for laminectomy is obtained by retracting the split spinous process laterally together with its attached paraspinal muscles. After successful decompression the two halves of the spinous process is re-sutured using a suture.

Post op protocol: Post operatively patients were evaluated for paraspinal muscle damage using CPK levels - 1hour and 48 hours post surgery. The patients were reviewed 1month, 3months and 6 months after surgery. The functional outcome was evaluated with Oswestry Disability Index, Japanese Orthopaedic Association scoring system, Visual Analogue Scale and a Tread-Mill test.

At 3 months the patients underwent electromyogram of paraspinal muscles. This was followed by a limited section computer tomography scan at 6 months to assess the fusion of the spinous process.

Results: Level of stenosis was most commonly seen at L3-L4 level. CPK levels compared to pre-operative, increased immediately during the post operative phase and started to decline by 48 hours. No change in the paraspinal muscles when compared between pre operative and 3 months post operative muscle status. Tread mill test showed the patient’s duration of walking improved with time after the procedure. The patients walked for a greater duration at their own speed when compared to a fixed speed of 1.2mph after the surgical procedure. The patients assessed for pain showed that VAS increased post operatively but reduced with time. The functional outcome assessed using JOA score and the impairment of disability measured using ODI showed improvement.

Union rates were lesser in the above 50 age group though the functional outcomes were the same in whom spine was united and those with uniting spinous processes.

Conclusions: The lumbar spinal canal splitting approach offers the advantages of a wider surgical working space. The damage to the muscles and ligaments are minimal. Insignificant denervation of muscles was present. Union rates were higher in younger age group. Decompression achieved by this method was good in both unilateral and bilateral stenosis when involving one level.

Keywords: Decompression; Lumbar Stenosis; Spinous

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Citation

Citation: Bharath R., et al. “Outcome Of Decompression in Lumbar Stenosis Using Spinous Process Splitting Approach". Acta Scientific Orthopaedics 5.9 (2022): 106-114.

Copyright

Copyright: © 2022 Bharath R., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.