Minimally Invasive Decompression in Lumbar Spinal Stenosis.

Abstract

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). Determine the levels and laterality for the decompression on the basis of the symptoms and findings on the MRI scan. Ensure the correct positioning of the patient and the proper setup of the equipment. Use fluoroscopy to localize the level(s) of the stenosis. Ensure the correct placement of the tube. Use a high-speed drill and Kerrison rongeur to enter the spinal canal. Proceed cautiously at the point where the spinal canal is usually narrowest. Resect the ligamentum flavum piecemeal with a Kerrison rongeur. Use the crossover technique to reach across the midline and decompress the contralateral lateral recess (Video 3). Perform a check to be certain that all steps have been completed before closing the skin. 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.