{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,8]],"date-time":"2025-11-08T12:15:12Z","timestamp":1762604112674},"reference-count":24,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>Split laminotomy is a technique for accessing the spinal canal from the posterior midline that minimizes muscle dissection and bone removal. Benefits of this approach in minimizing postoperative pain and muscle atrophy in the adult population have been reported, but pediatric data are limited. Herein, the authors evaluate the benefits of the split laminotomy technique in pediatric patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Data obtained in patients who underwent posterior spine surgery at Children\u2019s Hospital of Wisconsin for an intradural midline pathology between April 2008 and June 2015 were reviewed retrospectively. Each patient was assigned to one of two groups, the split-laminotomy or conventional-laminotomy group. The primary outcomes assessed were mean daily pain score, total opioid use over a period of 72 hours after surgery, and the degree of paraspinal muscle atrophy and fat infiltration found on short-term (1\u20134 months) and long-term (1\u20134 years) follow-up spine MRI studies.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>A total of 117 patients underwent lumbar-level surgery (83 conventional laminotomy, 34 split laminotomy), and 8 patients underwent thoracic-level surgery (4 in each group). No significant difference in the mean daily pain scores between groups was found. The daily opioid use was significantly lower in the split-laminotomy group on postoperative day 0 (POD0) and POD1 but not on POD2 (p = 0.01, 0.01, and 0.10, respectively). The total opioid use over the 72-hour postoperative period was significantly lower in the split-laminotomy group (p = 0.0008). The fat\/muscle ratio was significantly higher in both the short-term and long-term follow-up periods in the conventional-laminotomy group (p = 0.01 and 0.0002, respectively). The rate of change of paraspinal muscle fat infiltration was significantly lower in the split-laminotomy group than in the conventional-laminotomy group (p = 0.007). The incidence of complications was not significantly different between groups (p = 0.08).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>This study was of the largest series reported thus far of pediatric patients who underwent split laminotomy and the only controlled study that has involved children. The authors\u2019 results reinforce the short-term benefit of split laminotomy in minimizing acute postoperative pain and long-term benefits of decreasing muscle atrophy and fatty degeneration, which are known to be associated with the development of chronic pain and spinal instability. Additional efforts for assessing long-term effects in the development of chronic pain, spinal instability, and spinal deformity are still necessary.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2017.12.peds17368","type":"journal-article","created":{"date-parts":[[2018,3,23]],"date-time":"2018-03-23T13:55:56Z","timestamp":1521813356000},"page":"615-625","source":"Crossref","is-referenced-by-count":13,"title":["Split laminotomy versus conventional laminotomy: postoperative outcomes in pediatric patients"],"prefix":"10.3171","volume":"21","author":[{"given":"Elsa V.","family":"Arocho-Quinones","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amie","family":"Kolimas","sequence":"additional","affiliation":[{"name":"Chicago College of Osteopathic Medicine, Downers Grove, Illinois;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter S.","family":"LaViolette","sequence":"additional","affiliation":[{"name":"Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruce A.","family":"Kaufman","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"Department of Neurosurgery, Children\u2019s Hospital of Wisconsin, Milwaukee, Wisconsin; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew B.","family":"Foy","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"Department of Neurosurgery, Children\u2019s Hospital of Wisconsin, Milwaukee, Wisconsin; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marike","family":"Zwienenberg","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of California Davis Medical Center, Sacramento, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sean M.","family":"Lew","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"Department of Neurosurgery, Children\u2019s Hospital of Wisconsin, Milwaukee, Wisconsin; and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Pediatr Emerg Care","doi-asserted-by":"publisher","first-page":"1281","DOI":"10.1097\/PEC.0b013e3182767d66","article-title":"The use of the faces, legs, activity, cry and consolability scale to assess procedural pain and distress in young children","volume":"28","author":"Babl FE","year":"2012","unstructured":"Babl FE, Crellin D, Cheng J, Sullivan TP, O\u2019Sullivan R, Hutchinson A: The use of the faces, legs, activity, cry and consolability scale to assess procedural pain and distress in young children. 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