Internal decompression for multiple levels of lumbar spinal stenosis: a technical note.
In cases of lumbar spinal stenosis, use of the wide decompressive procedure for neural compression without regard for the integrity of facets tends to lead to instability and the chronic pain syndrome. Experience with the posterior lumbar interbody fusion technique indicates that, in cases of multiple levels of spinal canal stenosis, the decompression can be made adequately by inferior and superior marginal laminotomy, mesial facetectomy with an osteotome, and foraminotomy with an angle bone punch and a supersonic curette. Internal thinning of the thickened lamina can be achieved by the shaving action of the supersonic curette done from within the spinal canal. This technique achieves the necessary internal decompression of the multiple levels of spinal stenosis without interruption of the integrity of the motion segment. The spinous processes and the supraspinous ligaments and the lateral half of the facet, with its firm fibrous capsules, are scrupulously preserved. The disc is not removed unless it is overtly extruded.