Kuppan Naveenkumar, Velayudham Raja, Parthasarathy Sathyanarayanan, Mohanen Pragash
Department of Orthopaedics, Sri Manakula Vinayagar Medical College & Hospital, Puducherry, India.
J Orthop Case Rep. 2025 Jun;15(6):19-23. doi: 10.13107/jocr.2025.v15.i06.5648.
The spinal canal is narrower in the upper lumbar levels than in the lower lumbar levels. Due to these reasons, the selection of a surgical approach is challenging. Fenestration discectomy at this level is more prone to neurological injury in most cases. Wide laminectomy or transforaminal approach is commonly used in upper lumbar disc surgeries. Surgical procedures using wide laminectomy and facetectomy give wide decompression but cause instability and need surgical fusion in most cases. We discuss an alternative approach for high lumbar disc disease using spinous process osteotomy, where minimally invasive non-fusion spine surgery is done with the preservation of posterior spinal elements.
A 38-year-old male presented with low backache and weakness of bilateral lower limbs for 2 weeks after lifting a heavy object. He also complained of bowel and bladder incontinence. Radiographs show L2-L3 disc space narrowing with no sign of instability in dynamic views. MRI showed an L2-L3 disc bulge with an extruded disc fragment compressing the central canal. Since the patient was young, to avoid fusion and adjacent segment disease, we planned for L2-L3 discectomy using a minimally invasive spinous process osteotomy approach. During the post-operative period, there was significant improvement in motor power and bowel and bladder control. The patient was mobilized from day 01 with support. With 1 year of follow-up, the patient is pain-free and has returned to his routine activities. Follow-up X-ray of the patient shows no sign of instability.
Spinous process osteotomy also minimizes tissue injury by preserving the paraspinal musculature and the interspinous, supraspinous ligament complex, and facets. Spinous process osteotomy is a modality of treatment for high lumbar disc disease in young patients without the need for spinal fusion.
腰椎上段的椎管比下段狭窄。由于这些原因，手术入路的选择具有挑战性。在大多数情况下，该节段的开窗髓核摘除术更容易导致神经损伤。腰椎上段椎间盘手术通常采用广泛椎板切除术或经椎间孔入路。使用广泛椎板切除术和小关节切除术的手术操作可实现广泛减压，但在大多数情况下会导致脊柱不稳定，需要进行手术融合。我们讨论一种使用棘突截骨术治疗高位腰椎间盘疾病的替代方法，即通过保留脊柱后部结构进行微创非融合脊柱手术。
一名38岁男性在重物搬运后出现腰痛和双下肢无力2周。他还伴有大小便失禁。X线片显示L2-L3椎间盘间隙变窄，动态位片无不稳定迹象。MRI显示L2-L3椎间盘膨出，有椎间盘碎片突出压迫中央管。由于患者年轻，为避免融合及相邻节段疾病，我们计划采用微创棘突截骨术进行L2-L3椎间盘切除术。术后，运动能力以及大小便控制情况有显著改善。术后第1天患者在辅助下即可活动。随访1年，患者无痛，已恢复日常活动。患者的随访X线片无不稳定迹象。
棘突截骨术还通过保留椎旁肌肉组织、棘间和棘上韧带复合体以及小关节，将组织损伤降至最低。棘突截骨术是治疗年轻患者高位腰椎间盘疾病的一种方法，无需进行脊柱融合。
