Prospective, randomized controlled study.
To compare the functional outcomes and extent of paraspinal muscle damage between 2 decompressive techniques for lumbar canal stenosis.
Lumbar spinous process splitting decompression (LSPSD) preserves the muscular and liga-mentous attachments of the posterior elements of the spine. It can potentially avoid problems such as paraspinal muscle atrophy and trunk extensor weakness that can occur after conventional midline decompression. However, large series prospective randomized controlled studies are lacking.
Patients with lumbar canal stenosis were randomly allocated into 2 groups: LSPSD (28 patients) and conventional midline decompression (23 patients). The differences in operative time, blood loss, time to comfortable mobilization, and hospital stay were studied. Paraspinal muscle damage was assessed by postoperative rise in creatine phosphokinase and C-reactive protein levels. Functional outcome was evaluated at 1 year by Japanese Orthopaedic Association score, neurogenic claudication outcome score, and visual analogue scale for back pain and neurogenic claudication.
Fifty-one patients of mean age 56 years were followed-up for a mean 14.2 ± 2.9 months. There were no significant differences in the operative time, blood loss, and hospital stay. Both the groups showed significant improvement in the functional outcome scores at 1 year. Between the 2 groups, the Japanese Orthopaedic Association score, neurogenic claudication outcome score improvement, visual analogue scale for back pain, neurogenic claudication visual analogue scale, and the postoperative changes in serum C-reactive protein and creatine phosphokinase levels did not show any statistically significant difference. On the basis of the Japanese Orthopaedic Association recovery rate, it was found that 73.9% of conventional midline decompression group had good outcomes compared with only 60.7% after LSPSD.
The functional outcome scores, back pain, and claudication pain in the immediate period and at the end of 1 year are similar in both the techniques. More patients had better functional outcomes after conventional decompression than the LSPSD technique. On the basis of this study, the superiority of one technique compared with the other is not established, mandating the need for further long-term studies.
Level of Evidence: 2
A prospective, randomized controlled study of 51 patients was performed to compare the efficacy of 2 different surgical techniques for lumbar canal stenosis. There were no significant differences in the outcomes both in the immediate postoperative period and at the end of 1 year between the 2 groups. Because both the techniques produced equivalent results at 1 year, the superiority of one technique over the other could not be established.
From the Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India.
Address correspondence and reprint requests to S. Rajasekaran, MS, MCh, FRCS(Ed), FRCS(London), FACS, PhD, Department of Orthopaedics and Spine Surgery, Ganga Hospital, 313, Mettupalayam Rd, Coimbatore-641 011, Tamil Nadu, India; E-mail: firstname.lastname@example.org
Acknowledgment date: February 13, 2013. Revision date: April 22, 2013. Acceptance date: June 6, 2013.
The manuscript submitted does not contain information about medical device(s)/drug(s).
AO Spine India research grant and the Ganga Orthopaedic Research and Education Foundation funds were received in support of this work.
No relevant financial activities outside the submitted work.