title: Facet-sparing decompression with a minimally invasive flexible microblade shaver: a prospective operative analysis.
abstract: METHODS
  This is a detailed description of a facet-sparing decompression technique and a prospective observational study of 59 subjects.
  
  
  OBJECTIVE
  To describe a facet-sparing decompression technique, quantify operative parameters, adverse events, and anatomic changes following decompression with a flexible microblade shaving system.
  
  
  BACKGROUND
  Decompression in patients with lumbar spinal stenosis is a common surgical procedure. However, obtaining a thorough decompression while leaving enough tissue to avoid destabilization can be challenging. Decompression with a flexible, through-the-foramen system may mitigate some of these challenges.
  
  
  METHODS
  Fifty-nine subjects diagnosed with lumbar spinal stenosis were recruited into this study. Subjects underwent decompression with a flexible, microblade decompression system at a total of 88 levels between L2 and S1. Subject demographics, details of the procedure, and operation, including adverse events were collected. Preoperative and postoperative computed tomography scans and plain radiographs were obtained from a subset of 12 subjects and quantitatively assessed for bone removal and preservation of stabilizing structures.
  
  
  RESULTS
  Fifty-nine subjects had 88 levels treated, 51% single-level and 49% 2-level with L4-L5 being the most commonly decompressed level. Operative time, blood loss, and length of stay were similar to or less than that seen in the historical control. The system was successfully used for decompression in 95.8% of the attempted foramina. Three operative complications were reported, all dural tears (5.1%). These dural tears occurred before introduction of the flexible decompression system. Computed tomography scans from 12 subjects demonstrate access to the lateral recess and foramen with removal of <6% of the superior facet cross-sectional area.
  
  
  CONCLUSIONS
  The flexible microblade shaving system provided thorough decompression with few intraoperative complications. Operative variables were favorable compared to the literature and radiographic decompression was achieved to a great extent while allowing for the preservation of the facet joints and midline structures.
authors.affiliation: *Pacific Brain and Spine, Castro Valley, CA †Spine Works Institute, North Richland Hills, TX ‡Spine Clinic of Monterey Bay, Soquel, CA §Tuckahoe Orthopaedics, Richmond, VA ∥OrthoGeorgia, Macon, GA ¶Masonovations, Minneapolis, MN #Tower Orthopaedics and Neurological Spine Institute, Beverly Hills, CA.
authors.forename: Lawrence D
authors.initials: LD
authors.lastname: Dickinson
authors.forename: Jeffery
authors.initials: J
authors.lastname: Phelps
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Summa
authors.forename: Jed S
authors.initials: JS
authors.lastname: Vanichkachorn
authors.forename: Winston R
authors.initials: WR
authors.lastname: Jeshuran
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Randall
authors.forename: Ronnie I
authors.initials: RI
authors.lastname: Mimran
authors.forename: Michelle
authors.initials: M
authors.lastname: Mitchell
authors.forename: Mitchell M
authors.initials: MM
authors.lastname: Macenski
authors.forename: Carl
authors.initials: C
authors.lastname: Lauryssen
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D019299:Decompression, Surgical / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D003710:Demography; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation*; D059351:Organ Sparing Treatments / Q000295:instrumentation*; D018583:Pliability; D011446:Prospective Studies; D013130:Spinal Stenosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D021801:Zygapophyseal Joint / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*