Lumbar spinous process-splitting laminectomy for lumbar spinal canal stenosis

English Keywords:Lumbar spinal stenosis  Spinous process-splitting laminectomy  Decompression  Clinical results

English Abstract:

  【Abstract】 Objective：To investigate the clinical outcome of lumbar spinous process-splitting laminectomy for lumbar spinal canal stenosis.Method：28 cases of lumbar spinal canal stenosis，including 16 males and 12 females with the average age of 63.1 years（range，40-71 years）were reviewed retrospectively.The average duration of symptoms was 8.5 years（range，0.3-10 years）.The number of involved discs was one in 6 cases，two in 18 cases and three in 4 cases，and the affected levels were L3/4 in 20，L4/5 in 28 and L5/S1 in 6 cases.22 cases had unilateral and 6 cases had bilateral sciatica pain.The mean walking distance due to NIC was 315 meters（range，10-1000m）.All patients underwent lumbar spinous process-splitting laminectomy.The mean pre-operative JOA score，VAS for low back pain，leg pain and numbness were 10.3±1.4，4.6±0.7，7.7±1.0 and 6.1±2.3 respectively.The CPK level was measured 3 days after operation.The postoperative radiographic findings and function improvement were recorded during follow-up.Result：The mean operation time and blood loss were 115±5.6min（65-175min） and 116±12.5ml（50-500ml） respectively.The exposure time of single，double and three levels was 11.3±2.0min，20.2±2.6min and 26.1±2.1min respectively.Three days after surgery，the CPK was 336±16.1u/l.27 cases except 1 case had splitting spinous process united three months later under computed tomography.The mean follow-up was 25.3 months（16~36 months），the JOA score，improve rate，VAS for low back pain，leg pain and numbness at final follow-up were 24.7±3.5，（77.0±3.1）%，1.6±0.7，1.1±0.3 and 2.5±1.3 respectively.The postoperative JOA scores and VAS scores improved significantly than preoperative ones（P<0.05）.No lumbar instability and lumbar multifidus muscle atrophy was noted.Conclusion：Lumbar spinous process-splitting laminectomy can effectively protect bilateral multifidus and decrease the occurrence of postoperative low back pain，which is effective for managing lumbar spinal stenosis.