Pterion Prep CraniPro VUMC Case Prep
2026-06-27

Case Prep: Lumbar Laminectomy for Spinal Stenosis

Case / Approach Snapshot

One-Liner

[Age]yo [M/F] with [single/multilevel] lumbar spinal stenosis at [L_-L_] presenting with neurogenic claudication [± radiculopathy] planned for lumbar laminectomy/decompression [without fusion].

Figures, Imaging & Video

🎥 Operative video — search operative video on YouTube ▸ · The Neurosurgical Atlas ▸

CNS Video Library

🧭 Operative approach: Posterior thoracolumbar approach — detailed corridor setup, step-by-step technique & figures

Neurosurgical Atlas · AO Spine / Surgery Reference · Radiopaedia · PubMed Central — operative figures © linked; see media-sources.md

High-Yield Literature

Curated Image Set

Open-access figures are embedded from PubMed Central articles and kept unique to this guide.

Lumbar Laminectomy Spinal Stenosis — Figure 1 Figure 1. Lumbosacral transitional vertebra as evident in 3-dimensional images: unilateral (left) and bilateral (right) anomalies. Source: Is Lumbosacral Transitional Vertebra Associated with Degenerative Lumbar Spinal Stenosis? — BioMed Research International 2019; CC BY.

Lumbar Laminectomy Spinal Stenosis — Figure 2 Figure 2. Prevalence (%) of lumbosacral transitional vertebra (LSTV) in the male groups (control vs. stenosis). Source: Is Lumbosacral Transitional Vertebra Associated with Degenerative Lumbar Spinal Stenosis? — BioMed Research International 2019; CC BY.

Lumbar Laminectomy Spinal Stenosis — Figure 3 Figure 3. Prevalence (%) of lumbosacral transitional vertebra (LSTV) type in the female groups (control vs. stenosis). Source: Is Lumbosacral Transitional Vertebra Associated with Degenerative Lumbar Spinal Stenosis? — BioMed Research International 2019; CC BY.

Lumbar Laminectomy Spinal Stenosis — Figure 1 Figure 1. Surgical equipment for tubular microendoscopic decompression surgery. (a) Serial tubular dilator and retractor (METRx®). (b) Flexible arm assembly (METRx®). (c) Tubular retractor of the… Source: Microendoscopic Lumbar Posterior Decompression Surgery for Lumbar Spinal Stenosis: Literature Review — Medicina 2022; CC BY.

Lumbar Laminectomy Spinal Stenosis — Figure 2 Figure 2. Schematic presentation of the room setup. Source: Microendoscopic Lumbar Posterior Decompression Surgery for Lumbar Spinal Stenosis: Literature Review — Medicina 2022; CC BY.

History of Present Illness

Past Medical History

Imaging Review

MRI Lumbar

Labs

Neurological Examination

Surgical Planning

Case Logistics, OR Needs & Orders

Decompression without Fusion vs With Fusion

Position

Key Surgical Steps — Detailed

  1. Fluoroscopic level confirmation — localize with a spinal needle/marker, counting from the sacrum (and account for transitional anatomy/lumbosacral variants on the preop films); confirm the correct level before bony work
  2. Midline incision over the target levels; subperiosteal dissection of the paraspinal muscles off the spinous processes and laminae bilaterally (for central decompression), exposing out to the medial facets; place self-retaining retractors; re-confirm level
  3. Laminectomy: remove the spinous process and laminae at the stenotic level(s) — thin the lamina with a high-speed drill and/or use Kerrison rongeurs; begin in the midline where the canal is roomiest and work laterally; identify the ligamentum flavum as the deep layer protecting the dura
  4. Remove the hypertrophied ligamentum flavum (a major compressive element) — develop the plane off the underlying dura with a blunt dissector, then resect with Kerrisons, protecting the thecal sac
  5. Decompress the lateral recesses — undercut the hypertrophied superior articular facets (medial facetectomy), freeing the traversing nerve roots; preserve > 50% of each facet and the pars interarticularis to avoid iatrogenic instability
  6. Foraminal decompression — follow and decompress the exiting roots into the foramina; confirm each root is free with a probe/Woodson (ball-tip passes freely)
  7. Confirm adequate decompression — the dura re-expands and pulsates, traversing and exiting roots are free in the recesses/foramina
  8. (MIS alternative) — unilateral tubular approach with “over-the-top” contralateral decompression: undercut the base of the spinous process and contralateral lamina/ligamentum, decompressing both sides through a unilateral corridor while preserving the midline tension band (less destabilizing)
  9. Inspect for durotomy (common in tight stenosis with redundant roots/adhesions) — repair primarily (suture ± sealant/patch) if encountered
  10. Hemostasis of the epidural venous plexus (bipolar, hemostatic matrix, gentle), confirm no compressive hematoma, ± subfascial drain, layered closure

Critical Anatomy & Structures at Risk

  1. Dura / thecal sac / cauda equina — durotomy risk (esp. adherent in stenosis, redundant roots)
  2. Nerve roots (traversing and exiting) in lateral recess/foramen
  3. Pars interarticularis & facets — preserve to avoid iatrogenic instability/spondylolisthesis
  4. Epidural venous plexus

Equipment

Monitoring

Anesthesia

Potential Complications

  1. Dural tear/CSF leak (common in stenosis — repair, flat bed rest)
  2. Iatrogenic instability (excess facet/pars removal → may need fusion)
  3. Nerve root injury, epidural hematoma (new deficit → emergent MRI/return to OR)
  4. Recurrent stenosis, incomplete decompression, infection

Operative Note Template

Preoperative Diagnosis: Lumbar spinal stenosis at [L_-L_] with neurogenic claudication [± radiculopathy]

Postoperative Diagnosis: Same

Procedure: Lumbar laminectomy and decompression of the central canal, lateral recesses, and foramina at [L_-L_]

Surgeon / Assistant: Anesthesia: General endotracheal EBL / Fluids: Specimens: [Ligamentum flavum / bone — or none] Drains: [± subfascial drain] Implants: None Complications: None [/ incidental durotomy, repaired]

Indications: [Age]yo [M/F] with neurogenic claudication [and __ radiculopathy] from multilevel lumbar stenosis at [L-L_], refractory to conservative management (PT, injections), without instability on flexion-extension films. Risks/benefits/alternatives discussed; the patient elected decompression.

Description of Procedure: After consent and time-out, general anesthesia was induced. The patient was positioned prone on a [Jackson/Wilson] frame with the abdomen free and all pressure points and eyes padded. The back was prepped and draped and antibiotics given. The level was confirmed fluoroscopically.

A midline incision was made over [L_-L_] and subperiosteal dissection exposed the laminae bilaterally; the level was re-confirmed. A laminectomy was performed at [levels], thinning the laminae with a high-speed drill and completing with Kerrison rongeurs. The hypertrophied ligamentum flavum was removed off the dura, decompressing the central canal. The lateral recesses were decompressed by undercutting the medial facets (preserving >50% of the facets and the pars), freeing the traversing nerve roots, and the foramina were opened and confirmed patent with a probe. The thecal sac re-expanded and pulsated, and all roots were free. [The dura was inspected and intact / a small durotomy was repaired primarily with sealant.]

Meticulous epidural hemostasis was obtained, [a subfascial drain placed,] and the wound closed in anatomic layers. The patient was awakened neurologically at baseline and transferred to recovery in stable condition.

Postoperative Plan

Chief-Level Case Review

Use these as the senior-level mental model for Lumbar Laminectomy for Spinal Stenosis:

Common Pimp Questions

Use these to pressure-test preparation for Lumbar Laminectomy for Spinal Stenosis:

  1. What neurologic level and root are responsible for the presenting deficit?
  2. What is the decompression target and how will you know it is adequately decompressed?
  3. What instability, deformity, bone-quality, or fusion variable changes the construct?
  4. What vascular, visceral, dural, or neural structure is the main structure at risk?
  5. What postop brace, drain, mobilization, MAP, antibiotic, and DVT plan should be ordered?

Attending Preference Variables

Items that commonly vary by surgeon or institution: