469 - Bilateral Midline Decompression with a Unilateral Approach in Spinal S...

#469 Bilateral Midline Decompression with a Unilateral Approach in Spinal Stenosis Patients Utilizing a Minimally Invasive Portal

MIS Techniques and Outcomes

Poster Presented by: J. Aferzon

Author(s):

J. Aferzon (1)

(1) Middlesex Hospital, Neurosurgery, Middletown, CT, United States

Abstract

Purpose: Tubular portals are well-known instruments used for micro-discectomy surgery. They present significant challenges during bilateral and midline exposure for patients being treated for spinal stenosis. A new minimally invasive portal, the Lumiere Retractor,simplifies midline and contralateral access. This tool has been used in 20 patients diagnosed with spinal stenosis with and without spondylisthesis. Minimally invasive approaches utilizing this device can decrease tissue damage without compromising effective decompression. In all cases, the surgeon was able to spare the majority of interspinous ligament and ipsilateral facet, which in turn decreases the risk of iatrogenic instability and subsequent need for fusion.

Methods: Once a side of approach is selected by the surgeon, sequential dilation is performed. Next, the triangulated retractor is delivered. The retractor's one-step deployment mechanism offers an expanded field of vision with significant midline exposure. Afterwards, a standard hemi-laminectomy is performed, and then further ligamentous resection can be carried out across the midline.

Results: In all cases performed to date, the surgeon was able to achieve excellent decompressionwith minimal peri-operative and post-operative complications. In addition, interspinous and supraspinous ligaments were preserved.

Summary: This minimally invasive technique offers a reproducible and safe bi-lateral decompression through a unilateral approach.

Images:

Pre-op Axial MRI showing spinal stenosis at T1

Post-op Axial CT