Lamino-arthrectomy technique for lumbar spine stenosis

Abstract

Surgical treatment should to be proposed in lumbar spinal stenosis, when well conducted conservative treatment is insufficient (severe pain and/or neurologic involvement). The goal of the treatment is to enlarge the canal: decompression of the dura mater in case of central stenosis and, radicular decompression in case of lateral stenosis. Two opposing techniques can be used: the lamino-arthrectomy and the recalibration. We describe the lamino-arthrectomy techniques, results and complications about 202 operated cases. The classic laminectomy is a posterior resection, with a partial arthrectomy (to release the symptomatic root involved by degenerative arthritic changes in zygapophyseal joints) and a systematic exploration of the posterior vertebral body. In the "lobster shell" technique, the laminectomy is conducted on several levels with a jigsaw. The others gestures are identical to the classic laminectomy.The complications were of three types; during surgery (35 dura mater gaps, 10 radicular injuries), early post-operative (2 non compressive haematomas reoperated in two cases, 6 infections, 4 roots involvement and 4 paraplegias) and the latest complications (11 destabilisations, 4 recurrences). The results were good in 86,2% of the series (most of oldest patients) and, 71,4% of the patients regained normal locomotion. The posterolateral arthrodesis is discussed, with osteosynthesis by plates and pedicle screws technique described by R. Roy-Camille. The results prove the surgical efficiency of extensive lamino-arthrectomy in symptomatic narrow lumbar canal. The efficiency on lumbago and neurologic deficit is less.