Pedicle-Lengthening Osteotomy for the Treatment of Lumbar Spinal Stenosis: the Surgical Technique (Pilot Clinical Study)

Object Lumbar spinal stenosis (LSS) may lead to disabling neurogenic symptoms and has traditionally been treated using open laminectomy. A new technique for correcting LSS involves lengthening the lumbar pedicles through bilateral percutaneous pedicle osteotomies. In this paper, the authors' goal was to evaluate the changes in spinal canal dimensions and kinematic behavior after pedicle-lengthening osteotomies. Methods The kinematic behavior of 8 cadaveric lumbar segments was evaluated intact and after bilateral pedicle-lengthening osteotomies at the L-4, L-5, and L-4 and L-5 levels. Testing was conducted with and without a compressive preload using a custom kinematic apparatus that allowed for 3D tracking of each vertebra during flexion-extension, right-left bending, and right-left rotation. A validated finite element (FE) spine model was used to measure the changes in the cross-sectional area of the spinal canal and neural foramen after 2-, 3-, and 4.5-mm simulated pedicle-lengthening osteotomy procedures. Results The overall and segmental kinematics were not significantly altered after the pedicle-lengthening osteotomy procedure at the L-4 and/or L-5 pedicles. The kinematic signatures of the intact and lengthened states were similar for all motion pairs. The FE spine model yielded kinematics predictions within or close to the 95% confidence interval for the cadaveric data. The FE spine demonstrated substantial, pedicle length–dependent enlargement of the cross-sectional areas of the spinal canal and neural foramen after simulated pedicle lengthening. Conclusions Bilateral pedicle-lengthening osteotomies produced substantial increases in the cross-sectional areas of the spinal canal and neural foramen without significantly altering normal spinal kinematics. This technique deserves further study as a less invasive treatment option for LSS.

Download Full-text

Clinical Study on the Posterior Decompression and Posterolateral Fusion with Instrumentation in Lumbar Spinal Stenosis

The Journal of the Korean Orthopaedic Association ◽

10.4055/jkoa.1992.27.1.78 ◽

1992 ◽

Vol 27 (1) ◽

pp. 78

Author(s):

Byung Jik Kim ◽

Jung Kuk Seo ◽

Jeong Han Lee

Keyword(s):

Clinical Study ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Posterolateral Fusion ◽

Posterior Decompression ◽

Lumbar Spinal

Download Full-text

Pedicle-Lengthening Osteotomy for the Treatment of Lumbar Spinal Stenosis

Spinal Canal Stenosis ◽

10.1007/978-3-319-26270-3_4 ◽

2016 ◽

pp. 75-85

Author(s):

D. Greg Anderson

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Lengthening Osteotomy ◽

Lumbar Spinal

Download Full-text

Does surgical technique influence clinical outcome after lumbar spinal stenosis decompression? A comparative effectiveness study from the Norwegian Registry for Spine Surgery

European Spine Journal ◽

10.1007/s00586-016-4643-9 ◽

2016 ◽

Vol 26 (2) ◽

pp. 420-427 ◽

Cited By ~ 9

Author(s):

Erland Hermansen ◽

Ulla Kristina Romild ◽

Ivar Magne Austevoll ◽

Tore Solberg ◽

Kjersti Storheim ◽

...

Keyword(s):

Surgical Technique ◽

Clinical Outcome ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Spine Surgery ◽

Comparative Effectiveness ◽

Effectiveness Study ◽

Comparative Effectiveness Study ◽

Lumbar Spinal

Download Full-text

Percutaneous Pedicle-Lengthening Osteotomy in Minimal Invasive Spinal Surgery to Treat Degenerative Lumbar Spinal Stenosis: A Single-Center Preliminary Experience

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0038-1641148 ◽

2018 ◽

Vol 79 (05) ◽

pp. 365-371

Author(s):

Luigi Basile ◽

Carlo Gulì ◽

Aurelia Banco ◽

Giovanna Giordano ◽

Antonella Giugno ◽

...

Keyword(s):

Minimally Invasive ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Spinal Canal ◽

Invasive Procedure ◽

High Risk Population ◽

Minimally Invasive Procedure ◽

Clinical Series ◽

Lengthening Osteotomy ◽

Lumbar Spinal

Background Lumbar spinal stenosis (LSS) is a narrowing of the spinal canal due to spinal degeneration, and its main clinical symptom is neurogenic claudication. Surgical treatment is pursued for patients who do not improve with conservative care. Patients with symptomatic LSS who also have significant medical comorbidities, although clearly in need of intervention, are unattractive candidates for traditional open lumbar decompressive procedures. Thus it is important to explore minimally invasive surgical techniques to treat select patients with LSS. Methods This retrospective case series evaluated the clinical and radiographic outcomes of a new minimally invasive procedure to treat LSS: pedicle-lengthening osteotomy using the ALTUM system ((Innovative Surgical Designs, Inc., Bloomington, Indiana, United States). Peri- and postoperative demographic and radiographic data were collected from a clinical series of seven patients with moderate LSS who were > 60 years of age. Clinical outcome was evaluated using visual analog scale (VAS) scores and the spinal canal area on computed tomography scans. Results Twelve months after the procedure, scoring revealed a median improvement of 3.7 on the VAS for the back and 6.3 on the VAS for the leg, compared with the preoperative baseline (p < 0.05). The postoperative central area of the lumbar canal was significantly increased, by 0.39 cm2; the right and left neural foramina were enlarged by 0.29 cm2 and 0.47 cm2, respectively (p < 0.05). Conclusions In this preliminary study, the ALTUM system showed a good clinical and radiologic outcome 1 year after surgery. In an older or high-risk population, a short minimally invasive procedure may be beneficial for treating LSS.

Download Full-text