H M Mayer1, F Heider. 1. Wirbelsäulenzentrum, Schön Klinik München - Harlaching, Harlachinger Str. 51, 81547, München, Deutschland. MMayer@schoen-kliniken.de
Abstract
OBJECTIVE: Selective, bilateral multisegmental microsurgical decompression of lumbar spinal canal stenosis through separate, alternating cross-over approaches. INDICATIONS: Two- and multisegmental degenerative central and lateral lumbar spinal stenoses. CONTRAINDICATIONS: None (however, if stabilization is necessary, the Slalom technique is not possible). SURGICAL TECHNIQUE: Minimally invasive, muscle-sparing and facet-joint-sparing bilateral decompression of the lumbar spinal canal through 2 or more alternating microsurgical cross-over approaches from one side. POSTOPERATIVE MANAGEMENT: Early mobilization 4-6 h postoperatively. Soft lumbar brace for 4 weeks (optional). RESULTS: Between December 2010 and May 2011, the operation was performed in 35 patients (10 women; 25 men; age 71.8 years). The average time of surgery was 42 min/segment, the average blood loss was 20.3 ml/segment. Of the 35 patients, 15 did not required wound drainage. All patients were mobilized without restriction after 4-6 h, hospitalization was 5.2 days. There were 3 intraoperative complications (2 Dura lesions [5.7%] and 1 temporary L5 radiculopathy probably due to swelling of the L5 nerve root [2.8%]). Postoperatively there was a significant improvement in quality of life as measured with EQ 5D and Oswestry Disability Index as well as a significant improvement of walking distance and standing time.
OBJECTIVE: Selective, bilateral multisegmental microsurgical decompression of lumbar spinal canal stenosis through separate, alternating cross-over approaches. INDICATIONS: Two- and multisegmental degenerative central and lateral lumbar spinal stenoses. CONTRAINDICATIONS: None (however, if stabilization is necessary, the Slalom technique is not possible). SURGICAL TECHNIQUE: Minimally invasive, muscle-sparing and facet-joint-sparing bilateral decompression of the lumbar spinal canal through 2 or more alternating microsurgical cross-over approaches from one side. POSTOPERATIVE MANAGEMENT: Early mobilization 4-6 h postoperatively. Soft lumbar brace for 4 weeks (optional). RESULTS: Between December 2010 and May 2011, the operation was performed in 35 patients (10 women; 25 men; age 71.8 years). The average time of surgery was 42 min/segment, the average blood loss was 20.3 ml/segment. Of the 35 patients, 15 did not required wound drainage. All patients were mobilized without restriction after 4-6 h, hospitalization was 5.2 days. There were 3 intraoperative complications (2 Dura lesions [5.7%] and 1 temporary L5 radiculopathy probably due to swelling of the L5 nerve root [2.8%]). Postoperatively there was a significant improvement in quality of life as measured with EQ 5D and Oswestry Disability Index as well as a significant improvement of walking distance and standing time.
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