Spinous Process Osteotomy for High Lumbar Disc Disease - An Alternative for Transforaminal Lumbar Interbody Fusion in Young- A Case Report.

Abstract

Introduction: The spinal canal is narrower in the upper lumbar levels than in the lower lumbar levels. Due to these reasons, the selection of a surgical approach is challenging. Fenestration discectomy at this level is more prone to neurological injury in most cases. Wide laminectomy or transforaminal approach is commonly used in upper lumbar disc surgeries. Surgical procedures using wide laminectomy and facetectomy give wide decompression but cause instability and need surgical fusion in most cases. We discuss an alternative approach for high lumbar disc disease using spinous process osteotomy, where minimally invasive non-fusion spine surgery is done with the preservation of posterior spinal elements.

Case report: A 38-year-old male presented with low backache and weakness of bilateral lower limbs for 2 weeks after lifting a heavy object. He also complained of bowel and bladder incontinence. Radiographs show L2-L3 disc space narrowing with no sign of instability in dynamic views. MRI showed an L2-L3 disc bulge with an extruded disc fragment compressing the central canal. Since the patient was young, to avoid fusion and adjacent segment disease, we planned for L2-L3 discectomy using a minimally invasive spinous process osteotomy approach. During the post-operative period, there was significant improvement in motor power and bowel and bladder control. The patient was mobilized from day 01 with support. With 1 year of follow-up, the patient is pain-free and has returned to his routine activities. Follow-up X-ray of the patient shows no sign of instability.

Conclusion: Spinous process osteotomy also minimizes tissue injury by preserving the paraspinal musculature and the interspinous, supraspinous ligament complex, and facets. Spinous process osteotomy is a modality of treatment for high lumbar disc disease in young patients without the need for spinal fusion.