Microsurgical techniques in lumbar spinal stenosis

The rationale for microsurgical decompression is to maximize neural decompression while minimizing the destabilization and resection of uninvolved structures. Microsurgical decompression is appropriate for most degenerative lumbar spinal stenosis because the pathoanatomy tends to be concentrated at the levels of the disk space and foramen. Careful preoperative analysis of the imaging studies will guide the surgeon to the most appropriate method of decompression for a particular patient and help focus the decompression to the appropriate regions. Thorough knowledge of surgical spinal anatomy is mandatory because the exposure is limited with a microsurgical approach; however, visualization can be excellent with proper attention to surgical technique.