Sublaminar osteotomy for lumbar spinal stenosis: Surgical technique

Background: Lumbar spinal stenosis (LSS) is the primary indication for spinal surgery in patients aged 65 and older. The condition is characterized by neurovascular compression resulting from degenerative hypertrophy of the ligamentum flavum and facet joints. While surgical intervention is required when conservative management fails, standard procedures such as total laminectomy are associated with risks of iatrogenic instability, whereas instrumented fusion increases surgical morbidity, blood loss, and healthcare costs.

Objective: This article details a surgical technique for lumbar recalibration utilizing a sublaminar osteotomy to achieve effective decompression of the spinal canal while preserving the structural integrity of the posterior arch and facet joints.

Key Points: The procedure involves a medial sagittal incision followed by the detachment of the erector spinae muscles. After performing a transverse osteotomy of the inferior facet joint process and a medial facetectomy, a sublaminar osteotomy is executed through the enlarged interlaminar space. An osteotome is used to divide the lamina through the cancellous bone, allowing for the en bloc extraction of a bone fragment containing the ligamentum flavum insertion. This intraosseous approach facilitates complete decompression of the dural sac and nerve roots while maintaining the caudal portion of the posterior arch for muscle reinsertion. Clinical application of this technique in over 1,500 patients demonstrated no instances of postoperative iatrogenic instability.

Conclusion: Lumbar recalibration combined with sublaminar osteotomy offers a reproducible method for treating symptomatic LSS. By preserving the posterior elements and facet joints, the technique minimizes the risk of mechanical instability and avoids the complications associated with more extensive decompressive or instrumented procedures.