Minimally invasive Lumbar decompression for lumbar canal stenosis Minimally invasive lumbar decompression is a keyhole procedure done to widen the spinal canal and decompress to nerves to relieve compression on pinched nerve and is called tubular decompression. What is lumbar canal stenosis? Lumbar canal stenosis is a common spinal disorder resulting as a part of the ageing process. It is a condition in which there is a narrowing of the spinal canal causing compression of the spinal cord and nerves travelling through your lower back into legs. Stenosis results due to as a part of ageing and degeneration of the spine, wear and tear of the spine which can lead to thickenings of ligaments and soft tissue, overgrowth of bone, bulging disc leading on to compression on nerves and spinal cord. What are the symptoms? Back pain Pain in the buttocks, legs, and calves. Numbness or tingling in the leg or foot. Relief of pain with bending forward, sitting or lying down. Cramp in the calves while walking requiring frequent short rests. Rarely – weakness of legs and loss of normal bowel and bladder function. How is it diagnosed? Diagnosis is based on history, symptoms, neurological examination and imaging (dynamic x rays and MRI ) What are the treatment options? Treatment depends upon the degree of stenosis and severity of symptoms Non-surgical treatment Medications – Anti-inflammatory medications and NSAIDS, Anti-convulsant (Gabapentin ), Muscle relaxants Physical therapy and exercise – Strengthening back and abdominal muscles, stretching exercises Epidural steroid injection – Good short term benefit in mild symptoms Surgical treatment Surgery is indicated in patients who have failed medical line of management with poor quality of life due to pain and weakness and in patients with neurogenic claudication. Surgery is performed in a minimally invasive technique called tubular decompression. The primary goal of surgery is to decompress the spinal cord and nerve and create space for the nerves. This surgery is performed under general anaesthesia. A small incision of fewer than 2 cms is made in the lower back on one side of the back. With help of tubular retractors and splitting of muscles, the desired area is reached and bone (lamina ) covering the nerve and thickened soft tissue is removed to create more room which is also accompanied by trimming (undercutting ) of facet joints and enlarging the neural foramen ( where spinal nerve exits the spinal canal ). Both sides nerves can be decompressed through a single incision without damaging the muscle and minimal bone removal thus preserving spinal stability.
