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lumbar_laminectomy

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.

see Minimally Invasive Lumbar Laminectomy.

Complications

Associated with significant blood loss, postoperative wound pain, prolonged hospital stay and impaired lumbar stability requiring fusion or stabilization. Modification to the original technique to reduce the morbidity without affecting its effectiveness include less invasive surgery such as partial laminectomy or bilateral laminotomy decompression, foraminotomy with medial facetectomy as well as microdiscectomy.

However, the technique is associated with considerable trauma, postoperative spinal instability, degeneration acceleration near the segment, and nerve adhesion 11).

Case series

1)
Bouras T, Stranjalis G, Loufardaki M, Sourtzis I, Stavrinou LC, Sakas DE. Predictors of long-term outcome in an elderly group after laminectomy for lumbar stenosis. J Neurosurg Spine. 2010;59:329–34.
2)
Johnsson KE, Redlund-Johnell I, Udén A, Willner S. Preoperative and postoperative instability in lumbar spinal stenosis. Spine (Phila Pa 1976) 1989;14:591–593.
3)
Tuite GF, Stern JD, Doran SE, Papadopoulos SM, McGillicuddy JE, Oyedijo DI, et al. Outcome after laminectomy for lumbar spinal stenosis. Part I : Clinical correlations. J Neurosurg. 1994;81:699–706.
4)
Aryanpur J, Ducker T. Multilevel lumbar laminotomies : an alternative to laminectomy in the treatment of lumbar stenosis. Neurosurgery. 1990;26:429–432. discussion 433.
5)
Getty CJ, Johnson JR, Kirwan EO, Sullivan MF. Partial undercutting facetectomy for bony entrapment of the lumbar nerve root. J Bone Joint Surg Br. 1981;63-B:330–335.
6)
Herron LD, Pheasant HC. Bilateral laminotomy and discectomy for segmental lumbar disc disease. Decompression with stability. Spine (Phila Pa 1976) 1983;8:86–97.
7)
Ji YC, Kim YB, Hwang SN, Park SW, Kwon JT, Min BK. Efficacy of unilateral laminectomy for bilateral decompression in elderly lumbar spinal stenosis. J Korean Neurosurg Soc. 2005;37:410–415.
8)
Poletti CE. Central lumbar stenosis caused by ligamentum flavum : unilateral laminotomy for bilateral ligamentectomy : preliminary report of two cases. Neurosurgery. 1995;37:343–347.
9)
Spetzger U, Bertalanffy H, Naujokat C, von Keyserlingk DG, Gilsbach JM. Unilateral laminotomy for bilateral decompression of lumbar spinal stenosis. Part I : Anatomical and surgical considerations. Acta Neurochir (Wien) 1997;139:392–396.
10)
Watanabe K, Hosoya T, Shiraishi T, Matsumoto M, Chiba K, Toyama Y. Lumbar spinous process-splitting laminectomy for lumbar canal stenosis. Technical note. J Neurosurg Spine. 2005;3:405–408.
11)
Gelalis ID, Stafilas KS, Korompilias AV, Zacharis KC, Beris AE, Xenakis TA. Decompressive surgery for degenerative lumbar spinal stenosis: long term results. Int Orthop. 2006;30:59–63.
lumbar_laminectomy.txt · Last modified: 2019/08/14 11:33 by administrador