Department of Neurosurgery, Paracelsus Medical Private University, Salzburg, Austria.
Department of Neurosurgery, Cannizzaro Hospital, Catania, Italy.
J Neurol Surg A Cent Eur Neurosurg. 2024 Mar;85(2):195-201. doi: 10.1055/a-1715-3958. Epub 2021 Dec 7.
Laminotomy for lumbar stenosis is a well-defined procedure and represents a routine in every neurosurgical department. It is a common experience that the uni- or bilateral paraspinal muscle detachment, together with injury of the supra- and interspinous ligaments, can lead to postoperative pain. In the literature, the application of a minimally invasive technique, the lumbar spinous process-splitting (LSPS) technique, has been reported.
In this study, we present a case series of 12 patients who underwent LSPS from September 2019 to April 2020. Two patients had a cyst of the ligamentum flavum, eight a single-level lumbar canal stenosis (LCS), and two a two-level LCS. Moreover, we propose a novel morphological classification of postoperative muscle atrophy and present volumetric analysis of the decompression achieved.
There were no complications related to this technique. In all patients, the vertebral canal area was more than doubled by the procedure. The muscle sparing showed grade A, according to our classification.
To our knowledge, this is the first description of this surgical technique and the first LSPSL case series in Europe. Furthermore, cases of ligamentum flavum cyst removal using this safe and effective technique have not yet been reported.
腰椎管狭窄症的椎板切除术是一种明确的手术方法，也是每个神经外科部门的常规手术。大家普遍认为，单侧或双侧椎旁肌分离，加上棘上和棘间韧带的损伤，会导致术后疼痛。在文献中，已经报道了一种微创技术，即腰椎棘突劈开术（LSPS）。
在这项研究中，我们报告了 12 例 2019 年 9 月至 2020 年 4 月期间接受 LSPS 的患者。其中 2 例为黄韧带囊肿，8 例为单节段腰椎管狭窄症（LCS），2 例为两节段 LCS。此外，我们提出了一种新的术后肌肉萎缩形态学分类，并对减压效果进行了容积分析。
该技术无相关并发症。在所有患者中，通过该手术，椎管面积增加了一倍以上。根据我们的分类，肌肉保留程度为 A 级。
据我们所知，这是对这种手术技术的首次描述，也是欧洲首例 LSPSL 病例系列。此外，使用这种安全有效的技术切除黄韧带囊肿的病例尚未见报道。
