Unilateral Hemi-Laminotomy for Bilateral Lumbar Decompression

Early Experience Using Destandau technique

The gold standard of treatment for symptomatic lumbar spinal stenosis is a wide decompression via a bilateral paraspinal muscle stripping exposure. Although this traditional technique allows maximal neural decompression, there is morbidity related to stripping the paraspinal muscles and resection of stabilizing interspinous/supraspinous ligaments. An alternative is a less invasive microsurgical technique of unilateral hemi-laminotomy for bilateral decompression. Commonly known as lumbar segmental sublaminoplasty, the technique was developed by John A. McCulloch and Paul H. Young over 20 years ago. This technique enables bilateral central and foraminal neural decompression of one or two levels while limiting muscle stripping to one side and preserving the stabilizing midline ligamentous structures.

Endoscopic Approaches:

• Transforaminal(posterolateral)

• Interlaminar(posterior)

• Anterior(retroperitoneal)

Ideal operation for the lumbar canal stenosis would be one that could simultaneously achieve adequate decompression of the neural elements and minimize damage to posterior muscular, ligamentous and bony complex

• Endoscopic using Destandau Techniques :

IIt is a Tube Surgery

• Mobile but stable port

• Incision should not be more than 25mm-endoscope become unstable

• Camera inside(acts as eyes:no blockage of image as with microscope

• Minimal inventory

We use the following inclusion Criteria:

• predominant leg symptomatic;

• neurogenic claudication with or without paresis & Conservative therapy exhausted

Exclusion criteria are:

1. predominant back pain;

The followings are not a contraindication( in standard spine textbook:many of these conditions need fusion)

• foraminal stenosis in the lower level;

• disc herniation;

• degenerative spondylolisthesis more than Meyerding Grade I;

• Multidirectional rotation slide;

• Scoliosis more than 20 degrees;

• Prior surgery in the same segment;

• cauda equina syndrome.

• Obese

Advantages of this method:

1. Less invasive
2. Easier access to opposite side from same side, by tilting 30-45⁰
3. Stability maintained
4. Multiple level canal decompression possible
5. Revision is achievable