Spinous process splitting approach in microscopic decompression of lumbar canal stenosis

Nasef, Nabil Amin; Sherin, Ahmed; Abdelbary, Mohamed Elsayed

doi:10.21608/pajn.2025.321568.1146

Spinous process splitting approach in microscopic decompression of lumbar canal stenosis

Document Type : Original Articles

Authors

¹ Department of Neurosurgery. Kafr El-Sheikh University.

² Lecturer of Neurosurgery Neurosurgery Department Alexandria Universtity

³ Neurosurgery Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt

10.21608/pajn.2025.321568.1146

Abstract

Background: Conventional laminectomy (CL) is the gold standard treatment for surgical management of lumbar canal stenosis (LCS). This approach entails aggressive muscle retraction, bony and ligamentous disruption. The spinous process (SP) splitting is a minimally invasive approach for LCS surgical management, affording effective central and lateral recess decompression, yet with less morbidity .

Aim: This study aimed to evaluate the safety and efficacy of the SP splitting approach in LCS management representing a single center experience.

Materials and Methods: This retrospective study involved 120 patients with surgical LCS who presented to a single center between March 2014 and July 2022, with a minimum follow up of 12 months. Patient underwent SP splitting decompression. Clinical, functional and radiological status were evaluated. Operative findings and complications were assessed. Preoperative and postoperative Creatine phosphokinase (CPK) and C-reactive protein (CRP) levels were revised.

Results: The ODI and VAS scores significantly improved at 1 month and 1 year postoperatively. The mean maximum walking distance improved significantly after surgery. The CRP and CPK levels were not significantly different at 2 weeks postoperative compared to preoperative values. The mean A-P diameter of spinal canal significantly increased postoperatively. Complications included accidental durotomy in 1 (0.83%) patient, superficial infection in 1 (0.83%) patient, muscle atrophy in 3 (2.5%) patients, and need for reoperation in 2 (1.7%) patients.

Conclusions: The SP splitting approach is a safe and effective minimally invasive technique for LCS surgical management that achieves favorable clinical and radiological outcomes, yet, with minimal surgical morbidity.

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