Laminarthtrectomy

The partial laminectomy/arthrectomy or laminarthrectomy surgical procedure has been previously described in detail [9, 32]. Briefly, patients are placed in prone position with a padded support at the level of the iliac crests and sternum. A very slight flexion of hips and knees assures that the subjects lie in a lordotic position simulating the normal erect posture [14]. After a midline posterior skin and subcutaneous tissue incision the dissection goes through the dorsolumbar fascia approximately 5 mm to the left of the midline, preserving the supraspinous ligamentous attachment to the fascia. The multifidus is detached from the left side of the spinous processes and laminar attachments. An osteotomy is performed with a curved osteotome at the base of the spinous processes of the vertebrae above and below the stenotic levels, just superficially to their junction with the laminae. Flavectomies are carried out, and the superior and inferior laminae are partially resected. Partial facetectomies and foraminal decompressions are carried out under direct vision with the aid of Kerrisson rongeurs and/or a power drill. If needed, the remaining bridge of lamina is thinned. After completion of a thorough decompression the dorsolumbar fascia is resutured over a suction drain to the supraspinous ligamentous/fascial complex with the osteotomized spinous processes regaining their initial positions over the neural arches (Fig. 1). In a prospective study of 36 consecutive patients we observed a successful outcome of 58.3% at a minimum 1 year follow-up [16]. Successful surgical outcome was defined as an improvement in at least three of the following four criteria: self-reported pain on a visual analogue scale, self-reported functional status measured by low back outcome scale [12], reduction in pain during walking, and reduction in leg pain. Of the 15 patients (42%) who did not demonstrate sufficient improvement to be labeled a success 12 reported partial improvement.

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