12:45

Lumbar spine decompression for spinal stenosis surgical technique

Overview

Subscribe to get full access to this operation and the extensive Spine Surgery Atlas.

SUBSCRIBE


Learn the Lumbar spine decompression for spinal stenosis surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Lumbar spine decompression for spinal stenosis surgical procedure.

Lumbar spinal stenosis is a very common condition affecting up to up to 47% of adults over 60 years old, although only around 9% may be symptomatic.  Symptoms often come on with standing or walking and improve with leaning forwards or sitting down.  In some instances, patients may also experience a radiculopathy while at rest.

Spinal stenosis can occur at any level of the spine.  It is most commonly caused by facet joint hypertrophy, ligamentum flavum hypertrophy, and degenerative broad disc bulges.  Since the lumbar spine and cervical spine move more than the thoracic spine, stenotic changes are more common in these mobile sections of the spine.  More forces go through the lumbar spine which means stenotic changes are most common in this area.

Spinal stenosis can affect the central canal and lateral recesses but may also cause foraminal stenosis.  It can also be associated with spondylolisthesis, retrolisthesis, and lateral listhesis as well as any spinal deformity.  There is also a subgroup of patients who have congenital stenosis that predisposes them to becoming symptomatic if they develop degenerative changes later in life.

The condition often presents insidiously with spinal claudication.  This manifests itself as paraesthesia or aching, progressing to pain and weakness.  Patients typically have spinal claudication effecting both lower limbs but it can present unilaterally.  The pain often starts when patients have been standing in one position for more than a few minutes, or if they walk for more than 5-10 minutes.  Patients will often complain symptoms are worse if they have to walk slowly around shops.  However, leaning forward on a stick, frame, or shopping trolley often alleviate their symptoms since flexion makes the lumbar spinal canal wider.  Patients also describe that they need to sit down or lean forwards to allow their symptoms to resolve.

The vast majority of patients can be managed non-operatively and should be encouraged to stay as active as possible, with modification of activities that bring on their symptoms.  However, for those who have exhausted non-operative measures, surgery may be beneficial.

Lumbar decompression is one of the most common spinal procedures and doctors managing spinal patients should be familiar with the management options available, including lumbar decompression.

 

Author: Mr Stephen Morris FRCS (Tr & Orth).

Institution: The Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK.

Surgical Steps

Welcome to the surgical steps quiz.

This tests your ability to recall the correct order in which the key steps of an operation should be performed.

There will be various legitimate variations in this order but the quiz doesn’t reflect this.
Your reference point for the steps quiz is just our operative technique.
It’s one starting point in helping you to learn the technique.

  • You simply “drag & drop” the boxes containing the descriptions of the steps into the order you think fits and submit for marking.
  • If you get it correct first time you will be presented your certificate at the end of the quiz.
  • If you need to do more work on the steps you access your marked version by clicking the“re-sit the quiz” button.
  • This will show the steps you ordered correctly highlighted in green and the incorrect ones in red.
  • The correct green steps are fixed and won’t move.
  • The red steps move differently after your initial attempt and swap locations with the step they are dragged and dropped onto .
  • Finally resubmit the quiz once again.
  • The quiz will let you keep going until you get all the steps in the right order.
  • The correct green steps are fixed and won’t move.
  • The red steps move differently after your initial attempt and swap locations with the step they are dragged and dropped onto .
  • Finally resubmit the quiz once again.
  • The quiz will let you keep going until you get all the steps in the right order.

COURSE PROGRESS

Surgical Steps

Back to Course CPD / CME Dashboard
  • Did you find this technique helpful?
  • YesNo

Accreditations

Logo Logo Logo Logo Logo Logo

Associates & Partners

Logo Logo Logo Logo Logo Logo