A Novel Technique of Spinous Process Splitting Approach in Microscopic Spinal Decompression Surgery for Lumbar Canal Stenosis: An Outcome Study

Presented at SMISS Annual Forum 2018
By Ashish Jaiswal FNB, MS
With

Disclosures: Ashish Jaiswal FNB, MS None

Introduction:

Conventional decompression of lumbar canal stenosis sacrifices the midline osseoligamentous structure of spine which is crucial for structural stability of spine and also important for optimal functioning of paraspinal muscles. There has been constant endeavor to retain this important structure through various modifications of surgical technique. Spinous process splitting is one such useful technique in achieving adequate decompression for lumbar canal stenosis with reconstitution of midline osseoligamentous structure.

Aims/Objectives:

This study was undertaken to analyse the clinical and functional outcome of this novel technique.

Methods:

Forty patients with lumbar canal stenosis satisfying the inclusion criteria underwent decompression by spinous process splitting approach. Visual analogue scale for back pain, Oswestry disability index for low back pain, Japanese Orthopaedic Association score were assessed pre and post operatively. Operative time, blood loss and hospital stay were also noted.

Results:

Mean age of the patients in the study group was 54.27±14.0 yrs. Male to female sex ratio was 1.6. The mean number of decompression levels was 1.2 intervertebral levels (range, 1-3 levels; 1 level in 28 patients, 2 levels in 11 patients and 3 levels in 1 patient). The average operating time was 72.66±28.9 minutes. The average intraoperative blood loss was 77±99 ml. Average duration of hospital stay was 3.94±4.6 days. Mean follow up period was 9.6±3.7 months. The mean pre- and final follow up VAS of leg pain scores were 7.9±0.7 and 0.78±1.130 respectively. The mean pre- and final follow up VAS of back pain scores were 5.5±0.74 and 1.24±0.8 respectively. The mean pre- and final follow up ODI scores were 65.94 ±6. 8 and 19.02±8.9 respectively. The mean pre- and final follow up JOA scores were 10.1±4.4 and 22.32±1.97 respectively. The mean JOA recovery rate was 65.28 ± 8.5. Excellent or good outcome was seen in 82.5% of patients.

Conclusions:

Spinous process splitting approach achieves effective central and lateral decompression in lumbar canal stenosis with minimal damage to paraspinal muscles and allows reconstitution of midline osseoligamentous structure. This method is a viable alternative to conventional decompressive surgeries.