Relief of Lumbar Canal Stenosis Using Multilevel Subarticular Fenestrations as an Alternative to Wide Laminectomy: Preliminary Report

Abstract

We describe an operative approach to lumbar canal stenosis which, unlike laminectomy, takes into account the segmental pathology of the disease. At each level involved, a bilateral subarticular fenestration is performed under high magnification. The medial third of each facet joint is first removed with an air-powered drill; then the remaining two-thirds of the joint is undercut with the drill to allow a generous fenestration in the thickened ligamentum flavum and adjacent laminae. All tissue responsible for neural compression is removed, but the spinous processes, interspinous ligaments, and much of the facet joints and laminae are preserved. Spinal stability is maintained and, because tissue disruption is minimized, postoperative discomfort is usually reduced, promoting early mobility and reduced hospital stay. The operation is described in detail, and the results of operation in 32 patients are assessed. The follow-up periods now range from 17 to 58 months. Of 23 patients who presented with neurogenic claudication, 14 (61%) obtained complete relief and 7 (30%) improved significantly. The mean hospital stay was 9 days (range, 4 to 17 days).

Bilateral versus unilateral interlaminar approach for bilateral decompression in patients with single-level degenerative lumbar spinal stenosis: a multicenter retrospective study of 175 patients on postoperative pain, functional disability, and patient satisfaction

“…These numbers are higher than the success rates for laminectomy, which vary in the current literature between 50% and 70% 12,25,27,30,45,58,60 with satisfaction rates between 55% and 73%, 6,7,29,58,63 but are similar to the results of unilateral laminotomy studies (successful results in more than 80% of patients, and satisfaction rates ranging from 74.4% to 97%) 40,55,58,62 and bilateral series (good results reported in 68% to 90% of cases). 4,34,42,57,59,64 Interestingly, we did find a difference in patient satisfaction, as significantly more patients in the unilateral group were satisfied overall in comparison with the bilaterally operated patients (82.1% vs 69.1%, p = 0.047). This is in contrast to results reported by Thomé et al who investigated almost identical techniques (except they also preserved the supra-and interspinous ligaments while using the bilateral technique).…”

“…Both the bilateral interlaminar approach for bilateral decompression, 4,22,43,46,58,59,64 as well as the unilateral ap proach, 11,14,22,26,40,41,43,51,55,62 have been extensively researched and have shown promising results. Most of these studies, however, were limited by the size of the study population and choice of intervention.…”

“…9 In 1988, Young et al introduced microscope-assisted bilateral laminotomy. 64 In 1999, a less invasive unilateral approach was introduced for bilateral decompression. 62 Using this technique, the paraspinal muscles are unilaterally mobilized, thereby preserving the functional integrity of the contralateral muscles and inter-and supraspinous ligaments.…”

“…These less invasive lumbar microsurgical decompressive techniques have shown good clinical results and, at the same time, have reduced the chance of postoperative instability. 9,22,34,42,43,46,58,59,62,64 However, whether or not these two techniques are equal to each other in terms of important postoperative clinical outcomes and certain surgical parameters remains unclear. A large, preferably prospective, randomized study that compares only these two techniques is lacking; however, one needs to be critical when questioning the real benefits of such a study if both treatment options demonstrate similar and promising results.…”

Unilateral Minimally Invasive Posterior Lumbar Interbody Fusion (Unilateral Micro-PLIF) for Degenerative Spondylolisthesis: Surgical Technique

“…Interbody spacer far better results in term of disc height maintenance, preventing of collapse and indirect neural decompression than bone grafts alone. The first to report the unilateral approach for bilateral spinal canal decompression were Young et al (1988). Development of this surgical corridor requires the removal of bone from the ipsilateral spinolaminar junction.…”