Endoscopic Lumbar Decompression for Stenosis

What it is and why we do it

Lumbar spinal stenosis is a narrowing of the canal that carries the nerves to the legs, usually from thickened ligament, enlarged facet joints, and bulging discs that come with age. It causes leg pain, heaviness, or tiredness with standing and walking that eases when you sit or lean on a cart. When it limits your life despite non-surgical care, the treatment is to make room for the nerves.

A traditional laminectomy removes the back of the vertebra and the ligament through an incision of several centimeters. An endoscopic decompression reaches the same tissue through an incision about 1 centimeter wide. Working through a tube from one side, I trim the inner edge of the lamina and the overgrown ligament on my side, then angle the endoscope under the midline to do the same on the other side. The spinous process, the muscles, and most of each facet joint stay in place.

What happens during surgery

Under general anesthesia, X-ray guides the tube to the level. The endoscope shows the ligament, the bone, and the nerve sac on a large screen, under a steady flow of saline that keeps the view clear. Small burrs and punches remove bone and ligament a few millimeters at a time until the nerves are free on both sides. One level usually takes about an hour; two levels take longer. The incision is closed with a stitch or two.

Your recovery

Most people go home the same day or the next morning, walk the day of surgery, and need little opioid medicine. The leg symptoms often improve at once, though walking distance keeps increasing over weeks as the nerves recover. Back soreness is mild compared with open surgery. Desk work often restarts in one to two weeks. No brace is needed.

Activity and restrictions

Walk from the first day, building up the distance. For four weeks, no heavy lifting, deep bending, or twisting. Driving once you are off opioids and comfortable. A stationary bike and gentle core exercise at about four weeks, and physical therapy if you need help with strength and balance. See my playbook after lumbar decompression or endoscopic surgery.

Who is not a good fit

If your vertebra has slipped forward and the level is unstable, a decompression alone, by any method, can make the slip worse, and a fusion may be the right operation. Severe narrowing at many levels, a large curve, or stenosis with a nerve emergency are also better treated with open surgery. I will be clear about which situation you are in.

The science: for the curious

Leaving the midline bone and the facet joints intact matters because those structures hold the spine stable; removing less of them lowers the chance that the level later slips and needs a fusion. Long-term studies of endoscopic decompression show lasting relief of leg symptoms with low rates of later instability, and comparisons with open laminectomy show similar relief with less blood loss and a shorter hospital stay. The magnified view from inside the canal is what makes it possible to work under the midline safely.

Learn more

OrthoInfo, Lumbar Spinal Stenosis: orthoinfo.aaos.org (opens in a new tab)

My overview of endoscopic spine surgery compares every endoscopic procedure I offer.

Watch

Decompression of both sides from one small opening4:05

This handout is general education about this procedure and does not replace the specific plan, risks, and consent discussion we have together. Your own situation may differ: if anything here does not match what we talked about, what we talked about wins, so please ask me.