Spinous process splitting laminectomy for lumbar canal stenosis: a critical appraisal

Spinous process splitting laminectomy (SPSL) is a surgical technique for lumbar canal stenosis, which aims to preserve the paraspinal muscles. Twenty-five patients with lumbar canal stenosis who consecutively underwent SPSL from June 2005 to December 2005 were evaluated. Clinical outcomes were assessed using the visual analogue scale (VAS) scores and Oswestry disability index (ODI). Mean age of the patients at surgery was 62.6 years (range: 42-77 years). Seventeen patients underwent SPSL for single level stenosis, 4 for two levels, and 4 for three levels. In 10 patients, discectomy was simultaneously performed at the same level as SPSL. Of 23 patients (92%) followed for a 1-year period, VAS for back pain, leg pain, and ODI decreased significantly; from 4.8, 8.1, and 54.3-2.1, 2.7, and 23.1, respectively. However, a significant improvement (> 50% of their initial VAS/ODI score) of back pain, leg pain, and functional status was observed in only 65.2, 65.2, and 52.2%, respectively. Complications occurred in 4 patients (16%). Although SPSL for lumbar canal stenosis yielded relatively good clinical outcomes, the percentage of patients showing significant improvements in back pain, leg pain, and functional status were less than expected at one year after surgery.