Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland.
Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland; Department of Neurosurgery, Canton Hospital St. Gallen, University of St. Gallen Medical School, St. Gallen, Switzerland.
World Neurosurg. 2022 Apr;160:e80-e87. doi: 10.1016/j.wneu.2021.12.094. Epub 2021 Dec 29.
Several microsurgical techniques are available for the decompression of lumbar spinal stenosis (LSS). More recently, a spinous process-splitting laminectomy (SPSL) technique was introduced, with the premise of diminishing paraspinal muscle damage. This study aims to compare the neurologic and functional outcomes, as well as the differences in early postoperative pain and analgesic use during hospitalization after conventional decompression (CD) versus SPSL surgery for LSS.
Single-center retrospective analysis of all spinal decompression procedures (CD or SPSL) that were performed or supervised by one consulting spine surgeon, performed for LSS between 2015 and 2020. Preoperative neurologic symptoms, functional outcomes, as well as perioperative analgesic use and reported pain scales during hospitalization were analyzed.
From a total of 106 patients, 58 were treated using CD and 48 using SPSL. In both groups, around one-third of the patients were taking opiates preoperatively (38% for CD, 31% for SPSL). Patients submitted to SPSL reported more pain on first postoperative day but significantly less pain in the further postoperative course (day 3 numeric rating scale [NRS] 2.4 vs. 3.4, P = 0.03 and on day 5 NRS 2.5 vs. 3.7, P = 0.009). Equal or less cumulative doses of analgesics were administered postoperatively (significantly less paracetamol on day 5 compared with CD; P = 0.013). Both groups showed a similarly favorable outcome in terms of improved mobility and there were no significant differences between complications and re-stenosis rates between both techniques.
Patients treated with SPSL technique for LSS showed an equivalent favorable functional outcome compared to CD. However, SPSL patients showed significantly less subacute postoperative pain while using equal amounts or fewer analgesics postoperatively.
腰椎管狭窄症（LSS）的减压有几种显微外科技术。最近，一种棘突劈开椎板切除术（SPSL）技术被引入，前提是减少椎旁肌肉损伤。本研究旨在比较常规减压（CD）与 SPSL 手术治疗 LSS 后神经功能和功能结果，以及住院期间早期术后疼痛和镇痛药使用的差异。
对 2015 年至 2020 年间由一位咨询脊柱外科医生进行或监督的所有脊柱减压手术（CD 或 SPSL）进行单中心回顾性分析。分析了术前神经症状、功能结果以及围手术期镇痛药使用和住院期间报告的疼痛量表。
共有 106 例患者，其中 58 例采用 CD 治疗，48 例采用 SPSL 治疗。在两组中，约三分之一的患者术前服用阿片类药物（CD 组为 38%，SPSL 组为 31%）。接受 SPSL 的患者在术后第一天报告的疼痛更严重，但在进一步的术后过程中疼痛明显减轻（术后第 1 天数字评分量表[NRS]为 2.4 对 3.4，P=0.03，术后第 5 天 NRS 为 2.5 对 3.7，P=0.009）。术后给予相同或更少剂量的镇痛药（与 CD 相比，第 5 天的扑热息痛明显减少；P=0.013）。两组患者的活动能力均有明显改善，两种技术的并发症和再狭窄率无显著差异。
接受 SPSL 技术治疗 LSS 的患者与 CD 相比，功能结果同样良好。然而，SPSL 患者术后亚急性疼痛明显减轻，同时术后使用相同或更少的镇痛药。
