How I Do It: Mini-Open Decompression for Lumbar Spinal Stenosis Using the Quadrant Retractor System Without Fusion

Area of Science:

• Neurosurgery
• Minimally Invasive Spine Surgery

Background:

• Traditional open decompression for lumbar spinal stenosis (LSS) involves extensive muscle dissection and prolonged recovery.
• Minimally invasive techniques aim to reduce soft-tissue injury for LSS.
• The Quadrant retractor system, typically used for fusion, has limited reported use in non-fusion decompression.

Purpose of the Study:

• To describe a reproducible, muscle-sparing decompression technique for LSS using the Quadrant system.
• To detail a non-fusion approach for central and lateral recess stenosis.
• To highlight the benefits of avoiding instrumentation and fusion.

Main Methods:

• Utilized a paramedian Wiltse approach with a 4-5 cm vertical incision.
• Docked the Quadrant retractor on the facet-laminar junction.
• Performed microscopic decompression including ipsilateral laminotomy, medial facetectomy, and contralateral undercutting.

Main Results:

• The technique successfully achieved neural decompression for LSS.
• Preserved midline structures and minimized unnecessary tissue trauma.
• Demonstrated a muscle-sparing approach through a paramedian incision.

Conclusions:

• Quadrant-assisted decompression is a safe and efficient minimally invasive option for LSS.
• This technique offers an alternative to conventional laminectomy for selected patients.
• The method avoids instrumentation and fusion, potentially improving recovery.