Explain the basic steps involved in a laminectomy procedure performed to treat central spinal stenosis between L4 and S1

A skin incision is made between L3 and S1. The paraspinal muscles are elevated from the lamina between L3 and S1. The L4 and L5 spinous processes are resected. The pars interarticularis is identified at each level to ensure that bone removal does not compromise its integrity. The hypertrophic lamina of L4 and L5 are thinned with a motorized burr to facilitate removal with angled Kerrison rongeurs. Adhesions between the dural sac and surrounding tissue are released with a Penfield elevator. Starting from the L5-S1 interspace, lamina and hypertrophic ligamentum flavum are resected between L4 and S1. The midline decompression is widened to permit visualization of the lateral border of the dural sac as well as the medial border of the pedicle at each level to ensure adequate decompression (Fig. 51-1).

Figure 51-1. Decompression for central spinal stenosis. A, Midline bilateral laminectomy provides decompression of the cauda equina. B, Removal of the medial aspect of hypertrophic facet joints and infolded ligamentum flavum is necessary. (From Stambough JL. Technique for lumbar decompression of spinal stenosis. Oper Tech Orthop 1997;7:36-43, with permission.)

Figure 51-1. Decompression for central spinal stenosis. A, Midline bilateral laminectomy provides decompression of the cauda equina. B, Removal of the medial aspect of hypertrophic facet joints and infolded ligamentum flavum is necessary. (From Stambough JL. Technique for lumbar decompression of spinal stenosis. Oper Tech Orthop 1997;7:36-43, with permission.)

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