Minimally Invasive Laminectomy for Lumbar Stenosis
What is Lumbar Stenosis?
Lumbar stenosis is a condition resulting in narrowing of the spine. The narrowing of the spine is often due to bone spur formation, arthritis, thickening of the spinal ligaments and possibly bulging of the spinal discs. It is more common in older people. However, it occasionally occurs even in young patients, especially if there is a genetic component.
Lumbar Spinal Stenosis Symptoms
Symptoms can include back pain and sciatica, which results in pain in a leg, with possible weakness, numbness and tingling. Sciatica can also be known as radiculopathy and is caused by pinching of a nerve in the back. Lumbar spinal stenosis can also commonly cause what is known as neurogenic claudication. This condition causes pain, weakness, and or numbness with standing or walking. Sitting, lying down, or flexing the back classically relieves this condition. Patients often lean on a shopping cart when in the store and this allows them to stand or walk much further. Standing up straight is often difficult and patients may stand slightly bent over. MRI is required to make the diagnosis. If surgery is required to treat this condition, minimally invasive surgery is often an option.
Technique of Minimally Invasive Laminectomy
Lumbar stenosis patients are positioned face-down on the OR table. The location of the incision is often confirmed by an intraoperative X-ray, using fluoroscopy. A skin incision about 1 inch in length is made to one side of the middle of the back at the surgical level. Dilators are sequentially placed to split the muscle down to the lamina, the back part of the spine.
A retractor is then placed to hold the muscle tissue back and allow surgical access to the spine. Using a microscope, overlying soft tissue is removed and the bone exposed. Use of a microscope improves surgical lighting and vision, making the surgery more precise and accurate. Specially designed surgical instruments are then used to remove bone spurs and the lamina on the side of the approach. This is referred to as a lumbar laminectomy or lumbar decompression. The table is then tilted and the spinous process undercut. The anterior part of the lamina on the other side may then be removed. The ligament under the bone is opened and removed using special biting instruments. The disc can also be checked.
Advantages of Minimally Invasive Laminectomy
Both sides may be decompressed from an incision made from only one side. This preserves the midline spinous process and ligaments. The contra-lateral facet joint is also preserved. This makes the surgery much less destabilizing than open laminectomy. This approach may be used in patients with shifting of the spine, calleddestabilizing. With open surgery, laminectomy is usually combined with fusion as open laminectomy alone in this condition destabilizes the spine too much. With minimally invasive laminectomy, we have treated many patients with spondylolisthesis and stenosis with decompression alone. Clinical outcomes have generally been excellent. Avoiding fusion in this setting allows a much faster recovery and a reduction in complications. Not all patients are candidates for minimally invasive laminectomy.
Minimally invasive lumbar laminectomy generally involves smaller incisions, less postoperative pain, and less blood loss than open laminectomy. In addition to being less destabilizing to the spine, recovery is often faster. Many patients with spinal stenosis are elderly. However, minimally invasive lumbar laminectomy is more easily tolerated in this setting than open back surgery. We have successfully performed minimally invasive lumbar laminectomy in many patients in their 80’s. These patients have generally had a good outcome from surgery. Thus advanced age alone may not be an absolute contraindication to surgery in this setting.
Minimally Invasive Lumbar Laminectomy Recovery
Patients typically begin walking immediately after lumbar stenosis surgery. Patients generally go home the day after surgery, even if more than one level in the back requires surgery. By two weeks post-op, most patients are reducing their pain medication usage. Many already note an improved ability to walk and are standing up straighter than prior to back surgery.
In some cases, minimally invasive lumbar laminectomy may not be the best option for surgical treatment. Some patients with scar tissue from previous surgery, spinal deformities, or excess obesity may benefit from traditional open back surgery instead. Not all patients and not all conditions can be treated via a minimally invasive approach.
Schedule Your Lumbar Stenosis Consultation
Houston Neurosurgeons Dr. Bindal and Dr. Park will discuss your condition with you at the time of your consultation and inform you if surgery is appropriate at all. If surgery is appropriate, he will discuss whether minimally invasive lumbar laminectomy may be an option. Call Texas Spine & Neurosurgery Center today and schedule your consultation - (281) 313-0031.