ABSTRACT
Thoracic and lumbar laminectomies are well-tolerated, effective surgeries for symptomatic spinal stenosis. Indications for revision thoracic and lumbar surgery include inadequate decompression, symptom recurrence, instability, and postlaminectomy kyphosis following a decompressive laminectomy. Patients with postlaminectomy iatrogenic instability would not typically require dissection of the laminectomy membrane unless they presented with symptomatic foraminal or lateral recess stenosis, causing radicular symptoms as well as axial back pain. Operative technique begins with patient positioning as described here after general anesthesia. The primary goal of revision surgery is to achieve adequate decompression of the neural elements, obtain successful bony fusion if indicated, and correct symptomatic deformity. Surgical principles include ensuring adequate decompression of neural elements, obtaining solid fixation and spinal stabilization, and correcting spinal deformities. Neuromonitoring with both motor-evoked potentials and somatosensory evoked potentials is largely reserved for concomitant deformity correction; however, triggered electromyography can be a useful adjunct in placement of instrumentation.
