Julian is 68 years old and has been suffering from lumbar pain for 3 years. In addition, for some months now, every time he walks, his right leg hurts. Now his left leg also hurts, he has ramps in his legs. She thinks she gets tired much more than before. Her legs are weak. He has consulted his family doctor and after ruling out vascular problems, he has sent him to a specialist in Neurosurgery.
- How are you doing?
- Fine, but I am losing strength in my legs. I can walk less and less. I have brought you a lumbar MRI.
- Look, what you can see in the MRI is that you have a Lumbar Canal Stenosis (Figure 1). A narrow lumbar canal due to osteoarthritis. These cases are surgical if the disease is progressive, if you can walk for less and less time without pain and you lose strength in your legs. In addition to the lumbar MRI, an electromyogram is important, which will inform us of the importance of the lesion in the nerves of the lower extremities. If all the treatments fail, including pharmacological treatments, rehabilitation and radiofrequency rhizolysis, we recommend surgical intervention.
What does the intervention consist of?
It is called decompressive laminectomy. We make some “windows” in the posterior part of the vertebral bone so that the spinal cord has space and is freed from the oppression of the bone. We try to leave the bone in the middle part, the spinous processes, to minimize instability and thus avoid the use of screws (Figure 2).
Is it very dangerous?
Thanks to current techniques and fixation through the spinous processes, this technique is quite convenient, without losing vertebral mobility and reducing both the incision and possible complications (Figure 3).
Figure 1: degenerative lumbar canal stenosis.
Figure 2: bilateral hemilaminectomy.
Figure 3: posterior fixation.
Figure 4: avoidance of loss of spinal mobility.
Figure 5: reduction of the incision and surgical approach.