J Korean Neurosurg Soc.  2014 Sep;56(3):206-210. 10.3340/jkns.2014.56.3.206.

Central Decompressive Laminoplasty for Treatment of Lumbar Spinal Stenosis : Technique and Early Surgical Results

• Kwon YJ

• KMID: 2339958
• DOI: http://doi.org/10.3340/jkns.2014.56.3.206

Abstract

OBJECTIVE
Lumbar spinal stenosis is a common degenerative spine disease that requires surgical intervention. Currently, there is interest in minimally invasive surgery and various technical modifications of decompressive lumbar laminectomy without fusion. The purpose of this study was to present the author's surgical technique and results for decompression of spinal stenosis.
METHODS
The author performed surgery in 57 patients with lumbar spinal stenosis between 2006 and 2010. Data were gathered retrospectively via outpatient interviews and telephone questionnaires. The operation used in this study was named central decompressive laminoplasty (CDL), which allows thorough decompression of the lumbar spinal canal and proximal two foraminal nerve roots by undercutting the lamina and facet joint. Kyphotic prone positioning on elevated curvature of the frame or occasional use of an interlaminar spreader enables sufficient interlaminar working space. Pain was measured with a visual analogue scale (VAS). Surgical outcome was analyzed with the Oswestry Disability Index (ODI). Data were analyzed preoperatively and six months postoperatively.
RESULTS
The interlaminar window provided by this technique allowed for unhindered access to the central canal, lateral recess, and upper/lower foraminal zone, with near-total sparing of the facet joint. The VAS scores and ODI were significantly improved at six-month follow-up compared to preoperative levels (p<0.001, respectively). Excellent pain relief (>75% of initial VAS score) of back/buttock and leg was observed in 75.0% and 76.2% of patients, respectively.
CONCLUSION
CDL is easily applied, allows good field visualization and decompression, maintains stability by sparing ligament and bony structures, and shows excellent early surgical results.

Keyword

Spinal stenosis; Decompression; Laminoplasty; Facet joint; Stability

MeSH Terms

Decompression
Follow-Up Studies
Humans
Laminectomy
Leg
Ligaments
Outpatients
Surveys and Questionnaires
Retrospective Studies
Spinal Canal
Spinal Stenosis*
Spine
Surgical Procedures, Minimally Invasive
Telephone
Zygapophyseal Joint

Figure

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  Fig. 1 Intraoperative findings during interlaminar window exposure. A : In the beginning of the exposure, narrow interspinous distance (about 1cm) is noted after removal of small portion of spinous process. B : Gradual retraction using bony spreader between spinous processes in kyphotic prone position provides wider surgical window.

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  Fig. 2 Intraoperative findings during removal of the tip of the superior articular process. A : Tilting down the table toward the opposite side provides the surgical view to expose the tip of the superior articular process (arrowheads). B : Decompression from contralateral side enables removal of the tip and widening of the neural foramen without disruptions of overlying inferior articular process and facet capsule.

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  Fig. 3 Decompression of a traversing root via contralateral trajectory. Compressed root by hypertrophied articular processes (A) can be decompressed by inclined undercutting removal without disruption of facet joint and overlying capsule (B).

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  Fig. 4 Pre (A)- and post (B)-operative CT findings in a surgical patient. Angular shaped undercutting of facet joint to the pedicle is performed (left). Undercutting of the internal portion of the L4 lamina (arrowheads) is noted in coronal (middle) and sagittal (right) plane.

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  Fig. 5 Pre (A)- and post (B)-operative 3D reconstructed CT. Postoperative view (B) reveals spared portions of spinous process, lamina, and facet, compared with preoperative view (A). Postoperative view shows wide decompressed bony window including central laminoplasty area (delineated by dotted line), which decompresses proximal exiting roots and preserves facet joints.

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