Microscopic Unilateral Laminotomy for Bilateral Decompression: 2-Dimensional Operative Video.

The open laminectomy for treatment of lumbar spinal stenosis was first described by Verbiest(.1) Although efficacious, it may result in postoperative instability because of violation of the posterior ligamentous complex, pain from a larger incision and greater muscle dissection, and atrophy of the paraspinal musculature. Several less invasive techniques have been developed to mitigate these effects.(2-4) The unilateral laminotomy for bilateral decompression (ULBD) involves a midline incision with unilateral exposure and muscle dissection. This allows the preservation of posterior midline tension band structures, resulting in comparable outcomes with open laminectomy, but with decreased blood loss and a shorter length of stay.(5-7) It seems to be effective in patients with and without degenerative spondylolisthesis.(8-10) Here, we present the case of an 80-year-old man with multiple medical comorbidities who presented with neurogenic claudication and bilateral leg pain. Imaging demonstrated diffuse lumbar spondylosis, with severe central canal and bilateral subarticular stenosis at L4/5 because of disk, facet, and ligamentum flavum pathology, in addition to a grade 1 spondylolisthesis at that level. Given his age, comorbidities, and subtle spondylolisthesis, a minimally invasive approach was chosen. The patient consented to the procedure. A microscopic unilateral laminotomy for bilateral decompression was performed. The patient was discharged on the first postoperative day and had no postoperative opioid requirement. He had complete resolution of his neurogenic claudication symptoms postoperatively. The microscopic ULBD is a safe and effective option for decompression of lumbar spinal stenosis, where a conventional open laminectomy or fusion approach is not indicated. Image at 5:06 used by permission from CCC: Springer Nature, Acta Neurochir (Wien), Unilateral laminotomy for bilateral decompression of lumbar spinal stenosis. Part I: Anatomical and surgical considerations, Spetzger et al, 2 (c) 1997 (doi: 10.1007/BF01808872.) Top image at 5:17 from Hong et al,3 (c) Lippincott Williams & Wilkins, Inc., used with permission.