Spinous Process-Splitting Laminectomy Versus Conventional Laminectomy: A Short-Term Outcome Study

BACKGROUND: Symptomatic lumbar spine stenosis (LSS) is a common spine degenerative disease often associated with back pain and neurogenic claudication pain. Laminectomy is a widely performed procedure in treating LSS, but it can lead to approach-related morbidity due to iatrogenic paraspinal muscle injury. Spinous process-splitting laminectomy (SPSL) is a muscle-preserving laminectomy technique that has been reported to provide superior functional outcomes and less postoperative pain. METHODS: This retrospective comparative study evaluated the conventional laminectomy (CL) and SPSL techniques regarding operative time, blood loss, postoperative pain, disability indices, and time to return to daily activities. RESULTS: A total of 27 patients were included in the study. The mean age of the participants was 62.5 ± 7.8 years, with 13 patients in the CL group and 14 patients in the SPSL group. The average intraoperative blood loss was less in the SPSL group (123.21 ± 54.12 ml) compared to the CL group (188.46 ± 79.46 ml). The mean operative time was 67.86 ± 33.27 min in the SPSL group and 87.69 ± 32.44 min in the CL group. The mean immediate postoperative low back pain on the Visual Analog Scale (VAS) at day one was 2.8 ± 0.6 for the CL group and 2.0 ± 0.0 for the SPSL group (p-value = 0.001). At six months, the mean postoperative low back pain on VAS was 0.77 ± 0.44 for the CL group and 0.21 ± 0.43 for the SPSL group (p-value = 0.012). The average Oswestry Disability Index (ODI) score at six months postoperatively was 2.21 ± 0.43 for the SPSL group and 4.38 ± 4.73 for the CL group (p-value = 0.001). The average time to return to normal activities of daily living was 2.07 ± 0.27 days in the SPSL group, much less than 6.77 ± 4.6 days in the CL group (p-value < 0.01). CONCLUSION: SPSL represents a minimally invasive alternative to CL, with significant reductions in operative time and intraoperative blood loss. It also results in less postoperative pain and better functional outcomes, enabling an earlier return to daily activities.