Lumbar spinal stenosis successfully treated with lumbar spinous process-splitting laminoplasty

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A new study published online by the Journal of Neurosurgery has shown encouraging results for the use of a modified lumbar spinous process–splitting laminectomy (LSPSL) in which laminoplasty is performed as an alternative to lumbar laminectomy to treat lumbar spinal stenosis

Led by Shunsuke Kanbara, Chutoen General Medical Center, Shizuoka, Japan, the study used a modified version of the LSPSL procedure in which laminoplasty is performed instead of laminectomy. The study was conducted to analyse the efficacy of a procedure, which according to Kanbara and colleagues, “allows for better exposure of intraspinal nerve tissues, comparable to that achieved by conventional laminectomy while minimising damage to posterior supporting structures.”

Forty-seven patients with lumbar spinal stenosis were enrolled. Twenty-six patients underwent modified LSPSL and 21 patients underwent conventional laminectomy. Intraoperative blood loss and surgical duration were evaluated, while the Japanese Orthopaedic Association (JOA) scale scores were used to assess parameters before surgery and 12 months after surgery. The recovery rates of the patients were also evaluated. Postoperative paravertebral muscle atrophy was assessed using MRI and bone union rates between the split spinous process and residual laminae were also examined.

Mean surgical time and intraoperative blood loss were similar, at 25.7 minutes and 42.4ml per one level in modified LSPSL and 22.7 minutes and 29.5ml in conventional laminectomy, as were the recovery rates of the JOA score, at 64.2% in modified LSPSL and 68.7% in conventional laminectomy. The degree of paravertebral muscle atrophy was significantly lower in the modified LSPSL procedure at 7.8%, compared to 22.2% in conventional laminectomy at 12 months after surgery (p<0.05). Fusion of the spinous process with the arcus vertebrae was also shown to be effective in the modified LSPSL procedure, measured at 56.3% and 81.3% 6 and 12 months 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,” conclude the authors.