Endoscopic Decompression for Lumbar Canal Stenosis

Narrowing of the lumbar spinal canal is a common problem after the age of sixty years. This limits the patient’s standing time and walking distance because of pain, numbness, heaviness or weakness in one or both legs. Patients may or may not have back pain.

Patients often require surgery for symptomatic lumbar canal stenosis and sadly, many of them end up having fusion surgery which is rarely indicated in this case. Endoscopic decompression is widening of the tight lumbar canal using a ten millimeters endoscope. The procedure is safe, very effective and is often done as a day case. Although this is done through a one-centimeter incision per each level, the most important advantage of endoscopic decompression is the fact that most patients do NOT require a fusion surgery. This is because the inherent smaller diameter of the endoscope and the superb visibility it offers the surgeon, allows better decompression of the entire spinal canal from one side. This preserves the stabilising structures of that segment of the spine, namely the bones, muscles and ligaments and therefore negates the need to stabilise with screws, cages and bone graft. Open surgery removes some and sometimes most of these stabilising structures forcing the surgeon to fuse that particular segment. Fusion surgery is much bigger than endoscopic decompression and carries a higher risk of complications including adjacent level disease; acceleration of wear and tear in the disc above or below the fused part. This doesn’t mean that fusion surgery shouldn’t be done at all. On the contrary, it can be life changing specifically in deformity and instability cases.