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Restoration of the Spinous Process Following Muscle-Preserving Posterior Lumbar Decompression via Sagittal Splitting of the Spinous Process

BACKGROUND: In lumbar spinal stenosis, spinous process-splitting decompression has demonstrated good clinical outcomes with preservation of the posterior ligamentous complex and paraspinal muscles in comparison to conventional laminectomy, but the radiological consequence and clinical impact of the...

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Autores principales: Wi, Seung Myung, Lee, Hui Jong, Chang, Sam Yeol, Kwon, Oh Hyo, Lee, Choon-Ki, Chang, Bong-Soon, Kim, Hyoungmin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Orthopaedic Association 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6389526/
https://www.ncbi.nlm.nih.gov/pubmed/30838113
http://dx.doi.org/10.4055/cios.2019.11.1.95
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author Wi, Seung Myung
Lee, Hui Jong
Chang, Sam Yeol
Kwon, Oh Hyo
Lee, Choon-Ki
Chang, Bong-Soon
Kim, Hyoungmin
author_facet Wi, Seung Myung
Lee, Hui Jong
Chang, Sam Yeol
Kwon, Oh Hyo
Lee, Choon-Ki
Chang, Bong-Soon
Kim, Hyoungmin
author_sort Wi, Seung Myung
collection PubMed
description BACKGROUND: In lumbar spinal stenosis, spinous process-splitting decompression has demonstrated good clinical outcomes with preservation of the posterior ligamentous complex and paraspinal muscles in comparison to conventional laminectomy, but the radiological consequence and clinical impact of the split spinous processes have not been fully understood. METHODS: Seventy-three patients who underwent spinous process-splitting decompression were included. The bone union rate and pattern were evaluated by computed tomography performed 6–18 months after surgery and compared among subgroups divided according to the number of levels decompressed and the extent of spinous process splitting. The bone union pattern was classified into three categories: complete union, partial union, and nonunion. The visual analog scale (VAS) score, Oswestry disability index (ODI), and walking distance assessed both before and 24–36 months after surgery were compared among subgroups divided according to the union pattern of the split spinous process. RESULTS: Overall, the rates of complete union, partial union, and nonunion were 51.7%, 43.2%, and 5.1%, respectively. In the subgroup with partial splitting of the spinous process, the rates were 85.7%, 14.3%, and 0%, respectively; those of the subgroup with total splitting of the spinous process were 32.9%, 59.2%, and 7.9%, respectively. With single-level decompression, a higher rate of union was observed compared with multilevel decompression. The VAS, ODI, and walking distance were significantly improved after surgery and did not differ according to the degree of union of the split spinous process. CONCLUSIONS: We found that the single-level operation and partial splitting of the spinous process were favourable factors for obtaining complete restoration of the posterior bony structure of the lumbar spine in spinous process-splitting decompression.
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spelling pubmed-63895262019-03-06 Restoration of the Spinous Process Following Muscle-Preserving Posterior Lumbar Decompression via Sagittal Splitting of the Spinous Process Wi, Seung Myung Lee, Hui Jong Chang, Sam Yeol Kwon, Oh Hyo Lee, Choon-Ki Chang, Bong-Soon Kim, Hyoungmin Clin Orthop Surg Original Article BACKGROUND: In lumbar spinal stenosis, spinous process-splitting decompression has demonstrated good clinical outcomes with preservation of the posterior ligamentous complex and paraspinal muscles in comparison to conventional laminectomy, but the radiological consequence and clinical impact of the split spinous processes have not been fully understood. METHODS: Seventy-three patients who underwent spinous process-splitting decompression were included. The bone union rate and pattern were evaluated by computed tomography performed 6–18 months after surgery and compared among subgroups divided according to the number of levels decompressed and the extent of spinous process splitting. The bone union pattern was classified into three categories: complete union, partial union, and nonunion. The visual analog scale (VAS) score, Oswestry disability index (ODI), and walking distance assessed both before and 24–36 months after surgery were compared among subgroups divided according to the union pattern of the split spinous process. RESULTS: Overall, the rates of complete union, partial union, and nonunion were 51.7%, 43.2%, and 5.1%, respectively. In the subgroup with partial splitting of the spinous process, the rates were 85.7%, 14.3%, and 0%, respectively; those of the subgroup with total splitting of the spinous process were 32.9%, 59.2%, and 7.9%, respectively. With single-level decompression, a higher rate of union was observed compared with multilevel decompression. The VAS, ODI, and walking distance were significantly improved after surgery and did not differ according to the degree of union of the split spinous process. CONCLUSIONS: We found that the single-level operation and partial splitting of the spinous process were favourable factors for obtaining complete restoration of the posterior bony structure of the lumbar spine in spinous process-splitting decompression. The Korean Orthopaedic Association 2019-03 2019-02-18 /pmc/articles/PMC6389526/ /pubmed/30838113 http://dx.doi.org/10.4055/cios.2019.11.1.95 Text en Copyright © 2019 by The Korean Orthopaedic Association http://creativecommons.org/licenses/by-nc/4.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Wi, Seung Myung
Lee, Hui Jong
Chang, Sam Yeol
Kwon, Oh Hyo
Lee, Choon-Ki
Chang, Bong-Soon
Kim, Hyoungmin
Restoration of the Spinous Process Following Muscle-Preserving Posterior Lumbar Decompression via Sagittal Splitting of the Spinous Process
title Restoration of the Spinous Process Following Muscle-Preserving Posterior Lumbar Decompression via Sagittal Splitting of the Spinous Process
title_full Restoration of the Spinous Process Following Muscle-Preserving Posterior Lumbar Decompression via Sagittal Splitting of the Spinous Process
title_fullStr Restoration of the Spinous Process Following Muscle-Preserving Posterior Lumbar Decompression via Sagittal Splitting of the Spinous Process
title_full_unstemmed Restoration of the Spinous Process Following Muscle-Preserving Posterior Lumbar Decompression via Sagittal Splitting of the Spinous Process
title_short Restoration of the Spinous Process Following Muscle-Preserving Posterior Lumbar Decompression via Sagittal Splitting of the Spinous Process
title_sort restoration of the spinous process following muscle-preserving posterior lumbar decompression via sagittal splitting of the spinous process
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6389526/
https://www.ncbi.nlm.nih.gov/pubmed/30838113
http://dx.doi.org/10.4055/cios.2019.11.1.95
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