Lumbar decompressive
laminectomy for
spinal stenosis can be performed using a less-invasive, unilateral approach with subperiosteal dissection and
decompression by undermining the lamina from the ipsilateral to the contralateral side. A unilateral approach to bilateral
decompression can be supplemented with interspinous instrumentation and facet fusion, a combined procedure that has not been studied before. The less-invasive technique appears to be as effective for lumbar
stenosis as the traditional lumbar
laminectomy. It also causes less blood loss and reduced operating time, and so may benefit patients who are elderly, medically frail, or with multiple comorbidities. Fifteen patients (eight females, seven males) underwent
outpatient surgery by the author (HA) using this technique. These patients complained of progressive
lower back pain associated with radicular
pain exacerbated by prolonged standing or walking with improvement in flexed position of the lumbar spine with decreased walking distance ability. A one-level less-invasive lumbar
laminectomy and
foraminotomy with facet fusion and interspinous fixation were performed for
spinal stenosis in conjunction with a Grade I degenerative
spondylolisthesis. These patients all had a single-level facet fusion with bone graft material and local autograft. The approximate
surgical time for each patient was between 50 and 80 minutes. The visual analog scale for
pain (VAS) score decreased significantly after surgery; patients presented with preoperative VAS scores of 5-10/10 (mean 8.33/10). Postoperative VAS scores were 0-6/10 (mean 2/10), yielding a mean VAS improvement of 76% following surgery. Future analysis should be performed for evaluation of sustained VAS score, Oswestry Disability Index (ODI), Form 36 Health Survey Questionnaire (SF 36), and the Zurich Claudication Questionnaire (ZCQ).