Open Midline Decompression with Ligament Reconstruction for Multiple-Level Spinal Stenosis in Elderly Patients

(1) Background: Multiple lumbar spinal stenosis (LSS) is a degenerative disease that is increasingly prevalent with global aging. Multilevel fusion surgery is burdensome to perform in elderly patients, especially with osteoporosis and underlying disease. This study introduces open midline decompression (OMD) with ligament reconstruction as an alternative stabilization technique for elderly patients with multilevel LSS. (2) Methods: A retrospective review included 42 elderly patients aged 70 or older diagnosed with LSS at three or more levels and who underwent OMD with ligament reconstruction. Pre- and postoperative clinical and radiologic data were analyzed. (3) Results: Thirty-three patients underwent three-level surgeries, and twelve patients underwent four-level surgeries. The mean operative time was 240 ± 42.2 min (74.6 ± 14.9 min per level) with a mean blood loss of 282.9 ± 167.1 cc. Clinical outcome (VAS) and quality of life parameters (SF-12) showed significant improvement after surgery. Postoperative MRI showed sufficient decompression. Dynamic X-rays showed improvement in instability after surgery, but it was statistically insignificant. (4) Conclusions: OMD with ligament reconstruction provides effective neural decompression while preserving the posterior arch and offers soft stabilization with artificial ligaments. It is a safe and viable surgical option for elderly patients with multilevel LSS.