Management of lumbar spinal stenosis: a survey among Dutch spine surgeons.

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Abstract

[Indexed for MEDLINE] 12. JBJS Essent Surg Tech. 2016 Dec 14;6(4):e41. doi: 10.2106/JBJS.ST.16.00029. eCollection 2016 Dec 28. Minimally Invasive Decompression in Lumbar Spinal Stenosis. Lønne G(1)(2), Cha TD(2). Author information: (1)Department of Orthopaedic Surgery, Innlandet Hospital Trust, Lillehammer, Norway. (2)Department of Orthopaedics, Massachusetts General Hospital, Boston, Massachusetts. INTRODUCTION: Unlike traditional open laminectomy, minimally invasive decompression (MID) spares the important midline structures of the spine (i.e., the spinous process and the supraspinous and interspinous ligaments). STEP 1 PREOPERATIVE PLANNING: Determine the levels and laterality for the decompression on the basis of the symptoms and findings on the MRI scan. STEP 2 OPERATING ROOM SETUP: Ensure the correct positioning of the patient and the proper setup of the equipment. STEP 3 MARKING THE LEVELS: Use fluoroscopy to localize the level(s) of the stenosis. STEP 4 SKIN INCISION AND TUBE POSITIONING: Ensure the correct placement of the tube. STEP 5 RESECTION OF THE LOWER PART OF THE LAMINA: Use a high-speed drill and Kerrison rongeur to enter the spinal canal. STEP 6 RESECTION OF THE MEDIAL PART OF THE FACET JOINT: Proceed cautiously at the point where the spinal canal is usually narrowest. STEP 7 RESECTION OF THE LIGAMENTUM FLAVUM: Resect the ligamentum flavum piecemeal with a Kerrison rongeur. STEP 8 CROSSOVER TECHNIQUE OPTIONAL: Use the crossover technique to reach across the midline and decompress the contralateral lateral recess (Video 3). STEP 9 CLOSING THE WOUND: Perform a check to be certain that all steps have been completed before closing the skin. RESULTS: In the study by Lønne et al., the 41 patients managed with MID had significant improvement at 6 weeks and throughout the 2-year observation period7. DOI: 10.2106/JBJS.ST.16.00029 PMCID: PMC6132610