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Yoshiaki Toyama - One of the best experts on this subject based on the ideXlab platform.
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reduced postoperative wound pain after lumbar spinous process splitting Laminectomy for lumbar canal stenosis a randomized controlled study clinical article
Journal of Neurosurgery, 2011Co-Authors: Kota Watanabe, Morio Matsumoto, Takeshi Ikegami, Yuji Nishiwaki, Takashi Tsuji, Ken Ishii, Yuto Ogawa, Hironari Takaishi, Masaya Nakamura, Yoshiaki ToyamaAbstract:Object To reduce intraoperative damage to the posterior supporting structures of the lumbar spine during decompressive surgery for lumbar canal stenosis (LCS), lumbar spinous process–splitting Laminectomy (LSPSL or split Laminectomy) was developed. This prospective, randomized, controlled study was conducted to clarify whether the split Laminectomy decreases acute postoperative wound pain compared with conventional Laminectomy. Methods Forty-one patients with LCS were enrolled in this study. The patients were randomly assigned to either the LSPSL group (22 patients) or the conventional Laminectomy group (19 patients). Questionnaires regarding wound pain (intensity, depth, and duration) and activities of daily living (ADL) were administered at postoperative days (PODs) 3 and 7. Additionally, the authors evaluated the pre- and postoperative serum levels of C-reactive protein and creatine phosphokinase, the amount of pain analgesics used during a 3-day postoperative period, and the muscle atrophy rate measur...
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lumbar spinous process splitting Laminectomy for lumbar canal stenosis technical note
Journal of Neurosurgery, 2005Co-Authors: Koota Watanabe, Tateru Shiraishi, Morio Matsumoto, Kazuhiro Chiba, Toshihiko Hosoya, Yoshiaki ToyamaAbstract:In conventional Laminectomy for lumbar canal stenosis (LCS), intraoperative damage of posterior supporting structures can lead to irreversible atrophy of paraspinal muscles. In 2001, the authors developed a new procedure for lumbar Laminectomy, the lumbar spinous process-splitting Laminectomy (LSPSL). In this new procedure, the spinous process is split longitudinally in the middle and then divided at its base from the posterior arch, leaving the bilateral paraspinal muscles attached to the lateral aspects. Ample working space for Laminectomy is obtained by retracting the split spinous process laterally together with its attached paraspinal muscles. After successfully decompressing nerve tissues, each half of the split spinous process is reapproximated using a strong suture. Thus, the supra- and interspinous ligaments are preserved, as is the spinous process, and damage to the paraspinal muscles is minimal. Eighteen patients with LCS underwent surgery in which this new technique was used. Twenty patients in whom conventional Laminectomy was undertaken were chosen as controls. At 2 years, the clinical outcomes (as determined using the Japanese Orthopaedic Association [JOA] scores and recovery rate) and the rate of measured magnetic resonance imaging-documented paravertebral muscle atrophy were evaluated and compared between the two groups. The mean JOA score recovery rates were 67.6 and 59.2%, respectively, for patients treated with LSPSL and conventional Laminectomy; the mean rates of paravertebral muscle atrophy were 5.3 and 23.9%, respectively (p = 0.0005). Preservation of posterior supporting structures and satisfactory recovery rate after 2 years indicated that this technique can be a useful alternative to conventional decompression surgery for lumbar canal stenosis.
Chris Brown - One of the best experts on this subject based on the ideXlab platform.
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laminoplasty versus Laminectomy with fusion for the treatment of spondylotic cervical myelopathy short term follow up
European Spine Journal, 2017Co-Authors: Daniel J Blizzard, Mitchell R Klement, Adam M Caputo, Charles Sheets, Keith W Michael, Robert E Isaacs, Chris BrownAbstract:Laminoplasty and Laminectomy with fusion are two common procedures for the treatment of cervical spondylotic myelopathy. Controversy remains regarding the superior surgical treatment. To compare short-term follow-up of laminoplasty to Laminectomy with fusion for the treatment of cervical spondylotic myelopathy. Retrospective review comparing all patients undergoing surgical treatment for cervical spondylotic myelopathy by a single surgeon. All patients undergoing laminoplasty or Laminectomy with fusion by a single surgeon over a 5-year period (2007–2011). Cervical alignment and range of motion on pre- and post-operative radiographs and clinical outcome measures including Japanese Orthopaedic Association (JOA) scores, neck disability index (NDI), short form-12 mental (SF-12M) and physical (SF-12P) composite scores and visual analog pain scores for neck (VAS-N) and arm (VAS-A). Patients undergoing laminoplasty or Laminectomy with fusion by a single surgeon were reviewed. Cohorts of 41 laminoplasty patients and 31 Laminectomy with fusion patients were selected based on strict criteria. The cohorts were well matched based on pre-operative clinical scores, radiographic measurements, and demographics. The average follow-up was 19.2 months for laminoplasty and 18.2 months for Laminectomy with fusion. Evaluated outcomes included Japanese Orthopaedic Association (JOA) score, neck disability index (NDI), short form-12 (SF-12), visual analog pain scores (VAS), cervical sagittal alignment, cervical range of motion, length of stay, cost and complications. The improvement in JOA, SF-12 and VAS scores was similar in the two cohorts after surgery. There was no significant change in cervical sagittal alignment in either cohort. Range-of-motion decreased in both cohorts, but to a greater degree after Laminectomy with fusion. C5 nerve root palsy and infection were the most common complications in both cohorts. Laminectomy with fusion was associated with a higher rate of C5 nerve root palsy and overall complications. The average hospital length of stay and cost were significantly less with laminoplasty. This study provides evidence that laminoplasty may be superior to Laminectomy with fusion in preserving cervical range of motion, reducing hospital stay and minimizing cost. However, the significance of these differences remains unclear, as laminoplasty clinical outcome scores were generally comparable to Laminectomy with fusion.
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c5 palsy after cervical Laminectomy and fusion does width of Laminectomy matter
The Spine Journal, 2016Co-Authors: Mitchell R Klement, Lindsay T Kleeman, Daniel J Blizzard, Michael A Gallizzi, Megan Eure, Chris BrownAbstract:Abstract Background context A common complication of cervical Laminectomy and fusion with instrumentation (CLFI) is development of postoperative C5 nerve palsy. A proposed etiology is excess nerve tension from posterior drift of the spinal cord after decompression. We hypothesize that Laminectomy width will be significantly increased in patients with C5 palsy and will correlate with palsy severity. Purpose The purposes of this study were to evaluate Laminectomy width as a risk factor for C5 palsy and to assess correlation with palsy severity. Study design/setting : This is a retrospective, single-institution clinical study. Patient sample Patient population included all patients with cervical spondylotic myelopathy who underwent CLFI between 2007 and 2014 by a single surgeon. Patients who underwent CLFI for trauma, infection, or tumor or had previous or circumferential cervical surgery were excluded. All patients with a new C5 palsy received a postoperative magnetic resonance imaging. An additional computed tomography (CT) scan was ordered to assess hardware. All control patients received a CT scan at 6 months postoperatively to evaluate fusion. Outcome measures The association between width of Laminectomy and development of postopeative C5 palsy was measured. Methods Patient comorbidities including obesity, smoking history, and diabetes were recorded in addition to preopertaive and postoperative deltoid and biceps motor strength. Sagittal alignment was measured with C2–C7 Cobb angle preopertaive and postoperative radiographs. The width of Laminectomy was measured in a blinded fashion on the postoperative CT scan by two observers. Results Seventeen patients with C5 nerve palsy and 12 controls were identified. There were no baseline differences in age, sex, diabetes, smoking history, number of surgical levels, or sagittal alignment. Body mass index was significantly higher in the control cohort. There was no significant increase in the C3–C7 Laminectomy width in patients with postoperative C5 palsy. The width of Laminectomy measurments were highly similar between the two observers. There was no correlation between Laminectomy width and palsy severity. Conclusions This is the largest series of C5 palsies after Laminectomy documented with CT imaging. Laminectomy width was not associated with an increased risk of postoperative C5 palsy at any level. Reduction in Laminectomy width may not reduce rate of postoperative nerve palsy.
Hiroki Hirabayashi - One of the best experts on this subject based on the ideXlab platform.
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comparison of spinous process splitting Laminectomy versus conventional Laminectomy for lumbar spinal stenosis
Asian Spine Journal, 2014Co-Authors: Masashi Uehara, Shugo Kuraishi, Toshimasa Futatsugi, Keijiro Mukaiyama, Hiroyuki Hashidate, Shota Ikegami, Nobuhide Ogihara, Masayuki Shimizu, Jun Takahashi, Hiroki HirabayashiAbstract:STUDY DESIGN: Seventy-five patients who had been treated for lumbar spinal stenosis (LSS) were reviewed retrospectively. PURPOSE: Invasion into the paravertebral muscle can cause major problems after Laminectomy for LSS. To address these problems, we performed spinous process-splitting Laminectomy. We present a comparative study of decompression of LSS using 2 approaches. OVERVIEW OF LITERATURE: There are no other study has investigated the lumbar spinal instability after spinous process-splitting Laminectomy. METHODS: This study included 75 patients who underwent Laminectomy for the treatment of LSS and who were observed through follow-ups for more than 2 years. Fifty-five patients underwent spinous process-splitting Laminectomy (splitting group) and 20 patients underwent conventional Laminectomy (conventional group). We evaluated the clinical and radiographic results of each surgical procedure. RESULTS: Japanese Orthopaedic Association score improved significantly in both groups two years postoperatively. The following values were all significantly lower, as shown with p-values, in the splitting group compared to the conventional group: average operating time (p=0.002), postoperative C-reactive protein level (p=0.006), the mean postoperative number of days until returning to normal body temperature (p=0.047), and the mean change in angulation 2 years postoperatively (p=0.007). The adjacent segment degeneration occurred in 6 patients (10.9%) in the splitting group and 11 patients (55.0%) in the conventional group. CONCLUSIONS: In this study, the spinous process-splitting Laminectomy was shown to be less invasive and more stable for patients with LSS, compared to the conventional Laminectomy.
Morio Matsumoto - One of the best experts on this subject based on the ideXlab platform.
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reduced postoperative wound pain after lumbar spinous process splitting Laminectomy for lumbar canal stenosis a randomized controlled study clinical article
Journal of Neurosurgery, 2011Co-Authors: Kota Watanabe, Morio Matsumoto, Takeshi Ikegami, Yuji Nishiwaki, Takashi Tsuji, Ken Ishii, Yuto Ogawa, Hironari Takaishi, Masaya Nakamura, Yoshiaki ToyamaAbstract:Object To reduce intraoperative damage to the posterior supporting structures of the lumbar spine during decompressive surgery for lumbar canal stenosis (LCS), lumbar spinous process–splitting Laminectomy (LSPSL or split Laminectomy) was developed. This prospective, randomized, controlled study was conducted to clarify whether the split Laminectomy decreases acute postoperative wound pain compared with conventional Laminectomy. Methods Forty-one patients with LCS were enrolled in this study. The patients were randomly assigned to either the LSPSL group (22 patients) or the conventional Laminectomy group (19 patients). Questionnaires regarding wound pain (intensity, depth, and duration) and activities of daily living (ADL) were administered at postoperative days (PODs) 3 and 7. Additionally, the authors evaluated the pre- and postoperative serum levels of C-reactive protein and creatine phosphokinase, the amount of pain analgesics used during a 3-day postoperative period, and the muscle atrophy rate measur...
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lumbar spinous process splitting Laminectomy for lumbar canal stenosis technical note
Journal of Neurosurgery, 2005Co-Authors: Koota Watanabe, Tateru Shiraishi, Morio Matsumoto, Kazuhiro Chiba, Toshihiko Hosoya, Yoshiaki ToyamaAbstract:In conventional Laminectomy for lumbar canal stenosis (LCS), intraoperative damage of posterior supporting structures can lead to irreversible atrophy of paraspinal muscles. In 2001, the authors developed a new procedure for lumbar Laminectomy, the lumbar spinous process-splitting Laminectomy (LSPSL). In this new procedure, the spinous process is split longitudinally in the middle and then divided at its base from the posterior arch, leaving the bilateral paraspinal muscles attached to the lateral aspects. Ample working space for Laminectomy is obtained by retracting the split spinous process laterally together with its attached paraspinal muscles. After successfully decompressing nerve tissues, each half of the split spinous process is reapproximated using a strong suture. Thus, the supra- and interspinous ligaments are preserved, as is the spinous process, and damage to the paraspinal muscles is minimal. Eighteen patients with LCS underwent surgery in which this new technique was used. Twenty patients in whom conventional Laminectomy was undertaken were chosen as controls. At 2 years, the clinical outcomes (as determined using the Japanese Orthopaedic Association [JOA] scores and recovery rate) and the rate of measured magnetic resonance imaging-documented paravertebral muscle atrophy were evaluated and compared between the two groups. The mean JOA score recovery rates were 67.6 and 59.2%, respectively, for patients treated with LSPSL and conventional Laminectomy; the mean rates of paravertebral muscle atrophy were 5.3 and 23.9%, respectively (p = 0.0005). Preservation of posterior supporting structures and satisfactory recovery rate after 2 years indicated that this technique can be a useful alternative to conventional decompression surgery for lumbar canal stenosis.
Fumihiko Kato - One of the best experts on this subject based on the ideXlab platform.
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surgical outcomes of modified lumbar spinous process splitting Laminectomy for lumbar spinal stenosis
Journal of Neurosurgery, 2015Co-Authors: Shunsuke Kanbara, Masaaki Machino, Yasutsugu Yukawa, Fumihiko KatoAbstract:The lumbar spinous process–splitting Laminectomy (LSPSL) procedure was developed as an alternative to lumbar Laminectomy. In the LSPSL procedure, the spinous process is evenly split longitudinally and then divided at its base from the posterior arch, leaving the bilateral paravertebral muscle attached to the lateral aspects. This procedure allows for better exposure of intraspinal nerve tissues, comparable to that achieved by conventional Laminectomy while minimizing damage to posterior supporting structures. In this study, the authors make some modifications to the original LSPSL procedure (modified LSPSL), in which laminoplasty is performed instead of Laminectomy. The purpose of this study was to compare postoperative outcomes in modified LSPSL with those in conventional Laminectomy (CL) and to evaluate bone unions between the split spinous process and residual laminae following modified LSPSL. Forty-seven patients with lumbar spinal stenosis were enrolled in this study. Twenty-six patients underwent mo...
