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Minimally Invasive Decompression in Lumbar Spinal Stenosis

Introduction: Unlike traditional open laminectomy, minimally invasive decompression (MID) spares the important midline structures of the spine (i.e., the spinous process and the supraspinous and interspinous ligaments). Indications & Contraindications: Step 1 Preoperative Planning: Determine the levels and laterality for the decompression on the basis of the symptoms and findings on the MRI scan. Step 2 Operating Room Setup: Ensure the correct positioning of the patient and the proper setup of the equipment. Step 3 Marking the Levels: Use fluoroscopy to localize the level(s) of the stenosis. Step 4 Skin Incision and Tube Positioning: Ensure the correct placement of the tube. Step 5 Resection of the Lower Part of the Lamina: Use a high-speed drill and Kerrison rongeur to enter the spinal canal. Step 6 Resection of the Medial Part of the Facet Joint: Proceed cautiously at the point where the spinal canal is usually narrowest. Step 7 Resection of the Ligamentum Flavum: Resect the ligamentum flavum piecemeal with a Kerrison rongeur. Step 8 Crossover Technique Optional: Use the crossover technique to reach across the midline and decompress the contralateral lateral recess (Video 3). Step 9 Closing the Wound: Perform a check to be certain that all steps have been completed before closing the skin. Results: In the study by Lonne et al., the 41 patients managed with MID had significant improvement at 6 weeks and throughout the 2-year observation period(7). Pitfalls & Challenges:

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