Transfacet decompression with dowel fixation: a new technique for lumbar lateral spinal stenosis

Auto-stabilization consequent to spinal segment instability involves osteophyte formation. The most common lumbar spinal stenoses are due to uncinate process spurs at L 5. These spurs inaccessibly lie ventral to the facet joints. Most surgical methods for lateral stenotic lesions do not address the incipient instability. Facet destructive approaches further destabilize the segment. The new decompressive technique here preserves and stabilizes posterior supporting structures: ligaments are left intact; laminas (and facets) are distracted; 11 mm transfacet holes are bored, exactly dorsal to both the spurs and entrapped ganglia; the entrapment (even a lateral herniated disc) is decompressed through the drilled hole. 12 mm bone dowels are then driven into the holes, immediately stabilizing the segment. The dura is not exposed. Reviewed are fifty transfacet cases. In four, a posterior interbody fusion was performed via the transfacet holes. The procedure presents a new window to spinal lesions.