ABSTRACT
The gold standard of treatment for symptomatic lumbar spinal stenosis is a wide decompression via a bilateral paraspinal muscle stripping exposure. Although this traditional technique allows maximal neural decompression, there is morbidity related to stripping the paraspinal muscles and resection of stabilizing interspinous/supraspinous ligaments. Lumbar segmental sublaminoplasty compares favorably with other minimally invasive microsurgical decompression techniques such as bilateral hemi-laminotomies and interlaminar decompression. To maximize neural decompression while minimizing unnecessary bony and soft tissue resection, a thorough understanding of the exact locations of neural impingement is necessary. The lateral iliac crest provides the best superficial landmark to help localize the lower lumbar levels. Generally, the bony lateral iliac crest is in the same level as the L4–5 interspace. The operating position of the surgeon depends on the location of the pathology. For central stenosis alone, the surgeon stands on the side of the greater pathology and the hemi-laminotomy is performed on that side.
