A minimally invasive technique for decompression of the lumbar spine.
METHODS
The technical feasibility of percutaneous microendoscopic bilateral decompression of lumbar stenosis via a unilateral approach was evaluated in a human cadaver model.


OBJECTIVE
The purpose of this study was to determine the feasibility of using a microendoscopic laminotomy technique to treat spinal stenosis.


BACKGROUND
Minimally invasive surgery is an important means of reducing tissue trauma and patient morbidity. This may prove to be essential in improving pain and in reducing postoperative stress responses and delayed sequelae that can lead to unfortunate complications after otherwise uneventful procedures. To date, minimally invasive lumbar endoscopic techniques have not been used to decompress the lumbar spinal canal.


METHODS
In each of four cadavers, the laminae of L1 through L4 were subjected to one of four procedures consisting of unilateral microendoscopic laminotomy, bilateral microendoscopic laminotomy, unilateral open laminotomy, and bilateral open laminotomy. Every procedure was performed once at all levels. Computed tomography was performed before and after laminotomy to establish the extent of decompression of the spinal canal, and measurements of the midsagittal, interpedicular, and decompression diameters were taken.


RESULTS
The four procedures were successfully performed at every level. Satisfactory decompression of the spinal canal was achieved regardless of the approach used. The exiting nerve roots were well visualized when any one of these techniques was used. Complications, including dural tears and facet complex instability, were independent of the procedure performed.


CONCLUSIONS
Microendoscopic laminotomy can be used to decompress the spinal canal as effectively as an open laminotomy and may prove to be beneficial in decreasing the complications and morbidity of standard treatments for lumbar stenosis.
Guiot
Bernard H
BH
Institute for Spine Care, Chicago Institute of Neurosurgery & Neuroresearch, Chicago, Illinois, USA.
Khoo
Larry T
LT
Fessler
Richard G
RG
D002102:Cadaver; D019299:Decompression, Surgical / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005240:Feasibility Studies; D006801:Humans; D008161:Lumbosacral Region; D008866:Microsurgery; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods*; D013130:Spinal Stenosis / Q000601:surgery*; D013131:Spine / Q000000981:diagnostic imaging / Q000601:surgery; D013997:Time Factors; D014057:Tomography, X-Ray Computed