TL Decompression  

Dr. Wilson 

  • Lumbar Decompression 
    • Bottom to top by level and by lamina 
    1. SP removal with leksell 
    2. Decortication – purpose: thin the shelf so kerrisen can bite (some people use Burr, DW uses Leksell) 
      1. Narrow leksell as it is sharper and can decorticate outter lamina cortex 
      2. 5 leksell to decorticate 
  1. Find bony edge (ie: at L5S1 find L5 bottom edge of lamina 
    • Nerve hook or penfield to create a gap between flavum and bottom edge of lamina 
  2. Central Decompression 
    1. Stay fairly midline and go all the way up through the lamina 
      1. Keep kerrissen parallel with dura 
  3. Lateral Decompression 
    1. Once all the way through the lamina, turn around and go back down one side at a time, but keep the kerrisen parallel with the nerve root (obliquely poitned inferior and lateral) 
    2. Snap off IAP 
      1. Cut through the IAP laterally 
      2. The IAP is now only attached to SAP with soft tissues (capsule) 
      3. Remove with pituitary 
  4. Subarticular decompression 
    1. Now the SAP is revealed – we must do a subarticualr dc 
    2. Just bite paralle to nerve 
      1. You know where pedicle is 
      2. You know where nerve is (huggin the pedicle above)  

Ligamentum Flavum 

  • Superior 
    • Deep surface of superior lamina 
    • NOT attached to IAP of superior 
  • Inferior 
    • Superficial surface of inferior lamina 
    • DOES attach to SAP of inferior 
    • Prevents hyperflexion, restores resting position 

Dr. Lewis 

  • Goal of decompression = remove LF 
  • LF origin 
    • Midpoint of higher lamina 
  • LF insertion 
    • Deep surface of SAP 
  • Decompression 
    • Midline open lamina above 
    • Proximal to distal decompression of LF 
  • Subarticular stenosis 
    • Causes 
      • Hypertrophic LF 
  • Foraminal stenosis 
    • Causes 
      • Superolaterally migrated SAP