Global Spine J. All patients were followed up. Bone spurs can also be inherited. An official website of the United States government. Your provider may tell you to limit other activities. Firestein GS, et al. These symptoms are often caused by pinched nerves in the spine. Advertising revenue supports our not-for-profit mission. The trumpet laminectomy can diminish the muscle injury and has a benefit in that it conserves the inferior levels of the paraspinal muscle from atrophy. The two groups were compared in respect of surgery time and bleeding. 2013;7:5659. No use, distribution or reproduction is permitted which does not comply with these terms. Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional. A sterile bandage or dressing will be applied. Spinal stenosis occurs when compression in the spine causes pain, numbness, and weakness, usually in the legs. 5.Tsutsumimoto T, Shimogata M, Yoshimura Y, Misawa H. Union versus nonunion after posterolateral lumbar fusion: a comparison of long-term surgical outcomes in patients with degenerative lumbar spondylolisthesis. Part II: clinical experiences, Results after lumbar decompression with and without discectomy: comparison of the transspinous and conventional approaches. The primary symptom is a sharp pain that, Lower back pain is very common and often the result of a minor injury or overuse. The unpaired Students t-test, chi-square test, and Fisher exact test were used as appropriate to analyze differences in the preoperative clinical and demographic characteristics (age, sex ratio, duration of symptoms, clinical presentation, VAS, and ODI) in the intra operative variables and in clinical outcome variables between groups (VAS, ODI, and PSI scores as well as reoperations). Received 2015 Nov 5; Accepted 2016 Mar 15. Rajaee SS, Bae HW, Kanim LE, Delamarter RB. The wound infection rate is about 2% of all spinal surgery cases (60, 6365), and this complication was too infrequent in our study (2% in Groups 2 and 3). The procedural difficulty of the techniques was rated maximum in Group 3 (Table (Table33). At Johns Hopkins, the message was different. Comparison of both area measurements and postoperation leg pain VAS scores indicate no significant differences, which reveals that sufficient decompression was ensured in bilateral decompression via the unilateral approach. Spinal instability was demarcated as sagittal-plane translation of 5mm or more recognized on flexionextension X-ray (23, 26). In the present randomized study, patient satisfaction was 96.4% during the 12- to 18-month follow-up period in Group 1, which confirms the data of the above mentioned case series (49). Yamazaki K, Yoshida S, Ito T, Toba T, Kato S, Shimamura T. Postoperative outcome of lumbar spinal canal stenosis after fenestration: correlation with changes in intradural and extradural tube on magnetic resonance imaging, A minimally invasive technique for decompression of the lumbar spine. An epidural hematoma needing reoperation was recognized on MR imaging in Group 2 and one in Group 3 patients, and four Group 2 patients and two in Group 3 who presented with postoperative urinary retention (six cases totally). TLIF is a type of spinal fusion surgery designed to create solid bone and eliminate motion in a spinal segment. It is said that almost 90% of the patients who have a Laminectomy surgery get pain relief. VAS was used to evaluate low back and leg pain preoperatively and postoperatively at 1, 6, and 12months. Discectomy involves the partial or complete removal of a damaged intervertebral disk. Conclusions: Success rates of laminectomy with or without fusion, or laminoplasty may be successfully employed to address multilevel cervical pathology in a carefully selected population of patients. [8-12] Laminectomy was regarded as the gold standard surgical procedure for multilevel CSM. Accessed Aug. 2, 2022. This was accompanied by a major benefit in most outcome factors during a minimum follow-up period of 1year and is a current method with no instability effect, which offers sufficient decompression in the degenerative stenosis and increases patient comfort in the postoperative stage. A disk may be displaced or damaged because of injury or wear and tear. Among 163 patients, 120 patients (mean age 668years, range 4685years) by lumbar spinal stenosis unresponsive to tolerable conservative management were selected throughout a 36-month period. Once you are at home, it's important to keep the surgical incision area clean and dry. Follow any directions you are given for not eating or drinking before the surgery. Suction drains were regularly located. Without Fusion If spinal stenosis, the most common reason for a laminectomy, originates from problems in the nerves, then there is usually no need for a fusion, decreasing risk factors and increasing the odds of long-term success. There are frequent issues that contribute to clinical policymaking. Aspirin or certain other pain medicines may increase the chance of bleeding. Although laminectomy procedures have relatively low complication rates, some people may develop infections, spinal instability, or blood clots. Pain (VAS score), ODI scores, and general success rate (0% no success; 100% complete success) were logged at follow-up checkups at 1, 6, and around 12months after the operation. Once you are under anesthesia, a urinary drainage catheter may be inserted. Designed study and wrote paper: KH; Collected data: HQ. After your surgery, you will be moved to a recovery area until you are fully awake and alert. Dont let your low back pain limit your future. However, during laminotomy, a surgeon removes just a small part of the lamina. However, they may recommend a laminectomy if the symptoms persist despite the person trying other forms of treatment. Upper: axial postoperative CT scans. To assess patient satisfaction with the postoperative outcome, the PSI (a modified sub item of the NASS outcome questionnaire) was used (31). Explore Mayo Clinic studies of tests and procedures to help prevent, detect, treat or manage conditions. There are significant forces placed on the low back and the hardware. Intervertebral disks consist of thick rings of cartilage. Your healthcare provider may give you other instructions after the procedure, depending on your particular situation. . Adjacent Segment Disease and injury of spinal muscles are additional complications from fusion surgery. To better understand how to avoid lumbar fusions by using precisely guided PRP and stem cell injections please click on the video below. The Maine Lumbar Spine Study, Part III. The success rate of this surgery is high; 85% to 90% of surgical patients find the procedure eliminates their leg pain and 75% of patients say they have much better quality of life for a decade after the surgery. It is also a good idea to arrange for someone to help around the house for a few weeks after the surgery. Tell your healthcare provider if you are sensitive to or are allergic to any medicines, latex, tape, and anesthesia medicines (local and general). Fusion was not indicated in Group1 patients. https://orthoinfo.aaos.org/en/diseases--conditions/lumbar-spinal-stenosis. However, this will depend on the severity of the condition and symptoms before the operation. Mayer TG, Vanharanta H, Gatchel RJ, Mooney V, Barnes D, Judge L, et al. A laminectomy is a type of spinal surgery used to treat the narrowing and compression of the spinal cord. Other common causes of spinal stenosis that may require a laminectomy include: Although a laminectomy can help relieve the painful symptoms of spinal stenosis, a doctor may initially recommend less invasive treatment options, such as physical therapy and medications. Laminectomy is a simple decompressive procedure (6, 55), while bilateral laminotomy has been related to a prolonged operative duration (20, 24) and the unilateral approach has been thought technically more challenging (6). Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room. There are advantages and disadvantages of bilateral laminotomy above laminectomy. The overall fusion rate for multilevel ACDF was 69.6%, The fusion rate was 86.7% for 2 . Laminectomy enlarges your spinal canal to relieve pressure on the spinal cord or nerves, and has about an 80 percent success rate at improving walking abilities. Adequate decompression was achieved in all patients on the basis of surgeon satisfaction. the contents by NLM or the National Institutes of Health. So, l5 s1 surgery success rates would reflect in those statistics. A sharp midline cut was done with a 2-mm high-speed drill, preserving the ligamentous supplement to the rostral part of the spinous process (Figure (Figure1D)1D) (28). Or it may be done while you are awake under spinal anesthesia. There are a number of problems that arise as a direct result of lumbar fusion itself. During the next few weeks, a person should get plenty of rest and avoid: During the recovery process, a person should remember to take any prescription medication as their doctor indicates. Patients showing substantial residual or recurrent symptoms undertook postoperative MR imaging and flexionextension radiography. Are there regenerative alternative treatments? FOIA Degenerative disorders of the thoracic and lumbar spine. Patients pain assessment before and after surgery. The success rates of third and fourth spine surgeries are even lowerno more than 15% and 5%, respectively. One common reason for having a laminectomy is a herniated disk in the spine. The purpose of our prospective study was to compare the safety and the clinical outcomes after bilateral laminotomy, laminectomy, and trumpet laminectomy in patients with LSS who were randomized to one of the three action groups. Subsequently, the explanation of the bilateral laminotomy method (51), the authors of the clinical case series showed good results in 91% (29) at 1year; 82% (12), 87% (52), 78% (53), and 68% (5) at 2years; 85% (7) at 3years, and 74% (54) at 6years, in a prospective outcome study of 54 patients; Kleeman et al. Click here for an email preview. It can be very difficult to pinpoint the exact cause of back pain, even if imaging tests show disk problems or bone spurs. Different surgical techniques and approaches exist. 11th ed. In our study, a minimum follow-up period of 12months was obtainable for all patients. Based on your health condition, your healthcare provider may have other instructions for you. The total complication rate was lowest in patients who had experienced bilateral laminotomy. Elsevier; 2021. https://www.clinicalkey.com. Unlike preceding studies in which the authors permitted discectomy to be a portion of the decompression (8, 10, 12, 20, 25) or involved fusion procedures (20), we tried to study a uniform population. Investigating the power of music for dementia. Abumi K, Panjabi MM, Kramer KM, Duranceau J, Oxland T, Crisco JJ. Azar FM, et al. Finally, diabetic patients and osteoporotic or heavy smoker patients were excluded from the study. A doctor may recommend laminectomy for a person with spinal stenosis. Accessed Aug. 4, 2022. We designed the first prospective study to match the safety and consequences of bilateral laminotomy and trumpet laminectomy by laminectomy. A laminectomy is considered only after other medical treatments have not worked. 3.Greenwood J, McGregor A, Jones F, Hurley M. Evaluating rehabilitation following lumbar fusion surgery (REFS): study protocol for a randomised controlled trial. You may meet with a physical therapist before your surgery to discuss rehabilitation. During the procedure, a spine surgeon removes a small section of bone (called the lamina) from the lower spine. Operating decompression leads to an intense decrease of total pain in all three groups (p<0.001). The laminectomy surgery eases spinal cord pressure and pain. New masking guidelines are in effect starting April 24. The L3L4 and the L4L5 levels were most commonly involved [in 96 (42.2%) and 95 (41.8%) of cases, respectively]. Fusion . Treatment options for back pain include PRP and a patients own bone marrow-derived stem cells. Success rate; Alternatives; . Ankylosing Spondylitis Pain: Fact or Fiction, https://www.ncbi.nlm.nih.gov/books/NBK542274/, https://www.nhs.uk/conditions/lumbar-decompression-surgery/recovery/, https://www.nhs.uk/conditions/lumbar-decompression-surgery/risks/, https://www.niams.nih.gov/health-topics/spinal-stenosis, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5760430/, A 20-minute daily walk may improve heart health in those with high CVD risk, Alzheimers: New blood biomarker could predict risk of cognitive decline, Researchers investigate what causes psoriasis and how it spreads, Low-dose atropine eyedrops may delay onset of nearsightedness in children, Heart attack may speed up cognitive decline, study finds, Spinal stenosis: Everything you need to know, What to know about herniated disc surgery, numbness, aching, or tingling that radiates from the arms into the hands, numbness or aching that runs down the buttocks and into the legs, cramping or weakness in the hands, arms, legs, or feet, difficulty controlling bladder or bowel movements, spinal injuries from motor vehicle accidents or falls, bone spurs that grow into the spinal canal, stop taking any blood-thinning medications, avoid eating or drinking for several hours before the procedure, get a back brace and other supportive devices for use in the home, place clothes, food, utensils, and other necessary items in easily accessible places. 303-429-6448 Back pain relief: Ergonomic chair or fitness ball? This additional force in turn can lead to injury of these facet joints and discs leading to degeneration and arthritis. Schedule a Telemedicine consultation with a board-certified, fellowship-trained physician who can discuss your regenerative options. If a bulging or herniated disc is causing compression of the nerve roots, a small portion of the disc that is causing the compression will be removed to relieve the pressure from surrounding structures; A laminectomy is a procedure to remove a portion of the vertebrae, especially if there is a bone spur (a . A lumbar laminectomy is a surgery that treats compression of the spinal cord in your lower back. (38) described that splitting of the spinous process in laminectomy needs minimal separation of the muscles, which are protected from operative harm, and produces good outcomes. Your health care provider may prescribe medication to relieve pain at the incision site. Spine (Phila Pa 1976) 2012;37:6776. With Fusion Decompressive lumbar laminectomy for spinal stenosis, Dural tears secondary to operations on the lumbar spine. If a person met the inclusion criteria when given to the admitting doctor and informed consent was obtained, an obscured computer randomization tilt was used to allocate the patient to one of the action groups: bilateral laminotomy (Group 1), conventional laminectomy (Group2), and trumpet laminectomy (Group 3). Preoperative and postoperative computed tomography section areas of both groups were examined. In some cases after laminectomy and spinal fusion, it may take several months to return . The EBL was the lowest in patients who undertook the bilateral method in Group 1. Intraoperative parameters restrained during surgical decompression. These structures work with one another in a highly specialized and dependent manner. Most back pain gets better on its own within three months. VA underwent lumbar fusion several years ago for severe low back pain. To match the safety and the clinical consequences after a bilateral laminotomy, laminectomy and trumpet laminectomy in patients with lumbar spinal stenosis who were randomized to one of three treatment groups. 1 Compression of the spinal cord can lead to weakness and difficulty moving the hands, legs, and feet. Others have described smaller operative times for laminectomies (56), nonetheless records on laminectomy in which the facet joints are accurately secure are the outcome of less invasive surgery for lumbar stenosis. You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. These are: severity of stenosis (41), segmental mobility before surgery (42), medicinal comorbidity (43), facet tropism (44), and liquid inside the facets (36). You may get a sedative before the surgery to help you relax. Laminectomies, for the purpose of relieving pressure on spinal nerves, have a good short-term success rate, explaining why the procedure is considered one of the most common spinal surgeries performed. Functional results after anterior lumbar fusion at L5-S1 in patients with normal and abnormal MRI scans. The surgery involves cutting through important muscles, ligaments, and tendons to access the targeted disc. (A) (normal), (B) (Group 2), (C) (Group 1), and (D) (Group 3) arrow showed the replacement part of resected lamina in trumpet laminectomy. In the present randomized study, patient satisfaction was 96.4% during the 12- to 18-month follow-up period in Group 1 matched with 79.1 and 73.2% in Groups 2 and 3, respectively (p<0.01) (Table (Table55). Costs range from $26,022 to $44,000. The surgical staples or stitches are removed during a follow-up office visit. The spinous process, the supra- and interspinous ligaments, and a considerable percentage of the lamina stayed conserved (Figure (Figure1C)1C) (1113, 29). A laminectomy is considered only after other medical treatments have not worked. Postoperative CT scanning established adequate decompression in all patients, and reoperation was required in no patient for residual or recurrent spinal stenosis in the same segment(s) within 1218months. Numerous authors have planned more custom-made and fewer invasive techniques in the handling of acquired lumbar stenosis, including micro hemi laminotomy, interlaminar micro decompression, inter segmental micro decompression, recapturing micro laminoplasty, and segmental micro sub laminoplasty (810). The most obvious symptom of lumbar stenosis, neurogenic claudication improved in 91% of patients in Group 1 compared to 84 and 82% in Groups 2 and 3 (p<0.05), respectively. The lesion may involve the spinal cord, nerve [] This, in turn, can create spinal instability and pain. Unfortunately, lumbar fusion significantly compromises the health and integrity of these muscles. Laminectomy usually requires that you stay in the hospital one or more days. The lamina is a part of the vertebrae that covers and protects the spinal canal. You may have blood tests or other diagnostic tests. Results A total of 66 patients (mean age, 67 years; 80% women) underwent randomization. You may be told to stop these medicines before the procedure. You may be given an exercise plan to follow both in the hospital and after discharge. Collectively about 1 in 10 patients who have a low back fusion will need a second surgery to fix non-union or hardware failure (8). [13] But postoperative segmental instability and kyphosis is the main drawbacks of the technique. Expert Insight. For postoperative epidural hematomas, the occurrence ranges from 1 to 3% (7, 60). At that time, the tip of the spinous process was released by a dissector, and the base of it was cut by a high-speed drill. This pressure can cause pain, weakness or numbness that can radiate down arms or legs. Spetzger U, Bertalanffy H, Reinges MH, Gilsbach JM. Bilateral and unilateral laminotomy prove advantageous for patients, with reduced postoperative pain, no additional fusion surgery and improved health-related quality-of-life (6, 39, 4547). If laminectomy is being performed as part of surgical treatment for a herniated disk, the surgeon also removes the herniated portion of the disk and any pieces that have broken loose (diskectomy). The trumpet laminectomy can be achieved for lumbar canal stenosis patients of all ages and at all levels of spinal canal stenosis without spondylolisthesis complication. In particular, bilateral (1113) and unilateral laminotomy for bilateral decompression (1417) have been described. Multiple laminotomy compared with total laminectomy. However, it can sometimes be a symptom of conditions that affect the, The bones in the back have sponge-like discs between them. Most people will feel ready to drive around 23 weeks after the operation. Therefore, L5 S1 fusion surgery involves the surgical removal of the L5/S1 disc and fusing the L5 and S1 spinal bones together. A prospective study comparing decompression with decompression and intertransverse process arthrodesis. Certain activities may be limited after your surgery. PRP is rich in growth factors that can increase blood flow and healing. The anesthesiologist will continuously watch your heart rate, blood pressure, breathing, and blood oxygen level during the surgery. A doctor or other healthcare provider will explain the specific preparation requirements during an appointment before the surgery. For patients withlateral recess stenosis, the success rate was 58.7% at 6 weeks and 63.6% at 6 months; however, thesample was not large enough to be statistically significant. Doctors typically use this procedure for treating the symptoms of spinal stenosis and conditions such as herniated disks. Consider the following results: In one study 53 patients were followed for an average of 20 months after fusion surgery. Elsevier; 2023. https://www.clinicalkey.com. 6.Herkowitz HN, Kurz LT. Degenerative lumbar spondylolisthesis with spinal stenosis. All rights reserved. Accessed May 3, 2022. [ 3, 6, 14, 16, 17, 19, 23, 25] Following . The present study reported the efficacy and safety of the laminectomy, foraminotomy, discectomy, and medial facetectomy with spinal fixation using trans-pedicular screws for management of patients with spinal canal stenosis. Detwiler PW, Spetzler CB, Taylor SB, Crawford NR, Porter RW, Sonntag VK. A cervical laminectomy involves the removal of the lamina, the back portion of a spinal bone in the neck. Spinal fusion is a major surgery where one or more spinal bones (vertebrae) are fused together using screws, bolts, and or plates. Referring to our data, definite injury to a nerve root did not happen. It views the spine and all its moving parts as a whole. This creates more room within the spinal canal. Mayo Clinic does not endorse companies or products. In: Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. Perioperative parameters and complications were documented. After you are unconscious and can't feel pain: After surgery, you're moved to a recovery room where the health care team watches for complications from the surgery and anesthesia. In the series reported by Verbiest (58), a postoperative increased radicular deficit was perceived in 5% of laminectomy-treated cases. Laminectomy. equaled bilateral laminotomy with laminectomy and determined that laminotomy is acceptable for mild-to-moderate stenosis, then laminectomy is favored when handling severe stenosis or spondylolisthesis. Mayo Clinic; 2021. There is subsequent extensive damage of the paraspinal muscles, the interspinous ligament, the supraspinous ligament, posterior bone rudiments, and, occasionally, the capsular facet. The authors of a clinical series linking bilateral laminotomy or trumpet laminectomy have found complication rates inferior or similar to laminectomy (5, 7, 8, 11, 17) but the sizes of the patient groups have been smaller and the studies were mostly retrospective or lacked a control group. Because all processes were done, relevant statistics in the literature are rare (57), while the importance of the cosmetic consequence has been harnessed (6). In 2013, Yaman et al. Similarly, it still needs undressing of the Para spinal musculature and the possible risk of neural injury in a small occupied space is also a problem, especially in patients with severe central stenosis (18, 3739). information highlighted below and resubmit the form. Adjacent level stenosis requiring decompression occurred in one Group 2 patient and two patients in Group 3. The most common symptom of a herniated disk is sciatica. Unfortunately, after the surgery, the pain never changed. While protecting the supraspinous ligament and the interspinous ligament, the paravertebral muscle and the capsular facet were left totally undamaged. This study has been approved by the institutional review board of Mazandaran University of Medical Science, Sari, Iran, and written informed consent was obtained from the patients. Nerves may become pinched for a variety of reasons, including: Back surgery relieves this leg pain better than it does back pain. The incision will be closed with stitches or surgical staples. The influence of age, diagnosis, and procedure. A laminectomy usually requires a stay in a hospital. official website and that any information you provide is encrypted Following laminectomy, a person will likely notice significant relief from many symptoms of spinal stenosis. The healthcare staff will clean the skin over the surgical site with an antiseptic solution. Although longer surgery time looks like a disadvantage compared to the classic procedure, surgery time for bilateral decompression has been perceived to decline as the surgeon improves his learning curve, as in our study. Mayo Clinic offers appointments in Arizona, Florida and Minnesota and at Mayo Clinic Health System locations. These outcomes suggest that they are superior to laminectomy and trumpet laminectomy. The rate of follow-up was 89% at 1 year, 86% at 2 years, and 68% at 4 years. Bilateral Laminotomy is certified acceptable and harmless in decompression of lumbar stenosis, causing a highly significant decrease of symptoms and disability. However, there is a chance that the symptoms will return after the procedure. 2018;48(12):1430-4. Microdecompression for lumbar spinal canal stenosis, Relief of lumbar canal stenosis using multilevel subarticular fenestrations as an alternative to wide laminectomy: preliminary report. Laminoplasty with fusion: . Risks and side effects. Back or neck pain that interferes with normal daily activities may need surgery for treatment. Clinical and demographic data achieved in randomized patients with lumbar spinal stenosisa. Estefan, M., & Camino Willhuber, G. O. While satisfactory in handling the symptoms of neurogenic claudication, the occurrence of new onset spondylolisthesis is reported to be as high as 31% (35). Treatment options include PRP and your own bone marrow-derived stem cells. Why is this surgery done? As with any form of surgery, laminectomy carries a risk of some side effects. Sandwiched between each of the spinal bones is a disc. You're likely to spend a night or two in the hospital. Also known as decompression surgery, laminectomy enlarges your spinal canal to relieve pressure on the spinal cord or nerves. the unsubscribe link in the e-mail. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. According to the results available, we recommended bilateral laminotomy in all patients with Spinal Stenosis regardless of age and severity of illness, as their preferred treatment. Non-union occurs when the spinal bones that are bolted together fail to fuse or grow together. All patients undertook surgery after administration of general anesthesia in the prone position. How long does it take to recover? This method conserves posterior lumbar associate constructions aimed at spinal constancy and avoids weakening of the paraspinal muscle, allowing for enhanced disclosure of intraspinal nerves and sufficient decompression of the spinal channel. include protected health information. Similar Procedures: Anterior Cervical Discectomy and Fusion (ACDF) Levin K. Lumbar spinal stenosis: Treatment and prognosis. The incidence of postoperative hematomas after bilateral laminotomy must not vary from the low rates after micro discectomy, which agrees with our data. The practice of fine Kerrison rongeurs donated to the longer surgery time. The spinous process was uncovered 20-mm wide, centered at the interspinous level to be decompressed. In six patients, the latter part of the questionnaire (PSI) was inadequately completed, preventing analysis. They concluded that bilateral decompression through a unilateral approach is an effective method without any instability effect, which provides sufficient decompression in the degenerative stenosis and increases patient comfort in the postoperative period (50). The results so far have been hopeful, with success rates as high as 90%. are currently taking any prescription or over-the-counter medications, are pregnant or think they may be pregnant, have allergies to any medications, anesthetics, or latex, disinfect and clean the skin where they will make the incision, move the skin, muscle, and ligaments away so that they can access the spinal column, carefully cut away part or all of the lamina bones, remove bone spurs or any broken or loose disk fragments, correct any misaligned, fractured, or weak vertebrae by fusing two or more vertebrae, cover the closed incision with gauze bandages, lifting, pulling, or pushing heavy objects, an allergic reaction to the anesthetic or medication, unsuccessful treatment, which can lead to recurring symptoms, damage to the nerves, muscles, or tendons that stabilize the spine, postoperative back pain, especially after spinal fusion. Cerebrospinal fluid (CSF) can leak out of tears in the dura mater, which is the thick membrane surrounding the spinal cord. The benefit of a micro surgical method is the opportunity for an extensive bilateral decompression of the spinal canal or foramen, through a slight paraspinal muscular separation. On the right, the yellow arrows point to dark healthy spine muscles that were present prior to the surgery. These overgrowths are sometimes called bone spurs.
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