Case Study: Keyhole Lumbar Laminectomy

Patients with spinal stenosis usually present with symptoms of neurogenic claudication, with bilateral leg pain with walking and standing. A CT or MRI will often make the diagnosis.

Surgery is the appropriate treatment and the traditional METRxoperation is a decompressive lumbar laminectomy at the affected levels. The commonest level to be affected is at L4/5, and a normal surgical approach would usually require a midline incision of 10-15 centimetres. Patients would often take several days, sometimes up to a week, in hospital to recover.

An alternative is to do this procedure using keyhole techniques. In this way, the decompression can be done via a tubular retractor, inserted via a small paramedian incision.

A 77 year-old man presented with bilateral leg pain on walking and standing. His MRI scan showed a tight stenosis at L3/4 due to degenerative changes, with an associated synovial cyst of the right L3/4 facet joint. He proceeded to surgery, and a keyhole L3/4 decompression was performed, approached from the right hand side of L3/4. See scans below.

Figures 1 & 2 - Pre-op MRI
Figure 3 - Post-op CT

His symptoms were immediately relieved and he left hospital 48 hours after surgery. A postoperative CT scan (figure 3) showed the effective decompression, including of the central canal and the left side.

By - Prof David Walker, Neurosurgeon

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