Lumbar spinous process splitting decompression provides equivalent outcomes to conventional midline decompression in degenerative lumbar canal stenosis: A prospective, randomised controlled study of 51 patients

Study Design. Prospective, randomized controlled studyObjective. To compare the functional outcomes and extent of paraspinal muscle damage between two decompressive techniques for lumbar canal stenosis (LCS).Summary of Background Data. Lumbar spinous process splitting decompression (LSPSD) preserves the muscular and ligamentous attachments of the posterior elements of the spine. It can potentially avoid problems like paraspinal muscle atrophy and trunk extensor weakness that can occur following conventional midline decompression (CMD). However large series prospective randomized controlled studies are lacking.Methods. Patients with LCS were randomly allocated into two groups: LSPSD (28 patients) and CMD (23 patients). The differences in operative time, blood loss, time to comfortable mobilization and hospital stay were studied. Paraspinal muscle damage was assessed by post operative rise in CPK and CRP levels. Functional outcome was evaluated at one year by JOA score, NCOS, VAS for Back pain and Neurogenic Claudication.Results. 51 patients of mean age 56 years were followed up for a mean 14.2 ± 2.9 months. There were no significant differences in the operative time, blood loss, and hospital stay. Both the groups showed significant improvement in the functional outcome scores at one year. Between the two groups, the JOA score, NCOS improvement, BPVAS, NCVAS and the post-operative changes in serum CRP and CPK levels did not show any statistically significant difference. Based on JOA recovery rate, 73.9% of CMD group had good outcomes compared to only 60.7% after LSPSD.Conclusion. The functional outcome scores, back pain and claudication pain in the immediate period and at the end of one year are similar in both the techniques. More patients had better functional outcomes after conventional decompression than the LSPSD technique. Based on the present study, the superiority of one technique over the other is not established mandating the need for further long term studies.