Operative Neurosurgery’s Editor’s Choice: Ten-Step Minimally Invasive Spine Lumbar Decompression and Dural Repair Through Tubular Retractors

Minimally invasive spine (MIS) surgery has become increasingly common over the past 2 decades, as the usage of new surgical devices and techniques has evolved.1,2 In 1997, Spetzger et al3,4 first described unilateral laminotomy for bilateral decompression of the lumbar spine in a study detailing both surgical anatomy and clinical experiences, followed by McCulloch and Young a year later.5 These studies showed that bilateral decompression of the lumbar spinal canal is practical via a unilateral laminotomy. Smith and Foley concurrently introduced the microendoscopic tubular discectomy system, which allowed spinal surgeons to decompress symptomatic lumbar nerve roots using a tubular, minimally invasive approach.2 Subsequently, this approach has been adopted for the treatment of lumbar spinal stenosis, foraminal stenosis, disc herniation, andsynovial cysts, with the modification of using a microscope instead of an endoscope.6-10

In this study, we sought to provide a detailed description of the step-by-step techniques of MIS surgery with tubular retractors for microdiscectomy, foraminotomy, laminotomy for bilateral decompression, and synovial cyst resection in the lumbar spine, as these procedures are currently performed and taught at our institution. MIS surgery can potentially avoid more invasive fusion surgery and will allow treatment of patients, especially the elderly, who were previously not considered surgical candidates.11

From Ten-Step Minimally Invasive Spine Lumbar Decompression and Dural Repair Through Tubular Retractors by Mohamed Abdelatif Boukebir, MD, Connor David Berlin, BS, Rodrigo Navarro-Ramirez, MD, MSc, Tim Heiland, MD, Karsten Schöller, MD, Cameron Rawanduzy, BA, Sertaç Kirnaz, MD, Ajit Jada, MD and Roger Härtl, MD