Introduction: Unlike traditional open laminectomy, minimally invasive decompression (MID) spares the important midline structures of the spine (i.e., the spinous process and the supraspinous and interspinous ligaments).
Step 1 preoperative planning: Determine the levels and laterality for the decompression on the basis of the symptoms and findings on the MRI scan.
Step 2 operating room setup: Ensure the correct positioning of the patient and the proper setup of the equipment.
Step 3 marking the levels: Use fluoroscopy to localize the level(s) of the stenosis.
Step 4 skin incision and tube positioning: Ensure the correct placement of the tube.
Step 5 resection of the lower part of the lamina: Use a high-speed drill and Kerrison rongeur to enter the spinal canal.
Step 6 resection of the medial part of the facet joint: Proceed cautiously at the point where the spinal canal is usually narrowest.
Step 7 resection of the ligamentum flavum: Resect the ligamentum flavum piecemeal with a Kerrison rongeur.
Step 8 crossover technique optional: Use the crossover technique to reach across the midline and decompress the contralateral lateral recess (Video 3).
Step 9 closing the wound: Perform a check to be certain that all steps have been completed before closing the skin.
Results: In the study by Lønne et al., the 41 patients managed with MID had significant improvement at 6 weeks and throughout the 2-year observation period7.