Comparative study between Microdecompression and Decompressive Laminectomy in the management of Lumbar Canal Stenosis

Abstract

Background: For years, the gold standard treatment for symptomatic lumbar canal stenosis refractory to conservative management is a facet-preserving laminectomy. However, it has been suggested that extensive resection of the posterior bone, posterior ligaments and muscular structures leads to increases in postoperative pain, perioperative blood loss, complications and length of hospital stay (Celik et al., 2010). Controversy continues about the extent of bony decompression required to effectively decompress the spinal canal. As narrowing of the spinal canal occurs predominantly at the interlaminar region involving the hypertrophy of the facet joints and bulging of the intervertebral disc and the ligamentum flavum, resection of the whole vertebral arch may not be necessary. Alternatively, an interlaminar or undercutting laminectomy can be performed to decompress the spinal canal (Delank et al., 2002).

More recently, various authors have recommended surgical techniques that preserve posterior midline structures (i.e. spinous processes, vertebral arches, interspinous and supraspinous ligaments), as removal of these structures may contribute to instability after surgery (Bresnahan et al., 2009).

Laminotomy is the most commonly described decompressive procedure that preserves the posterior midline structures. Other techniques that are designed to preserve the posterior midline structures include endoscopic laminotomy and spinous process osteotomies. The amount of decompression achieved with these techniques has been shown to be approximately equal to that attained with laminectomy (Guiot et al., 2002).