The Procedure for Each Approach Is Presented

ABSTRACT

Title: / Transforaminal Decompression of Both Lateral and Central Lumbar Spinal Stenosis by Minimally Invasive Technique Aided by New Instruments.
Introduction: / To enable more thorough Minimally Invasive Spine Surgery (MISS) than usual decompression of the spinal stenosis (central and lateral recess) as from very large protruded discs, recurrent discs with scar tissue and bony spurs or spondylitic bars compressing the nerve root from below, a new set of micro spinal instruments have been developed including tubular retractors, large cannulae, more aggressive trephines, curettes, rasps, and ronguers.
Materials and Methods: /

Progressive series of different diameters tubular retractors, with appropriate sized dilators and more aggressive saw-toothed trephines are presented. Some tubular retractors have extensions like a duckbill on one side that can be oriented toward the nerve root to retract and protect it. 100 cases wherein these instruments were used are reported here. In addition, to show the complete decompression capability of MISS technique when more dorso-medial decompression is required, reference to the Microdecompressive Endoscopic Assisted Discectomy (MEAD) system for minimally invasive laminotomy is included. Laser application is included for laser thermodiskoplasty.

Procedures – Lateral Decompression and Paramedium Decompression Approaches: /

The procedure for each approach is presented.

Results: /

100 patients so treated as outpatients are reported here. The MEAD system is also presented to completely describe the range of instrumentation available for thorough lumbar decompression by methods of MISS. There were no intraoperative or postoperative complications. 90 patients (90%) had a good or excellent result. 9 had some continuing complaints but were improved overall. 1 did not significantly benefit from the procedure.

Illustrative Case Reports: / Three examples of severe spinal stenosis, two of them lateral, one of them central, are presented with illustrations.
Discussion: / A newly devised larger and more aggressive decompressive discectomy instruments safely and efficaciously allow wider and more complete removal of large or recurrent disc protrusions, scar tissue and bony spurs that cause nerve root compression, while protecting the adjacent nerve root. The MEAD system allows a minimal approach to laminotomy for decompression when that is required.
Conclusion: / Transforaminal Microdecompressive with newly devised instruments provides a safe and effective modality to achieve results in these difficult surgical problems where usual conventional posterior decompressive laminectomy or a standard MISS operation might not be adequate.
Primary Author Name/
Degree: / John C. Chiu, M.D., FRCS, FICS, Chief, Neurospinal Surgery.
Institutional Affiliation: / California Center for Minimally Invasive Spine Surgery.
Address: / 1001 Newbury Road
Thousand Oaks, CA 91320
Telephone: / (805) 375-7900
E-mail Address: /
Facsimile: / (805) 375-7975
Contributing Authors, Including Degrees, Institutional, Affiliations and
Addresses: / Thomas Clifford, M.D., Neurosurgeon California Center for Minimally Invasive Spine Surgery
Robert A. Princenthal, M.D., Director Musculoskeletal Diagnostics, Westlake MRI Westlake Village, CA
Romulo B. Sison, P.A., C.S.T., California Center for Minimally Invasive Spine Surgery

MISS Stenosis

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