Introduction Unlike traditional open laminectomy, minimally invasive decompression (MID) spares the important midline structures of the spine (i.e., the spinous process and the supraspinous and interspinous ligaments).
Indications & Contraindications
Step 1: Preoperative Planning Determine the levels and laterality for the decompression on the basis of the symptoms and findings on the MRI scan.
Step 2: Operating Room Setup Ensure the correct positioning of the patient and the proper setup of the equipment.
Step 3: Marking the Level(s) Use fluoroscopy to localize the level(s) of the stenosis.
Step 4: Skin Incision and Tube Positioning Ensure the correct placement of the tube.
Step 5: Resection of the Lower Part of the Lamina Use a high-speed drill and Kerrison rongeur to enter the spinal canal.
Step 6: Resection of the Medial Part of the Facet Joint Proceed cautiously at the point where the spinal canal is usually narrowest.
Step 7: Resection of the Ligamentum Flavum Resect the ligamentum flavum piecemeal with a Kerrison rongeur.
Step 8: Crossover Technique (Optional) Use the crossover technique to reach across the midline and decompress the contralateral lateral recess (Video 3).
Step 9: Closing the Wound Perform a check to be certain that all steps have been completed before closing the skin.
Results In the study by Lønne et al., the 41 patients managed with MID had significant improvement at 6 weeks and throughout the 2-year observation period7.
Pitfalls & Challenges
Unlike traditional open laminectomy, minimally invasive decompression (MID) spares the important midline structures of the spine (i.e., the spinous process and the supraspinous and interspinous ligaments). The benefits are faster recovery, fewer instability problems, and fewer complications1,2. The procedure can be used in most patients with lumbar spinal stenosis, including those with recess stenosis and those who have had …
Enter your JBJS login information below.