Multilevel lumbar laminotomies: an alternative to laminectomy in the treatment of lumbar stenosis.

The traditional treatment for lumbar stenosis is a wide laminectomy. This procedure has a high success rate and a low, but not insignificant, incidence of complications. Recently, however, a better understanding of the pathophysiology of spondylotic lumbar stenosis has led several authors to propose a more limited decompression directed specifically toward the offending area of compression. Over the past 5 years, we have treated 32 patients with lumbar stenosis using decompressive laminotomies. Our patients all had focal lateral recess stenosis that was diagnosed by computed tomography or magnetic resonance imaging. We performed decompressive laminotomies and foraminotomies at appropriate levels. This procedure is less disruptive than a full laminectomy and, in experienced hands, requires less operating time. At last follow-up, 90% of the patients so treated reported an excellent outcome--namely, total relief of symptoms and/or return to normal daily activities. There was no significant postoperative morbidity or mortality. We conclude that in a selected subgroup of patients with lumbar stenosis, multilevel laminotomies may be an acceptable alternative to laminectomy.