Baghdadi Yaser M K, Moussallem Charbel D, Shuaib Mohammed A, Clarke Michelle J, Dekutoski Mark B, Nassr Ahmad N
Orthopedics. 2016 Sep 1;39(5):e950-6. doi: 10.3928/01477447-20160616-03. Epub 2016 Jun 24.
Minimally invasive posterior spinous process-splitting laminoplasty preserving the paraspinal musculature has been introduced to treat patients with lumbar spinal stenosis. Despite its theoretical advantage of limiting muscular trauma, additional efforts are required to evaluate patients' clinical and functional results following this procedure. Between 2010 and 2012, 37 patients underwent spinous process-splitting laminoplasty for lumbar stenosis at a mean age of 68 years (range, 36-87 years) and were followed for minimum of 1 year (mean, 1.3 years). There were 22 (59%) men and 15 (41%) women. Mean number of levels treated with a spinous process-splitting laminoplasty was 2.2 (range, 1-6 levels). Patients had statistically significant improvements in their scores for all self-reported outcomes, including visual analog scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), and Short Form 36 (SF-36) components. Mean VAS significantly decreased by 4.4±3.2 points for back pain and 3.9±3.7 points for leg pain (P<.0001). Mean ODI significantly decreased by 17.5±19.1 points (P<.0001), and mean SF-36 significantly increased by 29±30.4 points (P=.0017) for the physical component and 21.8±25.6 points (P=.0062) for the mental health component. Four (10.8%) patients had a dural tear requiring repair (3 were intraoperative), 3 (8%) had an epidural hematoma requiring evacuation, 1 (2.7%) had an infection requiring irrigation and debridement, and 2 (5%) had additional decompression for symptom recurrence secondary to instability. Lumbar spinous process-splitting laminoplasty is a novel minimally invasive technique that provides adequate decompression for the neuronal elements and may avoid extensive paraspinal muscular damage associated with conventional laminectomy. Patients demonstrated significant improvements in pain and overall heath and function scores at a minimum 1-year follow-up. [Orthopedics.2016; 39(5):e950-e956.].
微创保留椎旁肌肉的棘突劈开椎板成形术已被用于治疗腰椎管狭窄症患者。尽管其在限制肌肉创伤方面具有理论优势，但仍需要进一步评估该手术后患者的临床和功能结果。2010年至2012年期间，37例患者接受了棘突劈开椎板成形术治疗腰椎管狭窄症，平均年龄68岁（范围36 - 87岁），随访至少1年（平均1.3年）。其中男性22例（59%），女性15例（41%）。棘突劈开椎板成形术治疗的平均节段数为2.2个（范围1 - 6个节段）。所有自我报告结局的评分均有统计学显著改善，包括背部和腿部疼痛的视觉模拟量表（VAS）、Oswestry功能障碍指数（ODI）以及简明健康调查问卷36项（SF - 36）的各项组成部分。背部疼痛的平均VAS显著降低4.4±3.2分，腿部疼痛显著降低3.9±3.7分（P <.0001）。平均ODI显著降低17.5±19.1分（P <.0001），SF - 36身体部分平均显著提高29±30.4分（P =.0017），心理健康部分平均显著提高21.8±25.6分（P =.0062）。4例（10.8%）患者出现硬膜撕裂需要修复（3例为术中发生），3例（8%）出现硬膜外血肿需要清除，1例（2.7%）出现感染需要冲洗和清创，2例（5%）因不稳定继发症状复发需要再次减压。腰椎棘突劈开椎板成形术是一种新型的微创技术，可为神经组织提供充分减压，并可避免与传统椎板切除术相关的广泛椎旁肌肉损伤。在至少1年的随访中，患者在疼痛以及总体健康和功能评分方面有显著改善。[《骨科》.2016; 39(5):e950 - e956.]
