Minimally Invasive Lumbar Decompression for the Treatment of Spinal Stenosis of the Lumbar Spine

Abstract

SUMMARY Lumbar spinal stenosis is one of the most common degenerative diseases of the elderly population, and a major cause of debilitating pain and decreased function. Lumbar spinal stenosis is almost always associated with neurogenic claudication characterized as pain worsened by standing or walking and relieved by lumbar flexion or sitting. While initial treatment of lumbar spinal stenosis may involve conservative therapies, as patients become more symptomatic the traditional treatment path has generally led to open laminectomy and other invasive, potentially destabilizing, procedures. More recently, less invasive alternatives to wide laminectomy have been developed. This article describes a new method of percutaneous lumbar decompression for treatment of neurogenic claudication secondary to lumbar spinal stenosis, the minimally invasive lumbar decompression procedure. We review the steps of successfully decompressing the hypertrophic ligamentum flavum and lamina, thereby alleviating pressure on neural structures. This is a major innovation in patient care and a step to reduce risks while minimizing costs.

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“…5 The average radiation dose received by patients has not been quantified in the published literature. For example, a percutaneous approach is defined by a 5-to 10-mm surgical incision; an endoscopic approach requires a 15-to 20-mm incision, and a typical open laminotomy requires a 4-to 6-cm incision.…”

“…5 An epidurogram is then performed for the purpose of identifying the hypertrophic ligamentum flavum. Appropriate bolstering is used as needed.…”

“…Appropriate bolstering is used as needed. 5 The MILD bone sculptor rongeur is placed through the access portal to the lamina. Use of the contralateral oblique view presents the thickest cross-section of the lamina, providing optimal ligamentum-infolding imaging.…”

“…5 An epidurogram is then performed for the purpose of identifying the hypertrophic ligamentum flavum. 5 Debulking of the ligamentum flavum is accomplished by removing the collagen-laden posterior portion of the ligament, while leaving the ventral fibers of the ligament intact. Next, the interlaminar space is identified through fluoroscopic visualization.…”

“…Use of the contralateral oblique view presents the thickest cross-section of the lamina, providing optimal ligamentum-infolding imaging. 5 The procedure can be performed bilaterally and on multiple vertebral levels in one or more sessions. 5 After the trajectory has been planned and the patient's skin marked, the MILD 6G portal and 7G trocar are inserted percutaneously.…”