Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Clin Orthop Surg. 2019 Mar;11(1):95-102. doi: 10.4055/cios.2019.11.1.95. Epub 2019 Feb 18.
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.
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.
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.
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.
与传统的椎板切除术相比，腰椎管狭窄症中棘突劈开减压在保留后韧带复合体和脊柱旁肌肉方面具有良好的临床效果，但劈开棘突的放射学后果和临床影响尚未完全了解。
纳入 73 例接受棘突劈开减压的患者。通过术后 6-18 个月的 CT 评估骨融合率和模式，并根据减压节段数和棘突劈开程度分为亚组进行比较。将骨融合模式分为完全融合、部分融合和未融合三种类型。根据劈开棘突融合模式，将术前和术后 24-36 个月的视觉模拟评分（VAS）、Oswestry 功能障碍指数（ODI）和步行距离进行比较。
总体而言，完全融合、部分融合和未融合的比例分别为 51.7%、43.2%和 5.1%。在棘突部分劈开的亚组中，比例分别为 85.7%、14.3%和 0%；在棘突完全劈开的亚组中，比例分别为 32.9%、59.2%和 7.9%。单节段减压时，融合率高于多节段减压。术后 VAS、ODI 和步行距离均明显改善，与劈开棘突的融合程度无关。
我们发现，单节段手术和棘突部分劈开是棘突劈开减压中获得腰椎后部骨性结构完全恢复的有利因素。
