CLINICAL STUDY ON MODIFIED LAMINOPLASTY WITH POSTERIOR COLUMN RESERVATION FOR TREATMENT OF LUMBAR SPINAL STENOSIS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SHANGZhenguo ^1,2 ,  LIYongmin ² , ZHANGJiwei ² , ZHOUJinguo ² , LIChao ² , TIANTao ²

1. Graduate School of North China University of Science and Technology, Tangshan Hebei, 063000, P.R.China;
2. The 1st Department of Spinal Surgery, the Second Hospital of Tangshan;

Corresponding author：

LIYongmin, Email: 2008.liyongmin@163.com

Keywords：

Lumbar spinal stenosis; Modified laminoplasty; Laminectomy

DOI：

10.7507/1002-1892.20160147

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Objective To investigate the technique and effectiveness of modified laminoplasty for lumbar spinal stenosis (LSS) and to explore the application value of modified laminoplasty in maintaining the stability of the spine by comparing with the conventional laminectomy. Methods Fifty-six patients with LSS were included between June 2012 and July 2013, and they were divided into 2 groups: 27 patients underwent modified laminoplasty in group A, and 29 patients received conventional laminectomy in group B. There was no significant difference in sex, age, disease duration, narrow segment, visual analogue scale (VAS) score of low back pain and leg pain, Japanese Orthopaedic Association (JOA) score, and walking tolerance between 2 groups (P > 0.05). The postoperative VAS score of low back pain and leg pain, JOA score, walking tolerance, X-ray film, and CT were used to evaluate the clinical results. Results Dural tear occurred in 2 cases of group A and 1 case of group B and were repaired during operation. All incisions primarily healed without infection. The patients were followed up 24-31 months (mean, 24.7 months) in group A, and 24-37 months (mean, 26.2 months) in group B. The bone healing time was 6-12 months (mean, 9 months) in group A. CT showed healing at the junction of spinous process and vertebral plate in group A at 12 months after operation; new scar in varying degre es was observed in group B. At last follow-up, lumbar spondylolisthesis and instability occurred in 4 and 2 cases of group B respectively, and received re-operation. The change value of slip distance was (0.27±0.23) mm in group A and was (0.83±1.22) mm in group B, showing significant difference (t=-2.405, P=0.023). The postoperative JOA score, VAS score, and walking tolerance were significantly improved when compared with preoperative ones in 2 groups (P < 0.05). At last follow-up, group A was better than group B in VAS score of low back pain (P < 0.05), but no significant difference was found in the other indexes between 2 groups (P > 0.05). Conclusion The modified laminoplasty is better than the conventional laminectomy in relieving low back pain and maintaining the stability of the lumbar spine.

Citation： SHANGZhenguo, LIYongmin, ZHANGJiwei, ZHOUJinguo, LIChao, TIANTao. CLINICAL STUDY ON MODIFIED LAMINOPLASTY WITH POSTERIOR COLUMN RESERVATION FOR TREATMENT OF LUMBAR SPINAL STENOSIS. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(6): 721-725. doi: 10.7507/1002-1892.20160147 Copy

1.	Schulte TL, Bullmann V, Lerner T, et al. Lumbar spinal stenosis. Der Orthopäde, 2006, 35(6): 675-694.
2.	Yücesoy K, Crawford NR. Increase in spinal canal area after inverse laminoplasty: an anatomical study. Spine (Phila Pa 1976), 2000, 25(21): 2771-2776.
3.	王众, 李骥, 廖腾, 等. 改良Kessler缝合法治疗Ⅱ区指屈肌腱断裂. 中医正骨, 2015, 26(11): 815-816.
4.	Bambakidis NC, Feiz-Erfan I, Klopfenstein JD, et al. Indications for surgical fusion of the cervical and lumbar motion segment. Spine (Phila Pa 1976), 2005, 30(16 Suppl): S2-6.
5.	Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical versus nonsurgical therapy for lumbar spinal stenosis. N Engl J Med, 2008, 358(8): 794-810.
6.	Watanabe K, Hosoya T, Shiraishi T, et al. Lumbar spinous process-splitting laminectomy for lumbar canal stenosis. J Neurosurg Spine, 2005, 3(5): 405-408.
7.	Olivero WC, Wang H, Hanigan WC, et al. Cauda equina syndrome (CES) from lumbar disc herniations. J Spinal Disord Tech, 2009, 22(3): 202-206.
8.	Omidi-Kashani F, Hasankhani EG, Ashjazadeh A. Lumbar spinal stenosis: who should be fused? An updated review. Asian Spine J, 2014, 8(4): 521-530.
9.	陆少磊, 黄公怡. 硬膜外瘢痕与腰椎手术失败综合征. 中华骨科杂志, 2000, 20(10): 630-633.
10.	Turner JA, Ersek M, Herron L, et al. Surgery for lumbar spinal stenosis. Attempted meta-analysis of the literature. Spine (Phila Pa 1976), 1992, 17(1): 1-8.
11.	Soares GG. Unilateral laminotomy for bilateral microdecompression of stenosis of the lumbar canal. Michigan Mathematical Journal, 2015, 14(3): 236-239.
12.	鞍安民, 陈仲, 邵振海, 等. 腰椎间盘突出症三术式远期疗效的比较. 中华骨科杂志, 1998, 18(12): 711-714.
13.	Postacchini F. Surgical management of lumbar spinal stenosis. Spine (Phila Pa 1976), 1999, 12(8): 809-816.
14.	Burton CV, Kirkaldy-Willis WH, Yong-Hing K, et al. Causes of failure of surgery on the lumbar spine. Clin Orthop Relat Res, 1981, (157): 191-199.
15.	Postacchini F, Cinotti G. Bone regrowth after surgical decompression for lumbar spinal stenosis. J Bone Joint Surg (Br), 1992, 74(6): 862-869.
16.	Deyo RA, Martin BI, Ching A, et al. Interspinous spacers compared with decompression or fusion for lumbar stenosis: complications and repeat operations in the Medicare population. Spine (Phila Pa 1976), 2013, 38(10): 865-872.
17.	Kothe R, Quante M, Engler N, et al. The effect of incidental dural lesions on outcome after decompression surgery for lumbar spinal stenosis: results of a multi-center study with 800 patients. Eur Spine J, 2016. [Epub ahead of print].
18.	Jayarao M, Chin LS. Results after lumbar decompression with and without discectomy: comparison of the transspinous and conventional approaches. Neurosurgery, 2010, 66(3 Suppl Operative): 152-160.
19.	Bresnahan L, Ogden AT, Natarajan RN, et al. A biomechanical evaluation of graded posterior element removal for treatment of lumbar stenosis: comparison of a minimally invasive approach with two standard laminectomy techniques. Spine (Phila Pa 1976), 2009, 34(1): 17-23.
20.	Tuli SM, Kapoor V, Jain AK, et al. Spinaplasty following lumbar laminectomy for multilevel lumbar spinal stenosis to prevent iatrogenic instability. Indian J Orthop, 2011, 45(5): 396-403.

1. Schulte TL, Bullmann V, Lerner T, et al. Lumbar spinal stenosis. Der Orthopäde, 2006, 35(6): 675-694.
2. Yücesoy K, Crawford NR. Increase in spinal canal area after inverse laminoplasty: an anatomical study. Spine (Phila Pa 1976), 2000, 25(21): 2771-2776.
3. 王众, 李骥, 廖腾, 等. 改良Kessler缝合法治疗Ⅱ区指屈肌腱断裂. 中医正骨, 2015, 26(11): 815-816.
4. Bambakidis NC, Feiz-Erfan I, Klopfenstein JD, et al. Indications for surgical fusion of the cervical and lumbar motion segment. Spine (Phila Pa 1976), 2005, 30(16 Suppl): S2-6.
5. Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical versus nonsurgical therapy for lumbar spinal stenosis. N Engl J Med, 2008, 358(8): 794-810.
6. Watanabe K, Hosoya T, Shiraishi T, et al. Lumbar spinous process-splitting laminectomy for lumbar canal stenosis. J Neurosurg Spine, 2005, 3(5): 405-408.
7. Olivero WC, Wang H, Hanigan WC, et al. Cauda equina syndrome (CES) from lumbar disc herniations. J Spinal Disord Tech, 2009, 22(3): 202-206.
8. Omidi-Kashani F, Hasankhani EG, Ashjazadeh A. Lumbar spinal stenosis: who should be fused? An updated review. Asian Spine J, 2014, 8(4): 521-530.
9. 陆少磊, 黄公怡. 硬膜外瘢痕与腰椎手术失败综合征. 中华骨科杂志, 2000, 20(10): 630-633.
10. Turner JA, Ersek M, Herron L, et al. Surgery for lumbar spinal stenosis. Attempted meta-analysis of the literature. Spine (Phila Pa 1976), 1992, 17(1): 1-8.
11. Soares GG. Unilateral laminotomy for bilateral microdecompression of stenosis of the lumbar canal. Michigan Mathematical Journal, 2015, 14(3): 236-239.
12. 鞍安民, 陈仲, 邵振海, 等. 腰椎间盘突出症三术式远期疗效的比较. 中华骨科杂志, 1998, 18(12): 711-714.
13. Postacchini F. Surgical management of lumbar spinal stenosis. Spine (Phila Pa 1976), 1999, 12(8): 809-816.
14. Burton CV, Kirkaldy-Willis WH, Yong-Hing K, et al. Causes of failure of surgery on the lumbar spine. Clin Orthop Relat Res, 1981, (157): 191-199.
15. Postacchini F, Cinotti G. Bone regrowth after surgical decompression for lumbar spinal stenosis. J Bone Joint Surg (Br), 1992, 74(6): 862-869.
16. Deyo RA, Martin BI, Ching A, et al. Interspinous spacers compared with decompression or fusion for lumbar stenosis: complications and repeat operations in the Medicare population. Spine (Phila Pa 1976), 2013, 38(10): 865-872.
17. Kothe R, Quante M, Engler N, et al. The effect of incidental dural lesions on outcome after decompression surgery for lumbar spinal stenosis: results of a multi-center study with 800 patients. Eur Spine J, 2016. [Epub ahead of print].
18. Jayarao M, Chin LS. Results after lumbar decompression with and without discectomy: comparison of the transspinous and conventional approaches. Neurosurgery, 2010, 66(3 Suppl Operative): 152-160.
19. Bresnahan L, Ogden AT, Natarajan RN, et al. A biomechanical evaluation of graded posterior element removal for treatment of lumbar stenosis: comparison of a minimally invasive approach with two standard laminectomy techniques. Spine (Phila Pa 1976), 2009, 34(1): 17-23.
20. Tuli SM, Kapoor V, Jain AK, et al. Spinaplasty following lumbar laminectomy for multilevel lumbar spinal stenosis to prevent iatrogenic instability. Indian J Orthop, 2011, 45(5): 396-403.

Chinese Journal of Reparative and Reconstructive Surgery

CLINICAL STUDY ON MODIFIED LAMINOPLASTY WITH POSTERIOR COLUMN RESERVATION FOR TREATMENT OF LUMBAR SPINAL STENOSIS

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