Full-Endoscopic Spinal Canal Decompression After Direct Midline Splitting of the Spinous Process: A Technical Note

Area of Science:

• Neurosurgery
• Minimally Invasive Spine Surgery
• Spinal Endoscopy

Background:

• Unilateral endoscopic approaches for lumbar spinal canal stenosis risk facet joint damage and incomplete decompression.
• Existing midline techniques may require larger retractors and incisions.

Purpose of the Study:

• To describe a less invasive full-endoscopic spinal canal decompression technique using a midline approach.
• To evaluate the efficacy and outcomes of this novel surgical method.

Main Methods:

• A 12mm midline skin incision was used, followed by direct splitting of the spinous process.
• Underwater full-endoscopic decompression was performed with a 7mm diameter instrument.
• Trumpet-shaped laminectomy and yellow ligament removal were utilized for decompression.

Main Results:

• Sufficient spinal canal decompression was achieved with preservation of both facet joints.
• The patient experienced improved sensory disturbance and was discharged on postoperative day 2 (modified Rankin Scale 1).
• The procedure utilized a significantly smaller incision (12mm) compared to traditional methods.

Conclusions:

• Midline splitting of the spinous process combined with full-endoscopic decompression is a valuable, less invasive surgical option.
• This technique provides a good symmetrical view and allows for adequate bilateral decompression.
• The method offers potential for reduced invasiveness and improved patient outcomes in lumbar spinal canal stenosis treatment.