title: Reduced postoperative wound pain after lumbar spinous process-splitting laminectomy for lumbar canal stenosis: a randomized controlled study.
abstract: OBJECTIVE
  to reduce intraoperative damage to the posterior supporting structures of the lumbar spine during decompressive surgery for lumbar canal stenosis (LCS), lumbar spinous process-splitting laminectomy (LSPSL or split laminectomy) was developed. This prospective, randomized, controlled study was conducted to clarify whether the split laminectomy decreases acute postoperative wound pain compared with conventional laminectomy.
  
  
  METHODS
  forty-one patients with LCS were enrolled in this study. The patients were randomly assigned to either the LSPSL group (22 patients) or the conventional laminectomy group (19 patients). Questionnaires regarding wound pain (intensity, depth, and duration) and activities of daily living (ADL) were administered at postoperative days (PODs) 3 and 7. Additionally, the authors evaluated the pre- and postoperative serum levels of C-reactive protein and creatine phosphokinase, the amount of pain analgesics used during a 3-day postoperative period, and the muscle atrophy rate measured on 1-month postsurgical MR images.
  
  
  RESULTS
  data obtained in patients in the LSPSL group and in 16 patients in the conventional laminectomy group were analyzed. The mean visual analog scale for wound pain on POD 7 was significantly lower in the LSPSL group (16 ± 17 mm vs 34 ± 31 mm, respectively; p = 0.04). The mean depth-of-pain scores on POD 7 were significantly lower in the LSPSL group than in the conventional group (0.9 ± 0.6 vs 1.7 ± 0.8, respectively; p = 0.013). On POD 3, the mean serum creatine phosphokinase level was significantly lower in the LSPSL group (126 ± 93 U/L) than in the other group (207 ± 150 U/L) (p = 0.02); on POD 7, the mean serum C-reactive protein level was significantly lower in the LSPSL group (1.1 ± 0.6 mg/dl) than in the conventional laminectomy group (1.9 ± 1.5 mg/dl) (p = 0.04). The number of pain analgesics taken during the 3-day postoperative period was lower in the LSPSL group than in the conventional laminectomy group (1.7 ± 1.3 tablets vs 2.3 ± 2.4 tablets, respectively; p = 0.22). The mean muscle atrophy rate was also significantly lower in the LSPSL group (24% ± 15% vs 43% ± 22%; p = 0.004).
  
  
  CONCLUSIONS
  lumbar spinous process-splitting laminectomy for the treatment of LCS reduced acute postoperative wound pain and prevented postoperative muscle atrophy compared with conventional laminectomy, possibly because of minimized damage to the paraspinal muscles.
authors.affiliation: Department of Advanced Therapy for Spine and Spinal Cord Disorders.
authors.forename: Kota
authors.initials: K
authors.lastname: Watanabe
authors.forename: Morio
authors.initials: M
authors.lastname: Matsumoto
authors.forename: Takeshi
authors.initials: T
authors.lastname: Ikegami
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nishiwaki
authors.forename: Takashi
authors.initials: T
authors.lastname: Tsuji
authors.forename: Ken
authors.initials: K
authors.lastname: Ishii
authors.forename: Yuto
authors.initials: Y
authors.lastname: Ogawa
authors.forename: Hironari
authors.initials: H
authors.lastname: Takaishi
authors.forename: Masaya
authors.initials: M
authors.lastname: Nakamura
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Toyama
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Chiba
mesh_terms: D000203:Activities of Daily Living / Q000145:classification; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000378:metabolism; D003402:Creatine Kinase / Q000097:blood; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007796:Laminectomy / Q000379:methods*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009133:Muscular Atrophy / Q000175:diagnosis / Q000517:prevention & control; D009460:Neurologic Examination; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000517:prevention & control*; D011183:Postoperative Complications / Q000175:diagnosis / Q000517:prevention & control; D011446:Prospective Studies; D013130:Spinal Stenosis / Q000601:surgery*; D011795:Surveys and Questionnaires
chemical_list: D002097:C-Reactive Protein; D003402:Creatine Kinase