Efficacy of Spinous Process Splitting Decompression Compared with Conventional Laminectomy for Degenerative Lumbar Stenosis.

BACKGROUND: Spinous process splitting decompression (SPSD) is a minimally invasive surgical technique. We evaluated the clinical and radiological outcomes of SPSD compared with conventional laminectomy for the treatment of degenerative lumbar spinal stenosis. METHODS: SPSD was performed in 144 patients (group 1) and conventional laminectomy was performed in 132 patients (group 2) for degenerative lumbar spinal stenosis. Operative time, blood loss, hospital stay, and complications were compared between groups. Functional outcome was evaluated 2 years after surgery by Oswestry Disability Index, visual analog scale for back pain and leg pain, and progress in walking capacity. Spinal anteroposterior diameter and cross-sectional area were assessed by magnetic resonance imaging and computed tomography. RESULTS: Both groups showed significant improvement in mean functional outcome scores of Oswestry Disability Index and mean visual analog scale for back and leg pain after surgery (P < 0.001), although the differences in scores between the groups (P > 0.05) were not statistically significant. Walking capacity was reported as "much better" and "moderately better" in 89% of patients in group 1 and 87.8% of patients in group 2 (P > 0.05). On the basis of radiographic findings, satisfactory neurological decompression was achieved in group 1 (72.2% increase in mean spinal anteroposterior diameter, 102.5% increase in cross-sectional area) and group 2 (80.3% in mean spinal anteroposterior diameter, 108.8% increase in cross-sectional area) (P > 0.05). CONCLUSIONS: Patients who underwent SPSD for lumbar spinal decompression had comparable functional recovery rates correlated with clinical and radiological improvement to patients who underwent conventional laminectomy.

The Carotid Endarterectomy Cadaveric Investigation for Cranial Nerve Injuries: Anatomical Study.

Cerebral stroke continues to be one of the leading causes of mortality and long-term morbidity; therefore, carotid endarterectomy (CEA) remains to be a popular treatment for both symptomatic and asymptomatic patients with carotid stenosis. Cranial nerve injuries remain one of the major contributor to the postoperative morbidities. Anatomical dissections were carried out on 44 sides of 22 cadaveric heads following the classical CEA procedure to investigate the variations of the local anatomy as a contributing factor to cranial nerve injuries. Concurrence of two variations was found to be important in hypoglossal nerve injury: the presence of a direct smaller vein in proximity of the carotid bifurcation, and the intersection of the hypoglossal nerve (HN) with this vein. Based on the sample investigated, this variation was observed significantly higher on the right side. Awareness of possible anatomical variations and early ligation of any small veins can significantly decrease iatrogenic injury risk.