Abstract
Objectives: Lumbar spinous process-splitting laminectomy (LSPSL) is one of the less invasive operative methods of decompression surgery for lumbar spinal stenosis (LSS). The aim of this research was to determine if multi-level decompression surgery was inferior to single-level decompression surgery when LSPSL was applied to LSS.
Materials and Methods: LSPSLs were performed for 39 patients with the cauda equina-type of LSS, and the patients were divided into three groups based on the number of decompressions (single level: 15 patients in group S, double level: 14 patients in group D, triple level: 10 patients in group T). Inclusion criteria consisted of: a lower grade of spondylolisthesis (less than Meyerding grade I), ranges of motion at decompression levels less than 20 degrees, Cobb angles less than 10 degrees, and durations of follow-up more than one year. The mean age of the patients was 69.7 years at the time of surgery, and the follow-up period averaged 21.5 months. Clinical outcomes were: JOA score, low back pain score of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), and visual analog scale (VAS) of low back pain. Dynamic lateral X-ray images were used to evaluate the translation of the vertebral bodies and range of motion at decompressed levels.
Results: There were no significant differences among the three groups at the pre-operative baseline. Average JOA scores were improved from 15.9 to 25.2 in group S, 16.2 to 23.2 in group D, and 15.7 to 24.6 in group T and VAS scores for low back pain were 5.2 to 2.1, 6.0 to 3.6, and 4.9 to 1.8 respectively. The gains in scores of JOABPEQ were 33.3 in group S, 34.6 in group D, and 28.7 in group T. All clinical outcomes revealed significant improvements at the last follow-up, and there was no evidence of worsening spondylolisthesis in any of the groups.
Conclusions: Based on short-term observation, multi-level decompression surgery was not inferior to single-level decompression surgery when LSPSL was applied to LSS patients.
