- Decompression
- Microscopy
- Over the top
- Indications
- Unilateral stenosis with unilateral leg pain and midline stenosis
- Midline
- Indications
- Bilateral stenosis and midline stenosis
- Unilateral stenosis with contralateral leg pain
- Tubular
- Over the top
- Indications
- Same for microscopy for obese patients
- Technique
- AP x-ray making sure beam is perpendicular to the disc space. X-ray to get marker over the lamino-facet junction of the desired level (image)
- Place first dilator to the lamino-facet junction and dissect soft tissue of bone in all directions but more so cranial caudal direction
- Place subsequent dilator. Make sure tube is 90 deg to the lamina in the sagittal plane and angled slightly medialy in the mediolateral plane so that it is parallel to the lamina.
- Insert tube and lock it to bed
- AP and lateral X-ray to check positioning of tube (image)
- Microscope in.
- Monopolar residual soft tissue off bone
- First view should be of the lamina at 9, medial facet at 6 and flavum at 3.
- Drill and kerison away the lamina and medial facet. Remove the visible flavum.
- This will show the main theca.
- Angle scope to look laterally to remove more of the medial facet to expose the transiting nerve root.
- Retract the nerve root away to perform discectomy
- Place large dilator back in and angle tube medially to remove more midline disc
- Remove tube and check for haemostasis.
- Endoscopic
- Uniportal
- Biportal
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