Reduced postoperative wound pain after lumbar spinous process–splitting laminectomy for lumbar canal stenosis: a randomized controlled study

2011 ◽  
Vol 14 (1) ◽  
pp. 51-58 ◽  
Author(s):  
Kota Watanabe ◽  
Morio Matsumoto ◽  
Takeshi Ikegami ◽  
Yuji Nishiwaki ◽  
Takashi Tsuji ◽  
...  
Keyword(s):  
Muscle Atrophy ◽  
Spinous Process ◽  
Controlled Study ◽  
Postoperative Wound ◽  
Atrophy Rate ◽  
Canal Stenosis ◽  
Wound Pain ◽  
The Mean ◽  
Pain Analgesics ◽  
Lumbar Spinous Process

Object To reduce intraoperative damage to the posterior supporting structures of the lumbar spine during decompressive surgery for lumbar canal stenosis (LCS), lumbar spinous process–splitting laminectomy (LSPSL or split laminectomy) was developed. This prospective, randomized, controlled study was conducted to clarify whether the split laminectomy decreases acute postoperative wound pain compared with conventional laminectomy. Methods Forty-one patients with LCS were enrolled in this study. The patients were randomly assigned to either the LSPSL group (22 patients) or the conventional laminectomy group (19 patients). Questionnaires regarding wound pain (intensity, depth, and duration) and activities of daily living (ADL) were administered at postoperative days (PODs) 3 and 7. Additionally, the authors evaluated the pre- and postoperative serum levels of C-reactive protein and creatine phosphokinase, the amount of pain analgesics used during a 3-day postoperative period, and the muscle atrophy rate measured on 1-month postsurgical MR images. Results Data obtained in patients in the LSPSL group and in 16 patients in the conventional laminectomy group were analyzed. The mean visual analog scale for wound pain on POD 7 was significantly lower in the LSPSL group (16 ± 17 mm vs 34 ± 31 mm, respectively; p = 0.04). The mean depth-of-pain scores on POD 7 were significantly lower in the LSPSL group than in the conventional group (0.9 ± 0.6 vs 1.7 ± 0.8, respectively; p = 0.013). On POD 3, the mean serum creatine phosphokinase level was significantly lower in the LSPSL group (126 ± 93 U/L) than in the other group (207 ± 150 U/L) (p = 0.02); on POD 7, the mean serum C-reactive protein level was significantly lower in the LSPSL group (1.1 ± 0.6 mg/dl) than in the conventional laminectomy group (1.9 ± 1.5 mg/dl) (p = 0.04). The number of pain analgesics taken during the 3-day postoperative period was lower in the LSPSL group than in the conventional laminectomy group (1.7 ± 1.3 tablets vs 2.3 ± 2.4 tablets, respectively; p = 0.22). The mean muscle atrophy rate was also significantly lower in the LSPSL group (24% ± 15% vs 43% ± 22%; p = 0.004). Conclusions Lumbar spinous process–splitting laminectomy for the treatment of LCS reduced acute postoperative wound pain and prevented postoperative muscle atrophy compared with conventional laminectomy, possibly because of minimized damage to the paraspinal muscles.

Lumbar spinous process—splitting laminectomy for lumbar canal stenosis

2005 ◽  
Vol 3 (5) ◽  
pp. 405-408 ◽  
Author(s):  
Kota Watanabe ◽  
Toshihiko Hosoya ◽  
Tateru Shiraishi ◽  
Morio Matsumoto ◽  
Kazuhiro Chiba ◽  
...  
Keyword(s):  
Spinous Process ◽  
Paraspinal Muscles ◽  
Paravertebral Muscle ◽  
Content Type ◽  
Lumbar Canal Stenosis ◽  
Canal Stenosis ◽  
The Mean ◽  
Supporting Structures ◽  
Lumbar Spinous Process ◽  
Fine Print

✓ In conventional laminectomy for lumbar canal stenosis (LCS), intraoperative damage of posterior supporting structures can lead to irreversible atrophy of paraspinal muscles. In 2001, the authors developed a new procedure for lumbar laminectomy, the lumbar spinous process—splitting laminectomy (LSPSL). In this new procedure, the spinous process is split longitudinally in the middle and then 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 successfully decompressing nerve tissues, each half of the split spinous process is reapproximated using a strong suture. Thus, the supra- and interspinous ligaments are preserved, as is the spinous process, and damage to the paraspinal muscles is minimal. Eighteen patients with LCS underwent surgery in which this new technique was used. Twenty patients in whom conventional laminectomy was undertaken were chosen as controls. At 2 years, the clinical outcomes (as determined using the Japanese Orthopaedic Association [JOA] scores and recovery rate) and the rate of measured magnetic resonance imaging—documented paravertebral muscle atrophy were evaluated and compared between the two groups. The mean JOA score recovery rates were 67.6 and 59.2%, respectively, for patients treated with LSPSL and conventional laminectomy; the mean rates of paravertebral muscle atrophy were 5.3 and 23.9%, respectively (p = 0.0005). Preservation of posterior supporting structures and satisfactory recovery rate after 2 years indicated that this technique can be a useful alternative to conventional decompression surgery for lumbar canal stenosis.

scholarly journals Microendoscopic Decompression Surgery for Lumbar Spinal Canal Stenosis via the Paramedian Approach: Preliminary Results

2012 ◽  
Vol 2 (2) ◽  
pp. 087-093 ◽  
Author(s):  
Kazunori Nomura ◽  
Munehito Yoshida
Keyword(s):  
Spinal Canal ◽  
Spinous Process ◽  
Japanese Orthopaedic Association ◽  
Spinal Canal Stenosis ◽  
Decompression Surgery ◽  
Lumbar Spinal Canal Stenosis ◽  
Canal Stenosis ◽  
The Mean ◽  
Lumbar Spinal Canal ◽  
Lumbar Spinal

The objective of this study was to evaluate the efficacy of a microendoscopic spinal decompression surgical technique using a novel approach for the treatment of lumbar spinal canal stenosis (LSCS). The following modifications were made to the conventional microendoscopic bilateral decompression via the unilateral approach: the base of the spinous process was first resected partially to secure a working space, so as not to separate the spinous process from the lamina. The tip of the tubular retractor was placed at the midline of the lamina, where laminectomy was performed microendoscopically. A total of 126 stenotic levels were decompressed in 70 patients. The mean operating time per level was 77.0 minutes, and the mean intraoperative blood loss per level was 15.0 mL. There were no dural tears or neurological injuries intraoperatively. Fracture of the spinous process was detected postoperatively in two patients, both of whom were asymptomatic. All patients could be followed up for at least 12 months. Their median Japanese Orthopaedic Association (JOA) score improved significantly from 16 points preoperatively to 27.5 points after the surgery (p < 0.001). The case series showed that the modifications of the technique improved the safety and ease of performance of the microendoscopic decompression surgery for LSCS.

scholarly journals Surgical outcomes of modified lumbar spinous process–splitting laminectomy for lumbar spinal stenosis

2015 ◽  
Vol 22 (4) ◽  
pp. 353-357 ◽  
Author(s):  
Shunsuke Kanbara ◽  
Yasutsugu Yukawa ◽  
Keigo Ito ◽  
Masaaki Machino ◽  
Fumihiko Kato
Keyword(s):  
Blood Loss ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Muscle Atrophy ◽  
Spinous Process ◽  
Intraoperative Blood Loss ◽  
Paravertebral Muscle ◽  
Paravertebral Muscles ◽  
Lumbar Spinal ◽  
Lumbar Spinous Process

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.

scholarly journals Postoperative Wound Pain and Hospital Stay in Patients of Open Lumbar Discectomy (OLD) Versus Endoscopic Lumbar Discectomy (ELD) in Lumbar Disc Herniation (LDH)

2020 ◽  
Vol 24 (1) ◽  
Author(s):  
SYED SHAHZAD HUSSAIN ◽  
USMAN AHMED KAMBOOH ◽  
ASIF RAZA ◽  
ADIL AMIN ◽  
SAMAN SHAHID ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Lumbar Disc ◽  
Invasive Procedure ◽  
Lumbar Discectomy ◽  
Postoperative Wound ◽  
Significant Difference ◽  
Wound Pain ◽  
The Mean ◽  
Group B ◽  
Endoscopic Lumbar Discectomy

Background: Endoscopic lumbar discectomy is also beneficial regarding relieving wound pain, less hospital stay and smaller incisions. We compared visual analog scores (VAS) and hospital stay in patients treated with either endoscopic lumbar discectomy or open lumbar discectomy postoperatively.Material and Methods: Half patients underwent open lumbar discectomy – OLD (group A) and half operated with endoscopic lumbar discectomy – ELD (group B). The pain was quantified through visual analog score (VAS) observation in all patients. A preoperative medical management included prescribing a combination of an analgesic and a muscle relaxant along with physiotherapy with an avoidance of lifting heavy loads. Mann- Whitney (U) tests were applied for the comparison of postoperative VAS and hospital stay between groups.Results: 85% patients were having left sided prolapsed paracentral disc, and 15% were having right sided prolapsed paracentral disc. The mean postoperative VAS was 4 in patients treated with ELD and it was 1.32 in patients treated with OLD. The mean hospital stay was 1.5 days in ELD treatment, whereas, it was 2.5 days in OLD treatment. A significant difference (p=0.037) was found in the comparison of mean post-operative VAS between two vertebral levels (i.e., L4-L5 & L5-S1). The post-operative VAS and hospital stay (days) in ELD group were statistically significantly higher than the OLD group (p values 0.000).Conclusion: ELD procedure was effective as compared to open lumbar discectomy in terms of postoperative wound site pain and hospital stay. Endoscopic Lumbar discectomy is a minimally invasive procedure for discectomy.

scholarly journals PRELIMINARY RESULTS OF VERTEBRAL CANAL DECOMPRESSION BY SPINOUS PROCESS SPLITTING

2019 ◽  
Vol 18 (3) ◽  
pp. 231-235
Author(s):  
THIAGO DANTAS MATOS ◽  
YONY OSORIO GARCIA ◽  
HERTON RODRIGO TAVARES COSTA ◽  
HELTON LUIZ APARECIDO DEFINO
Keyword(s):  
Surgical Treatment ◽  
Spinous Process ◽  
Lower Limbs ◽  
Radiographic Evaluation ◽  
Splitting Technique ◽  
Lumbar Canal Stenosis ◽  
Preliminary Results ◽  
Canal Stenosis ◽  
Lower Limb Pain ◽  
The Mean

ABSTRACT Objective Considering that the technique of spinous process splitting has been advocated as a less invasive treatment of lumbar stenosis, the objective of this study was to evaluate the preliminary results of this technique in the surgical treatment of lumbar canal stenosis. Methods Twenty patients with lumbar spinal canal stenosis who underwent surgical treatment for lumbar canal decompression with the spinous process splitting technique were assessed in the preoperative period and on postoperative days 1, 7 and 30 for VAS for lower back and lower limbs pain and radiographic evaluation of the operated segment. Results The mean visual analogue scale score for lumbar pain in the preoperative assessment was 4.2 ± 3.37 and 0.85 ± 0.88, 1.05 ± 1.19 and 1.15 ± 1.04 after 1, 7 and 30 postoperative days, respectively. The mean VAS score for lower limb pain was 8 ± 1.72 preoperatively, and 0.7 ± 1.13, 0.85 ± 1.04, and 1.05 ± 1 after 1, 7, and 30 postoperative days, respectively. There were no radiographic signs of instability of the vertebral segment operated in the radiographic evaluation. Conclusions Decompression of the lumbar canal through the spinous process splitting technique in patients with lumbar canal stenosis had good immediate and short-term results in relation to low back and lower limbs pain. Level of evidence IV; Therapeutic Study.

scholarly journals Complications Associated with Microscopic Lumbar Spinous Process-splitting Laminectomy for Degenerative Lumbar Canal Stenosis

2015 ◽  
Vol 29 (3) ◽  
pp. 304-309
Author(s):  
Makoto Senoo ◽  
Tsukasa Sato ◽  
Daisuke Mori ◽  
Mikio Nishiya ◽  
Yasufumi Otake
Keyword(s):  
Spinous Process ◽  
Lumbar Canal Stenosis ◽  
Canal Stenosis ◽  
Lumbar Spinous Process
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