Lumbar laminectomy
William Jason Mixter and Joseph S. Barr developed lumbar laminectomy in 1934.
Lumbar laminectomy, represents the standard operative treatment for lumbar spinal stenosis, but this procedure is often combined with fusion surgery. It is still discussed whether minimal-invasive decompression procedures are sufficient and if they compromise spinal stability as well.
The most common surgical method currently used is lumbar laminectomy, with complete decompression; this technique has a 5-year follow-up effective rate of 81.6% 1).
In many cases, the surgeon will remove arthritic bone and other structures that may be putting pressure on spinal nerves. This is called a lumbar decompression.
Indications
This lumbar spine surgery is typically performed to alleviate pain caused by neural impingement that can result from lumbar spinal stenosis.
The lumbar laminectomy is designed to remove a small portion of the bone over the nerve root and/or disc material from under the nerve root to give the nerve root more space and a better healing environment.
Technique
Wide laminectomy via bilateral paraspinal exposure is the conventional surgical approach for the decompression of spinal canal stenosis. This classic technique allows maximal operative exposure for bilateral neural canal and/or foraminal decompression. There is a resulting extensive violation of the paraspinal muscles, the interspinous ligament, the supraspinous ligament, posterior bone elements and sometimes the capsular facet.
Although lumbar laminectomy is the standard option of neural structure decompression, it can cause instability 2) and result in a less favorable outcomes at long-term follow-up 3).
Various technical modifications of the standard laminectomy have been reported in an attempt to adequately treat patients with spinal stenosis while maximizing the structural preservation of the spine 4) 5) 6) 7) 8) 9) 10).
Minimally Invasive Lumbar Laminectomy
Laminectomy and bilateral laminotomy are the standard procedures for decompression of lumbar spinal stenosis (LSS). With the aim of less invasiveness and better preservation of spinal stability, the technique of unilateral laminotomy for bilateral decompression (ULBD) was developed, it is a less destabilizing alternative to lumbar laminectomy and leads to good short-term outcomes. However, little is known about the long-term results including predictive factors.