Partial Resection of Spinous Process for the Elderly Patients with Thoraco-Lumbar Kyphosis: Technical Report
Hirohiko Inanami,
Hiroki Iwai,
So Kato,
Yuichi Takano,
Yohei Yuzawa,
Kazuyoshi Yanagisawa,
Takeshi Kaneko,
Tomohide Segawa,
Ko Matsudaira,
Hiroyuki Oka,
Masahito Oshina,
Masayoshi Fukusima,
Fumiko Saiki,
Yasushi Oshima
Affiliations
Hirohiko Inanami
Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, 3-17-5 Higashi-shinagawa Shinagawa-ku, Tokyo 140-0002, Japan
Hiroki Iwai
Department of Orthopaedic Surgery, Iwai Orthopaedic Medical Hospital, 8-17-2 Minamikoiwa Edogawa-ku, Tokyo 133-0056, Japan
So Kato
Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
Yuichi Takano
Department of Orthopaedic Surgery, Iwai Orthopaedic Medical Hospital, 8-17-2 Minamikoiwa Edogawa-ku, Tokyo 133-0056, Japan
Yohei Yuzawa
Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, 3-17-5 Higashi-shinagawa Shinagawa-ku, Tokyo 140-0002, Japan
Kazuyoshi Yanagisawa
Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, 3-17-5 Higashi-shinagawa Shinagawa-ku, Tokyo 140-0002, Japan
Takeshi Kaneko
Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, 3-17-5 Higashi-shinagawa Shinagawa-ku, Tokyo 140-0002, Japan
Tomohide Segawa
Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, 3-17-5 Higashi-shinagawa Shinagawa-ku, Tokyo 140-0002, Japan
Ko Matsudaira
22nd Century Medical & Research Center, Department of Medical Research and Management for Musculoskeletal Pain, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
Hiroyuki Oka
22nd Century Medical & Research Center, Department of Medical Research and Management for Musculoskeletal Pain, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
Masahito Oshina
Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
Masayoshi Fukusima
Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
Fumiko Saiki
Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
Yasushi Oshima
Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
Background and objectives: Global sagittal imbalance with lumbar hypo-lordosis can cause low back pain (LBP) during standing and/or walking. This condition has recently been well-known as one of the major causes of reduced health-related quality of life (HRQOL) in elderly populations. Decrease in disc space of anterior elements and an increase in the spinous process height of posterior elements may both contribute to the decrease in lordosis of the lumbar spine. To correct the sagittal imbalance, the mainstream option is still a highly invasive surgery, such as long-segment fusion with posterior wedge osteotomy. Therefore, we developed a treatment that is partial resection of several spinous processes of thoraco-lumbar spine (PRSP) and lumbar extension exercise to improve the flexibility of the spine as postoperative rehabilitation. Materials and Methods: Consecutively, seven patients with over 60 mm of sagittal vertical axis (SVA) underwent PRSP. The operation was performed with several small midline skin incisions under general anesthesia. After splitting the supraspinous ligaments, the cranial or caudal tip of the spinous process of several thoraco-lumbar spines was removed, and postoperative rehabilitation was followed to improve extension flexibility. Results: The average follow-up period was 13.0 months. The average blood loss and operation time were 11.4 mL and 47.4 min, respectively. The mean SVA improved from 119 to 93 mm but deteriorated in one case. The mean numerical rating scale of low back pain improved from 6.6 to 3.7 without any exacerbations. The mean Oswestry Disability Index score was improved from 32.4% to 19.1% in six cases, with one worsened case. Conclusions: We performed PRSP and lumbar extension exercise for the patients with LBP due to lumbar kyphosis. This minimally invasive treatment was considered to be effective in improving the symptoms of low back pain and HRQOL, especially of elderly patients with lumbar kyphosis.
