[Unilateral approach for over the top bilateral lumbar decompression]

Area of Science:

• Neurosurgery
• Spinal Surgery
• Minimally Invasive Procedures

Background:

• Degenerative spinal disorders cause significant morbidity, including neurogenic claudication and leg symptoms.
• Lumbar spinal stenosis, encompassing central, lateral recess, and foraminal narrowing, affects numerous patients.
• Current surgical options aim for effective decompression while minimizing iatrogenic trauma.

Purpose of the Study:

• To describe a microsurgical technique for bilateral cauda equina decompression.
• To achieve decompression using a unilateral over-the-top approach with minimal anatomical disruption.
• To evaluate the efficacy and safety of this minimally invasive method.

Main Methods:

• A unilateral microsurgical cross-over approach for bilateral lumbar spinal canal enlargement.
• Muscle-sparing and facet-joint-sparing technique.
• Indications include neurogenic claudication and leg symptoms from degenerative spinal stenosis, with no limitations on affected segments.

Main Results:

• Clinical outcomes are reported as good to excellent.
• Success rates for microsurgical decompression range from 73.5% to 95%.
• Reoperation rates are low, between 0.5% and 10%.

Conclusions:

• The unilateral over-the-top approach is an effective muscle-sparing technique for bilateral lumbar decompression.
• This method offers excellent clinical outcomes and low reoperation rates for spinal stenosis.
• It minimizes iatrogenic trauma while providing significant patient benefit.