Comparison of Modified Marmot Surgery and Lumbar Spinous Process Splitting Laminectomy in Lumbar Spinal Stenosis: Two-Year Outcomes

The lumbar spinous process–splitting laminectomy (LSPSL) procedure was developed as an alternative to lumbar laminectomy. In the LSPSL procedure, the spinous process is evenly split longitudinally and then divided at its base from the posterior arch, leaving the bilateral paravertebral muscle attached to the lateral aspects. This procedure allows for better exposure of intraspinal nerve tissues, comparable to that achieved by conventional laminectomy while minimizing damage to posterior supporting structures. In this study, the authors make some modifications to the original LSPSL procedure (modified LSPSL), in which laminoplasty is performed instead of laminectomy. The purpose of this study was to compare postoperative outcomes in modified LSPSL with those in conventional laminectomy (CL) and to evaluate bone unions between the split spinous process and residual laminae following modified LSPSL. Forty-seven patients with lumbar spinal stenosis were enrolled in this study. Twenty-six patients underwent modified LSPSL and 21 patients underwent CL. Intraoperative blood loss and surgical duration were evaluated. The Japanese Orthopaedic Association (JOA) scale scores were used to assess parameters before surgery and 12 months after surgery. The recovery rates were also evaluated. Postoperative paravertebral muscle atrophy was assessed using MRI. Bone union rates between the split spinous process and residual laminae were also examined. The mean surgical time and intraoperative blood loss were 25.7 minutes and 42.4 ml per 1 level in modified LSPSL, respectively, and 22.7 minutes and 29.5 ml in CL, respectively. The recovery rate of the JOA score was 64.2% in modified LSPSL and 68.7% in CL. The degree of paravertebral muscle atrophy was 7.8% in modified LSPSL and 22.2% in CL at 12 months after surgery (p < 0.05). The fusion rates of the spinous process with the arcus vertebrae at 6 and 12 months in modified LSPSL were 56.3% and 81.3%, respectively. The modified LSPSL procedure was less invasive to the paravertebral muscles and could be a laminoplasty; therefore, the modified LSPSL procedure presents an effective alternative to lumbar laminectomy.

Download Full-text

Post-Operative Spinal Epidural Hematoma after Thoracic and Lumbar Spinous Process-Splitting Laminectomy for Thoracic and Lumbar Spinal Stenosis

Spine Surgery and Related Research ◽

10.22603/ssrr.2018-0086 ◽

2019 ◽

Vol 3 (3) ◽

pp. 244-248

Author(s):

Yawara Eguchi ◽

Munetaka Suzuki ◽

Takashi Sato ◽

Hajime Yamanaka ◽

Hiroshi Tamai ◽

...

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Epidural Hematoma ◽

Spinous Process ◽

Spinal Epidural Hematoma ◽

Lumbar Spinal ◽

Spinal Epidural ◽

Lumbar Spinous Process

Download Full-text

Comparable increases in dural sac area after three different posterior decompression techniques for lumbar spinal stenosis: radiological results from a randomized controlled trial in the NORDSTEN study

European Spine Journal ◽

10.1007/s00586-020-06499-0 ◽

2020 ◽

Vol 29 (9) ◽

pp. 2254-2261

Author(s):

Erland Hermansen ◽

Ivar Magne Austevoll ◽

Christian Hellum ◽

Kjersti Storheim ◽

Tor Åge Myklebust ◽

...

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Controlled Trial ◽

Spinous Process ◽

Surgical Techniques ◽

Posterior Decompression ◽

Clinical Trial Registration ◽

Dural Sac ◽

Radiological Results ◽

Lumbar Spinal

Abstract Purpose To investigate changes in dural sac area after three different posterior decompression techniques in patients undergoing surgery for lumbar spinal stenosis. Summary of background data Decompression of the nerve roots is the main surgical treatment for lumbar spinal stenosis. The aim of this study was to radiologically investigate three commonly used posterior decompression techniques. Methods The present study reports data from one of two multicenter randomized trials included in the NORDSTEN study. In the present trial, involving 437 patients undergoing surgery, we report radiological results after three different midline retaining posterior decompression techniques: unilateral laminotomy with crossover (UL) (n = 146), bilateral laminotomy (BL) (n = 142) and spinous process osteotomy (SPO) (n = 149). MRI was performed before and three months after surgery. The increase in dural sac area and Schizas grade at the most stenotic level was evaluated. Three different predefined surgical indicators of substantial decompression were used: (1) postoperative dural sac area of > 100 mm2, (2) increase in the dural sac area of at least 50% and (3) postoperative Schizas grade A or B. Results No differences between the three surgical groups were found in the mean increase in dural sac area. Mean values were 66.0 (SD 41.5) mm2 in the UL-group, 71.9 (SD 37.1) mm2 in the BL-group and 68.1 (SD 41.0) mm2 in the SPO-group (p = 0.49). No differences in the three predefined surgical outcomes between the three groups were found. Conclusion For patients with lumbar spinal stenosis, the three different surgical techniques provided the same increase in dural sac area. Clinical trial registration The study is registered at ClinicalTrials.gov reference on November 22th 2013 under the identifier NCT02007083.

Download Full-text

Spinous Process Distractive Devices for Lumbar Spinal Stenosis

Minimally Invasive Spine Surgery ◽

10.3109/9781420013962-35 ◽

2007 ◽

pp. 353-364

Author(s):

Dimitriy Kondrashov ◽

Ken Y. Hsu ◽

James F. Zucherman

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Spinous Process ◽

Lumbar Spinal

Download Full-text

Modified Marmot Operation Versus Spinous Process Transverse Cutting Laminectomy for Lumbar Spinal Stenosis

Spine ◽

10.1097/brs.0b013e31829ff4ae ◽

2013 ◽

Vol 38 (23) ◽

pp. E1461-E1468 ◽

Cited By ~ 6

Author(s):

Mamoru Kawakami ◽

Shin-ichi Nakao ◽

Daisuke Fukui ◽

Yasunori Kadosaka ◽

Toshiko Matsuoka ◽

...

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Spinous Process ◽

Lumbar Spinal

Download Full-text

Spinous Process Osteotomy to Facilitate the Access to the Spinal Canal When Decompressing the Spinal Canal in Patients with Lumbar Spinal Stenosis

Asian Spine Journal ◽

10.4184/asj.2014.8.2.138 ◽

2014 ◽

Vol 8 (2) ◽

pp. 138 ◽

Cited By ~ 2

Author(s):

Erland Hermansen ◽

Gunnar Moen ◽

Anne Marie Fenstad ◽

Rune Birketvedt ◽

Kari Indrekvam

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Spinal Canal ◽

Spinous Process ◽

Lumbar Spinal

Download Full-text

Modified fenestration with restorative spinoplasty for lumbar spinal stenosis

Journal of Neurosurgery Spine ◽

10.3171/2009.2.spine08358 ◽

2009 ◽

Vol 10 (6) ◽

pp. 587-594 ◽

Cited By ~ 6

Author(s):

Ko Matsudaira ◽

Takashi Yamazaki ◽

Atsushi Seichi ◽

Kazuto Hoshi ◽

Nobuhiro Hara ◽

...

Keyword(s):

Intermittent Claudication ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Spinal Canal ◽

Spinous Process ◽

Easy Access ◽

Facet Joints ◽

Neurogenic Intermittent Claudication ◽

Lumbar Spinal

The authors developed an original procedure, modified fenestration with restorative spinoplasty (MFRS) for the treatment of lumbar spinal stenosis. The first step is to cut the spinous process in an L-shape, which is caudally reflected. This procedure allows easy access to the spinal canal, including lateral recesses, and makes it easy to perform a trumpet-style decompression of the nerve roots without violating the facet joints. After the decompression of neural tissues, the spinous process is anatomically restored (spinoplasty). The clinical outcomes at 2 years were evaluated using the Japanese Orthopaedic Association (JOA) scale and patients' satisfaction. Radiological follow-up included radiographs and CT. Between January 2000 and December 2002, 109 patients with neurogenic intermittent claudication with or without mild spondylolisthesis underwent MFRS. Of these, 101 were followed up for at least 2 years (follow-up rate 93%). The average score on the self-administered JOA scale in 89 patients without comorbidity causing gait disturbance improved from 13.3 preoperatively to 22.9 at 2 years' follow-up. Neurogenic intermittent claudication disappeared in all cases. The patients' assessment of treatment satisfaction was “satisfied” in 74 cases, “slightly satisfied” in 12, “slightly dissatisfied” in 2, and “dissatisfied” in 1 case. In 16 cases (18%), a minimum progression of slippage occurred, but no symptomatic instability or recurrent stenosis was observed. Computed tomography showed that the lateral part of the facet joints was well preserved, and the mean residual ratio was 80%. The MFRS technique produces an adequate and safe decompression of the spinal canal, even in patients with narrow and steep facet joints in whom conventional fenestration is technically demanding.

Download Full-text

Neural Decompression by Laminectomy with Spinoplasty for Lumbar Spinal Stenosis

Nepal Orthopaedic Association Journal ◽

10.3126/noaj.v1i1.8127 ◽

2013 ◽

Vol 1 (1) ◽

Author(s):

RK Pokharel ◽

K Kafle ◽

RL Pradhan ◽

LL Shah

Keyword(s):

Back Pain ◽

Conservative Treatment ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Spinous Process ◽

Radicular Pain ◽

Lower Limbs ◽

Neurogenic Claudication ◽

Neural Tissues ◽

Lumbar Spinal

BACKGROUND Lumbar spinal stenosis is one of the common morbid conditions of adult population. Surgical intervention is recommended if conservative treatment is not effective. Aim of the surgery is to decompress neural tissues and it may vary from simple unilateral foraminotomy or laminotomy to multilevel bilateral laminectomy. Conventional laminectomy violates posterior stability and foraminotomy limits access to the neural tissues. Different techniques have been developed for adequate decompression with preservation of posterior stabilizing structures. METHODS Degenerative lumbar spinal stenosis in 22 cases was treated by laminectomy with spinous process osteotomy and re-positioning during October 2007 to August 2009. All cases had back pain with radicular pain and intermittent neurogenic claudication. Average age of the cases was 49.5 years and the average duration of symptom was 7 months. Conservative treatment was tried for 4 months. Average follow up period was 2.5 months. RESULTS Post operatively 82% of the cases were satisfied. There was no radicular pain and intermittent claudication in all cases. Persistence of back pain and numbness in lower limbs was common complaints of majority of the cases. CONCLUSION “Laminectomy with spinous process osteotomy and re-positioning” technique easily decompresses lumbar spinal stenosis with preservation of posterior osteo-ligamentous structure. DOI: http://dx.doi.org/10.3126/noaj.v1i1.8127 Nepal Orthopaedic Association Journal Vol.1(1) 2010

Download Full-text