Patients with spinal stenosis usually present with symptoms of neurogenic cluadication, 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 operation 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 do this procedure using keyhole techniques. In this way, the decompression can be done via a tubular retractor, inserted via a small paramedian incision.
There is much less musclar disssection but the neural decompression is just as effective. Patients often leave hospital the next day or 2 after surgery.
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 (click images to enlarge).
His symptoms were immediately relieved and he left hospital 48 hours after surgery. A postoperative CT scan showed the effective decompression, including of the central canal and the left side.
– By Prof David Walker