Spinous Process Osteotomy Research Articles

Effect of different interventions on lumbar spinal stenosis: a systematic evaluation and network meta-analysis

BackgroundSurgery is the preferred option for lumbar spinal stenosis (LSS) when conservative methods cannot meet the needs. Recent advancements in surgical techniques have brought various new methods for treating LSS. MethodFour databases, PubMed, Embase, the Cochrane Library, and Web of Science, were searched, covering the period from the establishment of the databases until May 2024. Randomized controlled trials (RCTs) were carried out to treat LSS using different surgical approaches. The outcome measures included the visual analogue scale (VAS) score, Oswestry disability index (ODI) score, surgical duration, intraoperative blood loss, and length of hospital stay of patients. Bayesian random-effects network meta-analysis (NMA) was performed using R software (V4.4) and STATA17.0 software to analyze each surgical approach. ResultsA total of 29 studies involving 4,200 patients were included. Nine intervention methods, including laminotomy, decompression, decompression plus fusion (DPF), endoscopic decompression, interspinous process spacer device (IPSD), laminectomy, minimally invasive decompression (MID), spinous process osteotomy (SPO), and lumbar interbody fusion (LIF), were analyzed. NMA results indicated that endoscopic decompression (SUCRA=88.70%) was the most effective in reducing short-term back VAS scores. IPSD (SUCRA=98.00%) was the most effective in reducing long-term back VAS scores, surgical duration (SUCRA=95.20%), and intraoperative blood loss (SUCRA=100.00%). Endoscopic decompression (SUCRA=83.60%) also showed the most significant effect in reducing hospital stays. ConclusionEndoscopic decompression can effectively improve short-term back VAS scores and reduce hospital stays, while IPSD is effective in reducing long-term back VAS scores with minimal surgical duration and blood loss.

A randomized trial on three different minimally invasive decompression techniques for lumbar spinal stenosis. Five years follow-up from the NORDSTEN-SST.

The short-term clinical outcome for midline-preserving posterior decompression techniques was comparable. The aim of this study was to evaluate long-term clinical results after three different midline-preserving posterior decompression techniques. In the NORDSTEN spinal stenosis trial (NORDSTEN-SST) 437 patients were randomized to three different midline-retaining posterior decompression techniques: Unilateral laminotomy with crossover (UL), bilateral laminotomy (BL) and spinous process osteotomy (SPO). Primary outcome was the mean change in Oswestry disability index (ODI) score at five-years follow-up. Secondary outcomes were the proportion of patients classified as success, mean change in EQ-5D, ZCQ-score, NRS-score for leg and low back pain, a seven-point Global Perceived Effect (GPE) Scale and proportion of subsequential spinal surgery. The number of patients that completed follow-up data after five years was 358 (82%): In the UL, BL and SPO group the numbers were 122, 119 and 117, respectively. Mean age at baseline was 66.7 (SD 8.2) years, mean BMI was 27.8 (SD 4.1), and 172/358 (48%) were female. In the UL group the mean change was -18.2 (95% CI -21.0 -5.4), in the BL group it was -19.0 (95% CI -21.9-16.1) and in the SPO it was -18.6 (95% CI -21.6-15.7) (p = 0.917). No significant differences in the secondary outcomes between the three surgical groups were found, also the subsequent spinal surgery rates were similar. There were no significant differences in patient reported outcomes and subsequent spinal surgery rates after the three different decompression techniques at five-year follow-up.

The Influence of Spinous Process Union on Clinical Outcomes After Spinous Process Osteotomy for Lumbar Spinal Stenosis After 2 Years: A Secondary Analysis From the NORDSTEN-Study.

Lumbar spinal stenosis is a prevalent and increasingly important cause of low back pain, leg pain, and walking impairment. Minimally invasive decompressive techniques such as spinous process (SP) osteotomy have become more common in recent years. The main aim of this study was to investigate the proportion of complete SP union and whether complete radiological healing after the osteotomy is associated with superior clinical outcome after 2 years. In this retrospective cohort study, 149 patients were included from the Spinal Stenosis Trial, a part of the NORwegian Degenerative spondylolisthesis and spinal STENosis study. Computed tomography imaging was performed 2 years postoperatively. The number of osteotomies and the number of SP unions were recorded. Patients were divided into groups based on the degree of union: nonunion, partial union, and complete union. Rate of success (>30% improvement in Oswestry Disability Index [ODI]) and mean change in ODI were the primary outcome measures. We compared the differences between baseline and follow-up between the Degree of Union groups. The study included 102 of 149 eligible patients. Ten patients (9.8%) were classified as having nonunion, 15 (14.7%) as having partial union, and 77 (75.5%) as having complete union. Of the 155 osteotomies, there were 122 classified as union (77%). The success rate was 74%, with no influence of SP union. The mean change in the ODI was -20.1 (95% CI -37.0, 14.2) with no influence of SP union. We found no influence of SP union, classified by computed tomography, on clinical outcome 2 years after SP osteotomy in patients with lumbar spinal stenosis. Supplying useful information about SPO to assist surgeons in the choice of decompressive technique.

Prolapsed Lumbar Intervertebral Disc (PLID) Surgery and Our Experiences

Background: Herniated lumbar disc is the most common specific cause of low back pain. Surgery results in better outcome for cases with exclusive severe radicular pain and health-related quality of life improves after lumbar disc herniation (LDH) surgery. Objective: To determine the outcome of lumbar disc herniation surgery and to assess the effect of factors that could predict the outcome of surgery. Materials and method: This observational study was done in Delta Medical College & Hospital, Mirpur, Dhaka, during March 2016 to January 2019. We evaluated 54 patients who had undergone operations for lumbar disc herniation using three different surgical techniques (laminectomy, fenestration and discectomy, and spinous process osteotomy) for low back pain and radicular pain. Results: Forty six (85.19%) patients were male and 8(14.81%) were female. Age range was 18-60 years. Forty nine (90.74%) were new patient and 5(9.26%) had recurrent disc prolapse. Diagnosis was confirmed by MRI. Fifty (92.59%) patients had no pain after surgery and only 2(3.70%) patients needed reoperation and 2(3.70%) had occasional pain. Conclusion: Surgery for lumbar disc herniation is effective in reducing radicular pain. All three surgical approaches resulted in significant decrease in preoperative radicular pain and low back pain, but 100% good outcome was not achieved. Delta Med Col J. Jan 2021;9(1): 28-32

Introduction of a Novel Sequential Approach to the Ponte Osteotomy to Minimize Spinal Canal Exposure

Ponte osteotomy is an increasingly popular technique for multiplanar correction of adolescent idiopathic scoliosis. Prior cadaveric studies have suggested that sequential posterior spinal releases increase spinal flexibility. Here we introduce a novel technique involving a sequential approach to the Ponte osteotomy that minimizes spinal canal exposure. One fresh-frozen adult human cadaveric thoracic spine specimen with 4 cm of ribs was divided into three sections (T1-T5, T6-T9, T10-L1) and mounted for biomechanical testing. Each segment was loaded with five Newton meters under four conditions: baseline inferior facetectomy with supra/interspinous ligament release, superior articular process (SAP) osteotomy in situ, spinous process (SP) osteotomy in situ, and complete posterior column osteotomy with SP/SAP excision and ligamentum flavum release (PCO). Compared to baseline, in situ SAP osteotomy alone provided 3.5%, 7.6%, and 7.2% increase in flexion/extension, lateral bending, and axial rotation, respectively. In situ SP osteotomy increased flexion/extension, lateral bending, and axial rotation by 15%, 18%, and 10.3%, respectively. PCO increased flexion/extension, lateral bending, and axial rotation by 19.6%, 28.3%, and 12.2%, respectively. Our report introduces a novel approach where incremental increases in range of motion can be achieved with minimal spinal canal exposure and demonstrates feasibility in a cadaveric model.

Comparison of 3 Different Minimally Invasive Surgical Techniques for Lumbar Spinal Stenosis

Operations for lumbar spinal stenosis is the most often performed surgical procedure in the adult lumbar spine. This study reports the clinical outcome of the 3 most commonly used minimally invasive posterior decompression techniques. To compare the effectiveness of 3 minimally invasive posterior decompression techniques for lumbar spinal stenosis. This randomized clinical trial used a parallel group design and included patients with symptomatic and radiologically verified lumbar spinal stenosis without degenerative spondylolisthesis. Patients were enrolled between February 2014 and October 2018 at the orthopedic and neurosurgical departments of 16 Norwegian public hospitals. Statistical analysis was performed in the period from May to June 2021. Patients were randomized to undergo 1 of the 3 minimally invasive posterior decompression techniques: unilateral laminotomy with crossover, bilateral laminotomy, and spinous process osteotomy. Primary outcome was change in disability measured with Oswestry Disability Index (ODI; range 0-100), presented as mean change from baseline to 2-year follow-up and proportions of patients classified as success (>30% reduction in ODI). Secondary outcomes were mean change in quality of life, disease-specific symptom severity measured with Zurich Claudication Questionnaire (ZCQ), back pain and leg pain on a 10-point numeric rating score (NRS), patient perceived benefit of the surgical procedure, duration of the surgical procedure, blood loss, perioperative complications, number of reoperations, and length of hospital stay. In total, 437 patients were included with a median (IQR) age of 68 (62-73) years and 230 men (53%). Of the included patients, 146 were randomized to unilateral laminotomy with crossover, 142 to bilateral laminotomy, and 149 to spinous process osteotomy. The unilateral laminotomy with crossover group had a mean change of -17.9 ODI points (95% CI, -20.8 to -14.9), the bilateral laminotomy group had a mean change of -19.7 ODI points (95% CI, -22.7 to -16.8), and the spinous process osteotomy group had a mean change of -19.9 ODI points (95% CI, -22.8 to -17.0). There were no significant differences in primary or secondary outcomes among the 3 surgical procedures, except a longer duration of the surgical procedure in the bilateral laminotomy group. No differences in clinical outcomes or complication rates were found among the 3 minimally invasive posterior decompression techniques used to treat patients with lumbar spinal stenosis. ClinicalTrials.gov Identifier: NCT02007083.

Functional and radiological outcome of modified spinous process osteotomy (MSPO) technique in decompressive surgery for lumbar canal stenosis

Introduction: The Modified Spinous Process Osteotomy (MSPO) surgery is done for degenerative spinal canal stenosis which gives adequate exposure and avoid iatrogenic instability and long segment fusion following conventional laminectomy. The objective of this article is to evaluate clinical and radiological results of the MSPO. Materials and Methods: Total 20 patients (13 male and 7 female) were included and studied prospectively with multilevel degenerative lumbar canal stenosis that were operated for posterior decompression by MSPO and laminectomy after detailed clinical and radiological work up. Regular follow up was done at 6 weeks 3 months and 1 year, clinical assessment for leg pain and back pain done by VAS, functional measurement of disability by Oswestry Disability Index (ODI) done. Dynamic view X-ray of lumbar spine taken and compared to the preoperative X-ray. CT scan was taken at 1 year post op to assess the union of spinous process. Results: All patients were followed up for 3 years. All patients recovered completely from thigh and leg pain and no patients had neurological deterioration. VAS for LBA and leg pain improved significantly along with significant improvement in ODI. The overall results were good to excellent in 93% of the patients, fair in 7% and no poor outcome. All patients were satisfied with the outcome at the last follow-up. The osteotomised spinous process eventually united with the retained laminar bridge in all patients. Conclusion: A less invasive and less techniquelly demanding MSPO technique provides better exposure and visualization, retaining median structures with least disturbance of kinematics of the lumbar spine. This procedure gives advantages for early ambulation and normalisation of patient’s lifestyle and early return to work. Keywords: MSPO, Decompression, Laminectomies, Lumbar canal stenosis.

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

PurposeTo investigate changes in dural sac area after three different posterior decompression techniques in patients undergoing surgery for lumbar spinal stenosis.Summary of background dataDecompression 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.MethodsThe 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.ResultsNo 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.ConclusionFor patients with lumbar spinal stenosis, the three different surgical techniques provided the same increase in dural sac area.Clinical trial registrationThe study is registered at ClinicalTrials.gov reference on November 22th 2013 under the identifier NCT02007083.

＜Editors' Choice＞ Surgical outcomes of decompressive laminoplasty with spinous process osteotomy to treat lumbar spinal stenosis.

ABSTRACTDecompressive laminoplasty with spinous process osteotomy (LSPO) was developed as a less invasive procedure for lumbar decompression by Weiner et al. There are few reports extensively highlighting the surgical outcomes of LSPO. The purpose of this study was to evaluate the surgical outcomes of LSPO for lumbar spinal stenosis (LSS). In total, 23 patients with LSS were studied. All patients were followed up for more than 2 years. The Japanese Orthopedic Association (JOA) scores, the recovery rate (RR) of JOA scores, Visual analog scale (VAS) scores, responses to the JOA Back Pain Evaluation Questionnaire (JOABPEQ), sagittal alignment and segmental motion following LSPO were assessed preoperatively and 2 years postoperatively. Postoperative paravertebral muscle atrophy and bone union rates between the spinous process and the residual laminae were assessed. Preoperative and 2-year postoperative JOA scores were 13.0 points and 24.7 points, respectively (p<0.001). With respect to JOABPEQ, significant improvements were observed in pain-related disorders (p<0.05), walking ability (p<0.01), social life function (p<0.05), and mental health (p<0.05) dimensions. There were no significant differences between preoperative and 2-year postoperative sagittal alignment and range of motion. The degree of the paravertebral muscle atrophy at 2 years postoperatively was 23.0 % at spread side and 9.6 % at nonspread side (p<0.01). The fusion rate of the spinous process with the arcus vertebrae was 87%. This result reveals that LSPO could acquire the reconstruction of posterior supporting structures. We demonstrated that LSPO could be a one of the surgical options for LSS.

Biomechanical analysis of lumbar decompression surgery in relation to degenerative changes in the lumbar spine – Validated finite element analysis

BackgroundThere are no studies about the biomechanical analysis of lumbar decompression surgery in relation to degenerative changes of the lumbar spine. Therefore, the purpose of this study was to compare, by using finite element (FE) analysis, the biomechanical changes of the lumbar spine in terms of annulus stress and nucleus pressure after two different kinds of lumbar decompression surgery in relation to disc degenerative changes. MethodsThe validated intact and degenerated FE models (L2-5) were used in this study. In these two models, two different decompression surgical scenarios at L3-4, including conventional laminectomy (ConLa) and the spinous process osteotomy (SpinO), were simulated. Therefore, a total of six models were simulated. Under preloading, 7.5 Nm moments of flexion, extension, lateral bending, and torsion were imposed. In each model, the maximal von Mises stress on the annulus fibrosus and nucleus pressure at the index segment (L3-4) and adjacent segments (L2-3 and L4-5) were analyzed. ResultsThe ConLa model and disc degeneration model demonstrated a larger annulus stress at the decompression level (L3-4) under all four moments than were seen in the SpinO model and healthy disc model, respectively. Therefore, the ConLa model with moderate disc degeneration showed the highest annulus stress at the decompression level (L3-4). However, the percent change of annulus stress at L3-4 from the intact model to the matched decompression model was less in the moderate disc degeneration model than in the healthy disc model. ConclusionsAlthough the ConLa model with moderate disc degeneration showed the highest annulus stress, the degenerative models would be less influenced by the decompression technique.

Study-protocol for a randomized controlled trial comparing clinical and radiological results after three different posterior decompression techniques for lumbar spinal stenosis: the Spinal Stenosis Trial (SST) (part of the NORDSTEN Study)

BackgroundThere are several posterior decompression techniques for lumbar spinal stenosis (LSS). There is a trend towards performing less invasive surgical procedures, but no multicentre randomized controlled trials have evaluated the relative efficacy of these techniques at short and long-term.Method/designA multicentre randomized controlled trial [the Spinal Stenosis Trial (SST) (part of the NORDSTEN study)] including 465 patients aged 18–80 years with neurogenic claudication or radiating pain and MRI findings indicating lumbar spinal stenosis without spondylolisthesis is performed to compare three posterior decompression techniques: unilateral laminotomy with crossover, bilateral laminotomy and spinous process osteotomy. The primary outcome is change in Oswestry Disability Index (ODI 2 years postoperatively). Secondary outcomes are change in EQ-5D, Zurich Claudication Questionnaire, and Numeric Rating Scale for leg-pain and back-pain. Also recorded were Global Perceived Effect score, complications, length of hospital stay, reoperation rate 2 years postoperatively, difference in recurrence of symptoms or postoperative instability, and MRI change in the dural sac area. Further, a 5 and 10 years follow-up is planned with the same outcome measures.DiscussionNewer and less invasive techniques are increasingly favoured in surgery for LSS. This trial will compare the clinical and radiological results of three different techniques, and may contribute to better clinical decision making in the surgical treatment of LSS.Trial registrationClinicalTrials.gov reference: NCT02007083 (November 22, 2013).

Does pre-operative magnetic resonance imaging of the lumbar multifidus muscle predict clinical outcomes following lumbar spinal decompression for symptomatic spinal stenosis?

To investigate whether pre-operative magnetic resonance imaging (MRI) of the lumbar multifidus muscle (LMM) would predict clinical outcomes following lumbar spinal decompression for symptomatic spinal stenosis. A prospective cohort of patients with symptomatic neurogenic claudication, documented spinal stenosis on pre-operative MRI underwent spinal decompression. All subjects completed standardised outcome measures (Core Outcome Measures Index (COMI), Oswestry Disability Index (ODI v2.1) pre-operatively, 1 and 2years post-surgery. Surgery was performed using a standardised lumbar spinous process osteotomy for access, followed by a decompression of the central canal, lateral recess and foraminal zones as indicated by the pre-operative MRI. Lumbar MRI scans were evaluated by two independent observers who assessed the axial CSA of the LMM bilaterally and the degree of muscle atrophy according to the Kader classification (2000). Changes in COMI and ODI scores at 1 and 2years were investigated for statistically significant correlations with CSA of LMM and Kader grading. Statistical analyses utilised Student's t test, kappa coefficient for inter-observer agreement and Bland-Altman Limits of Agreement (BALOA). 66 patients (41 female) aged between 29 and 86years underwent single-level decompression in 44, two-level decompression in 16 and three-level decompression in 6 cases. No significant correlation was observed between improvements in ODI and COMI relative to age, degree of stenosis, posterior fat thickness or psoas CSA. Those subjects with the greatest LMM atrophy relative to psoas CSA and L5 vertebral body area on pre-operative MRI had the least absolute improvement in both ODI and COMI scores (p=0.006). Reduced LMM CSA (<8.5cm2) and muscle atrophy were associated with less favourable outcomes following lumbar spinal decompression. Pre-operative CSA of LMM appeared to be a more reliable predictor of post-operative clinical outcomes compared to the Kader Grading Score. This is the first study to investigate the prognostic value of pre-operative MRI appearance and CSA of LMM with respect to post-operative outcome following lumbar decompression surgery. Healthy pre-operative LMM is associated with better outcomes following lumbar spinal decompression.

Only walking matters-assessment following lumbar stenosis decompression.

Multiple outcome measures exist to evaluate the outcomes of spinal decompression surgery; however, these tend to be complex and are difficult to express to the patient pre-operatively to accurately guide their expectations. We present outcomes, in terms of walking distance measurement, of a prospective single surgeon series of 76 consecutive patients with spinal stenosis. 76 patients (mean age 68.8years; 48-91years) had decompression surgery using spinous process osteotomy. Accurate measurement of walking distance was used as an outcome measure, and factors that affect it were evaluated. Walking distance was measured pre-operatively, post-operatively and at 3months follow-up using a measuring wheel. The minimum follow-up was 5years. The mean distances walked were 78.1, 419.9 and 1285m, respectively. Pre-operative disc height (p=0.023) and male gender (p=0.039) predicted a significant improvement in walking distance, while age (p=0.23), ASA grade (p=0.39) and the number of levels operated on (p=0.89) did not significantly affect the increase in walking distance. 12 patients experienced post-operative complications (15.8%), and at last clinical follow-up (6.3years, 5.1-6.9years) 27 patients (35.5%) had residual leg symptoms and 8 had undergone further revision procedures (10.5%). This study demonstrates that walking distance is an accurate and accessible method of determining surgical outcomes.

The outcome of decompression alone for lumbar spinal stenosis with degenerative spondylolisthesis.

Lumbar spinal stenosis in the presence of degenerative spondylolisthesis is generally treated by means of surgery. The role of lumbar decompression without fusion is not clear. Therefore, the aim of this study was to assess whether patients who undergo decompression alone have a favourable outcome without the need for a subsequent fusion. This is a prospective cohort study with single blinding of 83 consecutive patients with lumbar stenosis and degenerative spondylolisthesis treated by decompression, without fusion, using a spinous process osteotomy. Blinded observers collected pre- and post-operative Oswestry Disability Index (ODI), EuroQol Five Dimensions (EQ-5D), and visual analogue scale (VAS) for back and leg pain scores prospectively. Failures for this study were those patients who required a subsequent lumbar fusion procedure at the decompressed levels. Statistical analysis was performed using paired t test and Mann-Whitney test. There were 36 males and 47 females with a mean age of 66years (range 35-82). The mean follow-up was 36months (range 19-48months). The mean pre-operative ODI, EQ-5D, and VAS scores were 52 [standard deviation (SD) 18], 0.25 (SD 0.30), and 61 (SD 22), respectively. All mean scores improved post-operatively to 38 (SD 23), 0.54 (SD 0.34) and 36 (SD 27), respectively. There was a statistically significant improvement in all scores (p≤0.0001). Nine patients (11%) required a subsequent fusion procedure and five patients (6%) required revision decompression surgery alone. Our study's results show that a lumbar decompression procedure without arthrodesis in a consecutive cohort of patients with lumbar spinal stenosis with degenerative spondylolisthesis had a significant post-operative improvement in ODI, EQ-5D, and VAS. The rate of post-operative instability and subsequent fusion is not high. Only one in 10 patients in this group ended up needing a subsequent fusion at a mean follow-up of 36months, indicating that fusion is not always necessary in these patients.

Outcome and Differences in the Clinical Results of Three Different Surgical Methods for Lumbar Disk Herniation

Introduction We aimed to study the following gaps in the literature. (1) Clinical results of spinous process osteotomy for the treatment of LDH is scarce in the literature. (2) Studies comparing clinical outcomes between laminectomy and osteotomy have not been reported. (3) Results of MAPN with open techniques have not been compared. We sought to study the outcome of surgery for LDH by conducting a comparative study between three different surgical techniques; we aimed to find whether any of these approaches were more efficacious in reducing pain or improving patients' quality of life. In addition, factors that could predict the outcome of LDH surgery were assessed. Materials and Methods We evaluated 148 patients who had operations for lumbar disk herniation from March 2006 to March 2011 using three different surgical techniques (laminectomy, microscopically assisted percutaneous nucleotomy, and spinous process osteotomy) by using Japanese Orthopaedic Association (JOA) Back Pain Evaluation Questionnaire, Resumption of Activities of Daily Living scale and changes of visual analog scale (VAS) for low back pain and radicular pain. Our study questionnaire addressed patient subjective satisfaction with the operation, residual complaints, and job resumption. Results Ninety-four percent of our patients were satisfied with the results of their surgeries. VAS documented an overall 93.3% success rate for reduction of radicular pain. Laminectomy resulted in better outcome in terms of JOA Back Pain Evaluation Questionnaire. The outcome of surgery did not significantly differ by age, sex, level of education, preoperative VAS for back, preoperative VAS for radicular pain, return to previous job, or level of herniation. Conclusion Surgery for lumbar disk herniation is effective in reducing radicular pain (93.4%). All three surgical approaches resulted in significant decrease in preoperative radicular pain and low back pain, but intergroup variation in the outcome was not achieved. As indicated by JOA Back Pain Evaluation Questionnaire–Low Back Pain (JOABPQ-LBP) and lumbar function functional scores, laminectomy achieved significantly better outcome compared with other methods. It is worth mentioning that relief of radicular pain was associated with subjective satisfaction with the surgery among our study population.

Lumbar Canal Stenosis-A Study of Spinous Process Osteotomy in Posterior Decompression

Study Design: Prospective Background: Lumbar canal stenosis (LCS) remains one of the most frequently encountered, clinically important degenerative spinal disorders in the ageing population. Diagnosing it clinicallyis made more difficult due tocoexisting degeneration of the spine, hip or knee joint or diseased vessels and nerves of lower limbs or due to de-conditioning of spinal musculature and ligaments. Purpose of the study: The purpose of our study was to assess the results of spinous process osteotomy & laminotomy in cases of lumbar canal stenosis. Material and Methods: It was prospective study with 25 confirmed cases of lumbar canal stenosis adhering to inclusion criteria and stable spine. Patients were assessed pre-operative and post- operative using LINS Functional Ability Criteria, VAS scale for back pain and leg pain, JOAS score and Satisfactory Recovery Rate- Hirabayashi Method( Based on Pre-op and Post-op JOAS scores) with an average follow-up of 1 year. Results: There were 25 patients, 12 (48%) males and 13 (52%) females. Mean age of group was 44.48 ± 7.52.There were14 (56%) patients with two level involvement followed by 6 (24%) patients with three level involvement and 5 (20%) patients with single level involvement. In single level involvement maximum number was of L4-L5.All 25 (100%) patients presented with Claudication and radiculopathy; 9 (36%) had unilateral radiculopathy while 16 (64%) had bilateral radiculopathy.10(40%) patients had motor weakness and sensory involvement.1(4%) patient presented with cauda equina syndrome with associated sphincter involvement.All patients were treated with Spinous process osteotomy and fenestration and foraminotomy. In addition to that, discectomy was done in 14 (56%) patients while laminotomy was required in 3 (12%) patients Functional assessment as per LINS criteriashowed that satisfactory results (Percentage of patients in Excellent and Good Class) were achieved in 90% of the patients.There were sign

Lumbar disk herniation surgery: outcome and predictors.

Study Design A retrospective cohort study. Objectives To determine the outcome and any differences in the clinical results of three different surgical methods for lumbar disk herniation and to assess the effect of factors that could predict the outcome of surgery. Methods We evaluated 148 patients who had operations for lumbar disk herniation from March 2006 to March 2011 using three different surgical techniques (laminectomy, microscopically assisted percutaneous nucleotomy, and spinous process osteotomy) by using Japanese Orthopaedic Association (JOA) Back Pain Evaluation Questionnaire, Resumption of Activities of Daily Living scale and changes of visual analog scale (VAS) for low back pain and radicular pain. Our study questionnaire addressed patient subjective satisfaction with the operation, residual complaints, and job resumption. Data were analyzed with SPSS version 16.0 (SPSS, Inc., Chicago, Illinois, United States). Statistical significance was set at 0.05. For statistical analysis, chi-square test, Mann-Whitney U test, Kruskal-Wallis test, and repeated measure analysis were performed. For determining the confounding factors, univariate analysis by chi-square test was used and followed by logistic regression analysis. Results Ninety-four percent of our patients were satisfied with the results of their surgeries. VAS documented an overall 93.3% success rate for reduction of radicular pain. Laminectomy resulted in better outcome in terms of JOA Back Pain Evaluation Questionnaire. The outcome of surgery did not significantly differ by age, sex, level of education, preoperative VAS for back, preoperative VAS for radicular pain, return to previous job, or level of herniation. Conclusion Surgery for lumbar disk herniation is effective in reducing radicular pain (93.4%). All three surgical approaches resulted in significant decrease in preoperative radicular pain and low back pain, but intergroup variation in the outcome was not achieved. As indicated by JOA Back Pain Evaluation Questionnaire–Low Back Pain (JOABPQ-LBP) and lumbar function functional scores, laminectomy achieved significantly better outcome compared with other methods. It is worth mentioning that relief of radicular pain was associated with subjective satisfaction with the surgery among our study population. Predictive factors for ineffective surgical treatment for lumbar disk herniation were female sex and negative preoperative straight leg raising. Age, level of education, and preoperative VAS for low back pain were other factors that showed prediction power.

Spinous process osteotomy to facilitate the access to the spinal canal when decompressing the spinal canal in patients with lumbar spinal stenosis.

Study DesignRetrospective study.PurposeThe main purpose of this study was to investigate the union-rate of the spinous process after performing a spinous process osteotomy and whether union affects the clinical results after surgery.Overview of LiteratureIn the present study, spinous process osteotomy was used to facilitate access to the spinal canal when performing a decompressive procedure for lumbar spinal stenosis. The aim of this study was to evaluate the union rate of the spinous process and its effect on the clinical results of the procedure.MethodsAll patients were included in the study that underwent a decompressive procedure through spinous process osteotomy be between January 1, 2007 and December 31, 2007. Operation protocols were reviewed. A computed tomography (CT) scan was performed to evaluate the union of the osteotomies of the spinous process. According to the CT-scans, patients were divided into three groups: "complete-union," "partial-union," and "non-union." Patients reported their clinical results through a self-administered questionnaire.ResultsThe mean period of follow up was 21.6 months (range, 16-28 months). A total of 44% of the performed osteotomies were considered as united. Ten patients (18%) were classified as "complete-union," 30 patients (55%) as "partial-union," and 15 patients (27%) as "non-union." The "complete-union" group showed better clinical results and scored significantly better in the Oswestry Disability Index and EQ-5D. However, no statistical difference was found in the pain-scores. There were no differences between the "partial-union" group and the "no-union" group.ConclusionsWe found a radiologic union for 60 out of 135 (44%) spinous process osteotomies.

Neural Decompression by Laminectomy with Spinoplasty for Lumbar Spinal Stenosis

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

Less invasive and less technically demanding decompressive procedure for lumbar spinal stenosis—appropriate for general orthopaedic surgeons?

This article presents the clinical and radiological results of the modified spinous process osteotomy decompressive procedure (MSPO), which affords excellent visualisation and provides wide access for Kerrison rongeur use and angulation while minimising destruction of tissues not directly involved in the pathological process. A total of 50 patients with degenerative lumbar spinal stenosis underwent MSPO between 2002 and 2005. The minimum follow-up period was fiveyears. Patient's walking distance ability was 85.4m (5-180m) preoperatively and 2,560m (1500-8000m) at the last follow-up. Leg pain improved in 100% of the patients and back pain improved in 89% at the last follow-up. The overall results were good to excellent in 90% of the patients, fair in 16% and all patients were satisfied with the outcome at the last follow-up. The osteotomised spinous process eventually united with the retained laminar bridge in all patients within ninemonths after surgery. Degenerative lumbar spinal stenosis can be adequately decompressed with less violation of the integrity of the posterior elements using MSPO. The described technique of MSPO yielded promising results with few complications. The authors believe MSPO is less technically demanding and appropriate for general orthopaedic surgeons, occasional spine surgeons and chief residents.