Acta Scientific Orthopaedics (ISSN: 2581-8635)

Research Article Volume 5 Issue 9

Outcome Of Decompression in Lumbar Stenosis Using Spinous Process Splitting Approach

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

References

  1. Curlee MP. “Spinal stenosis”. In Canale ST, Beaty JH Ed. Campbell's Operative Orthopaedics, 11th Philapdelphia. Mosby Elsevier (2007): 2274-2284.
  2. Tan SB. “Spinal canal stenosis”. Singapore Medical Journal 4 (2003): 168-169.
  3. Çavuşoğlu H., et al. “Midterm outcome after unilateral approach for bilateral decompression of lumbar spinal stenosis: 5-year prospective study”. European Spine Journal 12 (2007): 2133-2142.
  4. Shetty AP., et al. “Lumbar spinous process split decompression”. European Spine Journal 19 (2010): 357-358.
  5. Genevay S and Atlas SJ. “Lumbar Spinal Stenosis”. Best Practice and Research: Clinical Rheumatology 2 (2011): 253-265.
  6. Thomas SA. “Spinal stenosis: history and physical examination”. Physical Medicine and Rehabilitation Clinics of North America 14 (2003): 29-39.
  7. Binder DK., et al. “Lumbar Spinal Stenosis”. Seminars in Neurology 2 (2002): 157-165.
  8. Garfin SR., et al. “Spinal Stenosis”. The Journal of Bone and Joint Surgery 81-A (1999): 572-586.
  9. Verbiest H. “A radicular syndrome from developmental narrowing of the lumbar vertebral canal”. Journal of Bone and Joint Surgery2 (1954): 230-237.
  10. Verbiest H. “Further experiences on the Pathological influence of developmental narrowness of bony lumbar vertebral canal”. Journal of Bone and Joint Surgery 37B (1954): 576.
  11. Verbiest H. “Results of surgical treatment of idiopathic developmental stenosis of the lumbar vertebral canal-A review of twenty seven years experience”. Jounral of Bone and Joint Surgery2 (1977): 181-188.
  12. Wiltse L., et al. “The paraspinal Sacrospinalis- Splitting Approach to the Lumbar Spine”. The Journal of Bone and Joint Surgery 50-A.5 (1968): 919-926.
  13. Katz JN., et al. “The outcome of Decompressive Laminectomy for Degenerative Lumbar Stenosis”. The Journal of Bone and Joint Surgery 73-A.6-1 (1991): 809-816.
  14. Weiner BK., et al. “Microdecompression for Lumbar Spinal Canal Stenosis”. Spine21 (1999): 2268.
  15. Watanabe K., et al. “Lumbar spinous process-splitting laminectomy for lumbar canal stenosis”. Journal of Neurosurgery: Spine 5 (2005): 405-408.
  16. Troullier H. “Operative treatment for degenerative lumbar canal stenosis”. Acta Orthopaedica Belgica 70 (2004): 337-343.
  17. Deyo RA., et al. “Trends, Major Medical Complications, and Charges Associated with Surgery for Lumbar Spinal Stenosis in Older Adults”. JAMA 13 (2010): 1259-1265.
  18. Tai CL., et al. “Biomechanical comparison of lumbar spine instability between laminectomy and bilateral laminotomy for spinal stenosis syndrome-an experimental study in porcine model”. BMC Musculoskeletal Disorders 9 (2008): 2474-2484.
  19. Nellensteijn J., et al. “Transforaminal endoscopic surgery for lumbar stenosis: a systematic review”. European Spine Journal 19 (2010): 879-886.
  20. Goh KJ., et al. “The clinical syndrome associated with lumbar spinal stenosis”. European Neurology 52 (2004): 242-249.
  21. Suwa H., et al. “Postoperative changes in paraspinal muscle thickness after various lumbar back surgery procedures”. Neurologia Medico-Chirurgica (Tokyo)3 (2000): 151-154.
  22. Yukawa Y., et al. “A Comprehensive Study of Patients with Surgically Treated Lumbar Spinal Stenosis with Neurogenic Claudication”. The Journal of Bone and Joint Surgery 84 (2002): 1954-1959.
  23. Kawaguchi Y., et al. “Clinical and Radiographic Results of Expansive Lumbar Laminoplasty in Patients with Spinal Stenosis”. The Journal of Bone and Joint Surgery 87 (2005): 292-299.
  24. Weiner KB., et al. “Outcomes of decompression for lumbar spinal canal stenosis based upon preoperative radiographic severity”. Journal of Orthopaedic Surgery and Research3 (2007): 1-7.
  25. Kotil K., et al. “Serum creatine phosphokinase activity and histological changes in the multifidus muscle: a prospective randomized controlled comparative study of discectomy with or without retraction”. Journal of Neurosurgery: Spine 2 (2007): 121-125.
  26. Haig AJ., et al. “Electromyographic and Magnetic Resonance Imaging to Predict Lumbar Stenosis, Low-Back Pain, and No Back Symptoms”. The Journal of Bone and Joint Surgery 89-A (2007): 358-366.
  27. Brock M., et al. “Lumbar microdiscectomy: subperiosteal versus transmuscular approach and influence on the early postoperative analgesic consumption”. European Spine Journal 17 (2008): 518-522.
  28. Park BS., et al. “Minimally Invasive Muscle Sparing Transmuscular Microdiscectomy: Technique and Comparison with Conventional Subperiosteal Microdiscectomy during the Early Postoperative Period”. Journal of Korean Neurosurgical Society 48 (2010): 225-229.
  29. Haig AJ., et al. “A prospective, masked 18-month minimum follow-up on neurophysiologic changes in persons with spinal stenosis, low back pain, and no symptoms”. PMR2 (2009): 127-136.
  30. Datta G. “The impact of intermittent retraction on paraspinal muscle function during lumbar surgery”. Spine20 (2010): 1050-1057.
  31. Nath R., et al. “Functional outcome of surgical maganement of degenerative lumbar canal stenosis”. Indian Journal of Orthopaedics 46 (2012): 285-290.
  32. Spivak JM. “Current concepts review-Degenerative lumbar spinal stenosis”. The Journal of Bone and Joint Surgery 80-A.7 (1998): 1053-1066.
  33. Watters CW., et al. “North American Spine Society Clinical guidelines-Degenerative Spinal Stenosis; In North American Spine Society”. 1st Edition, Veterans Boulevard (2007): 1-262
  34. Gallucci M., et al. “Spinal stenosis In Goethem JWMV, Huawe L, Parizel P.M ed. Spinal imaging: Diagnostic imaging of spine and spinal cord”. 1st New York. Springer (2007): 185-211.
  35. Sirvanci M., et al. “Degenerative lumbar spinal stenosis: correlation with Oswestry Disability Index and MR Imaging”. European Spine Journal 17 (2008): 679-685.
  36. Steurer J., et al. “LumbSten: The lumbar spinal stenosis outcome Study”. BMC Musculoskeletal Disorders 11 (2010): 254.
  37. Fritz JM., et al. “Preliminary results of the use of a two-stage treadmill test as a clinical diagnostic tool in the differential diagnosis of lumbar spinal stenosis”. Journal of Spinal Disorders 5 (1997): 410-416.
  38. Barz T., et al. “The diagnostic value of a treadmill test in predicting lumbar spinal stenosis”. European Spine Journal 17 (2008): 686-690.
  39. Deen HG., et al. “Test-Retest reproducibility of the Exercise Treadmill Examination in Lumbar Spinal Stenosis”. Mayo Clinic Proceedings 75 (2000): 1002-1007.
  40. Tomkins CC., et al. “A criterion measure of walking capacity in lumbar spinal stenosis and its comparison with a treadmill protocol”. Spine 22 (2009): 2444-2449.
  41. Haig AJ., et al. “Electromyographic and Magnetic Resonance Imaging to Predict Lumbar Stenosis, Low-Back Pain, and No Back Symptoms”. The Journal of Bone and Joint Surgery 89 -A (2007): 358-366.
  42. Yuan PS and Albert TJ. “Nonsurgical and Surgical Management of Lumbar Spinal Stenosis”. The Journal of Bone and Joint Surgery 86 (2004): 2319-2330.
  43. Mazanec DJ., et al. “Lumbar canal stenosis: Start with nonsurgical therapy”. Cleveland Clinic Journal of Medicine 11 (2002): 909-917.
  44. Whitman MJ., et al. “Non surgical management of patients with lumbar spinal stenosis: a literature review and a case series of three patients managed with physical therapy”. Physical Medicine and Rehabilitation Clinics of North America 14 (2003): 77-101.
  45. Ishimoto Y., et al. “Prevalence of symptomatic lumbar spinal stenosis and its association with physical performance in a population-based cohort in Japan: the Wakayama Spine Study”. Osteoarthritis Cartilage10 (2012): 1103-1108.
  46. Fukui M., et al. “Japanese Orthopaedic Association back pain evaluation questionnaire. Verification of its reliability”. Journal of Orthopaedic Science 12 (2007): 526-532.
  47. Keller RB., et al. “Relationship Between Rates and Outcomes of Operative Treatment for Lumbar Disc Herniation and Spinal Stenosis”. Journal of Bone and Joint Surgery (1999): 752-762.
  48. Haro H., et al. “Prospective analysis of clinical evaluation and self-assessment by patients after decompression surgery for degenerative lumbar canal stenosis”. Spine Journal2 (2008): 380-384.
  49. G Costanzo., et al. “The role of JOA score as an indication for surgical or conservative treatment of symptomatic degenerative lumbar spinal stenosis”. Journal of Orthopaedics and Traumatology3 (2005): 150-153.
  50. Abbas J., et al. “Degenerative lumbar spinal stenosis and lumbar spine configuration”. European Spine Journal 19 (2010): 1865-1873.

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.




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