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.
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.
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.
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.
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).
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.
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).