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 five years. Patient's walking distance ability was 85.4 m (5-180 m) preoperatively and 2,560 m (1500-8000 m) 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 nine months 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.
Department of Orthopaedic Surgery, Kitasato University, School of Medicine, Kitasato1-15-1, Sagamihara, Kanagawa, Japan. mtakaso@kitasato-u.ac.jp
Masashi
M
Takaso
Toshiyuki
T
Nakazawa
Takayuki
T
Imura
Takamitsu
T
Okada
Kensuke
K
Fukushima
Masaki
M
Ueno
Wataru
W
Saito
Ryousuke
R
Shintani
Hiroyuki
H
Sakagami
Kazuhisa
K
Takahashi
Masashi
M
Yamazaki
Seiji
S
Ohtori
Toshiaki
T
Kotani
D000368:Aged; D000369:Aged, 80 and over; D001416:Back Pain / Q000209:etiology / Q000601:surgery; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D010027:Osteotomy / Q000379:methods; D017060:Patient Satisfaction; D011859:Radiography; D012189:Retrospective Studies; D013130:Spinal Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome