Operative Concept
Decompression strategy in severe lumbar stenosis
Severe stenosis requires a planned sequence for exposure, ligament handling, contralateral reach, and neural safety.
Defining the stenosis pattern
Central canal, lateral recess, and foraminal stenosis have different anatomical constraints. The decompression strategy begins by naming the compression pattern and symptomatic nerve target.
Preserving stability
Facet preservation, pars protection, and controlled bone removal are important when decompression is performed without fusion.
Technical boundaries
When adequate decompression would require destabilizing bone removal, the surgical plan may need to change from decompression alone to a stabilization strategy.