Modified Marmot Operation Versus Spinous Process Transverse Cutting Laminectomy For Lumbar Spinal Stenosis.
Spine (Phila Pa 1976). 2013 Jun 17;
Authors: Kawakami M, Nakao SI, Fukui D, Kadosaka Y, Matsuoka T
Study Design. Retrospective comparative cohort study.Objective. To compare clinical outcomes for lumbar spinal stenosis (? 3 levels) (LSS) treated with posterior decompression without exposing the paravertebral muscles (PVM) with outcomes from surgery with PVM exposure.Summary of Background Data. Exposure of the PVM can cause muscle injury and denervation, which may induce failed back. However, it is unknown whether LSS is more likely to lead to clinical improvement following PVM preservation than the procedure involving exposure of the PVM.Methods. Fifty-three patients with LSS were divided based on the timing of the surgery into two groups: modified split-spinous process laminotomy (Marmot operation) (MM) group (26 patients) or spinous process transverse cutting laminectomy through a unilateral approach (control) group (27 patients). The Japanese Orthopaedic Association Back Pain Questionnaire (JOABPEQ), visual analogue scale (VAS) of low back pain (LBP), and patients’ satisfaction were assessed preoperatively and 1 year postoperatively (PO). Operation time, blood loss, and creatine phosphokinase (CPK) and C-reactive protein (CRP) levels were measured 7 days PO. MRI changes in the PVM were evaluated at the follow-up.Results. The preoperative VAS and JOABPEQ scores did not differ between groups. The operation time did not differ between groups, but blood loss was less in the MM group than in the control group (129 vs 205 mL) (P < 0.05). CRP (1.1 vs 2.8 mg/dL) and CPK (68 vs 253 IU/L) levels were lower in the MM group (P < 0.05). The VAS score for LBP and patient satisfaction did not differ between groups. The JOABPEQ scores for pain-related disorders, gait disturbance, and social life disturbance improved significantly in the MM group compared with the control group (P < 0.05). Nine patients in the control group showed positive changes in the PVM.Conclusion. The MM operation was less invasive and produced superior clinical outcomes compared with laminectomy involving exposure of the PVM.
PMID: 23778375 [PubMed – as supplied by publisher]