Artikel
Split Laminectomy for spinal stenosis of the lumbar spine – a minimally invasive procedure
Split-Laminektomie bei lumbaler Spinalstenose – ein minimal-invasives Verfahren
Suche in Medline nach
Autoren
-
A. Kunsky
- Abteilung für Neurochirurgie, Universitätsklinik Innsbruck
-
M. Matas
- Department of Spinal Surgery, Royal Liverpool University Hospital, UK
-
R. Pillay
- Department of Spinal Surgery, Royal Liverpool University Hospital, UK
-
D. O´Donoghue
- Department of Spinal Surgery, Royal Liverpool University Hospital, UK
| Veröffentlicht: | 8. Mai 2006 |
|---|
Gliederung
Text
Objective: To describe a new less invasive decompressive technique for the treatment of lumbar spinal stenosis with preservation of the bilateral muscular attachments to the spinous processes.
Methods: The method described is based on a two-level decompression between L3 and L5. The patient is placed in the prone position, and a midline skin incision is made above the spinous process of L4. The L4 lamina to be removed is exposed by splitting the spinous process in half and separating it from each posterior arch using a sharp osteotome under fluoroscopic guidance, leaving the attachments of the multifidus muscles intact. A Caspar retractor is used to spread the two halves of the spinous processes, providing sufficient exposure to allow surgical excision of the laminae and ligamentum flavum using a microscope. The lamina L4 is removed either using a Kerrison rongeur or a high-speed drill with a fine diamond-tipped burr. The ligamenta flava of L3/4 and L4/5 can now be removed and the upper and lower laminae undercut. The split fragments of the L4 spinous process can then be re-approximated with a number 1 vicryl suture.
Conclusions: We propose that split laminectomy for the treatment of lumbar spinal stenosis is less invasive than the traditional laminectomy, by preservation of the bilateral muscular attachments to the spinous process.
