Greger Lønne1,2, Thomas D Cha2. 1. Department of Orthopaedic Surgery, Innlandet Hospital Trust, Lillehammer, Norway. 2. Department of Orthopaedics, Massachusetts General Hospital, Boston, Massachusetts.
Abstract
INTRODUCTION: Unlike traditional open laminectomy, minimally invasive decompression (MID) spares the important midline structures of the spine (i.e., the spinous process and the supraspinous and interspinous ligaments). STEP 1 PREOPERATIVE PLANNING: Determine the levels and laterality for the decompression on the basis of the symptoms and findings on the MRI scan. STEP 2 OPERATING ROOM SETUP: Ensure the correct positioning of the patient and the proper setup of the equipment. STEP 3 MARKING THE LEVELS: Use fluoroscopy to localize the level(s) of the stenosis. STEP 4 SKIN INCISION AND TUBE POSITIONING: Ensure the correct placement of the tube. STEP 5 RESECTION OF THE LOWER PART OF THE LAMINA: Use a high-speed drill and Kerrison rongeur to enter the spinal canal. STEP 6 RESECTION OF THE MEDIAL PART OF THE FACET JOINT: Proceed cautiously at the point where the spinal canal is usually narrowest. STEP 7 RESECTION OF THE LIGAMENTUM FLAVUM: Resect the ligamentum flavum piecemeal with a Kerrison rongeur. STEP 8 CROSSOVER TECHNIQUE OPTIONAL: Use the crossover technique to reach across the midline and decompress the contralateral lateral recess (Video 3). STEP 9 CLOSING THE WOUND: Perform a check to be certain that all steps have been completed before closing the skin. RESULTS: In the study by Lønne et al., the 41 patients managed with MID had significant improvement at 6 weeks and throughout the 2-year observation period7.
INTRODUCTION: Unlike traditional open laminectomy, minimally invasive decompression (MID) spares the important midline structures of the spine (i.e., the spinous process and the supraspinous and interspinous ligaments). STEP 1 PREOPERATIVE PLANNING: Determine the levels and laterality for the decompression on the basis of the symptoms and findings on the MRI scan. STEP 2 OPERATING ROOM SETUP: Ensure the correct positioning of the patient and the proper setup of the equipment. STEP 3 MARKING THE LEVELS: Use fluoroscopy to localize the level(s) of the stenosis. STEP 4 SKIN INCISION AND TUBE POSITIONING: Ensure the correct placement of the tube. STEP 5 RESECTION OF THE LOWER PART OF THE LAMINA: Use a high-speed drill and Kerrison rongeur to enter the spinal canal. STEP 6 RESECTION OF THE MEDIAL PART OF THE FACET JOINT: Proceed cautiously at the point where the spinal canal is usually narrowest. STEP 7 RESECTION OF THE LIGAMENTUM FLAVUM: Resect the ligamentum flavum piecemeal with a Kerrison rongeur. STEP 8 CROSSOVER TECHNIQUE OPTIONAL: Use the crossover technique to reach across the midline and decompress the contralateral lateral recess (Video 3). STEP 9 CLOSING THE WOUND: Perform a check to be certain that all steps have been completed before closing the skin. RESULTS: In the study by Lønne et al., the 41 patients managed with MID had significant improvement at 6 weeks and throughout the 2-year observation period7.
Authors: Greger Lønne; Lars Gunnar Johnsen; Ivar Rossvoll; Hege Andresen; Kjersti Storheim; John Anker Zwart; Øystein P Nygaard Journal: Spine (Phila Pa 1976) Date: 2015-01-15 Impact factor: 3.468