Navigation-Assisted Bilateral Troughing Technique for Lumbar Laminectomy: A Stepwise Approach to Safe, Teachable, and Efficient Decompression

Le résumé fourni par la source

Lumbar laminectomy is one of the most common spinal procedures, yet the extent of bone removal remains highly operator-dependent, resulting in significant variability in decompression outcomes. Insufficient decompression risks symptom persistence, while over-resection of the facet joints causes iatrogenic instability, and uncontrolled instrument passes near the inner lamina cortex carry well-documented risk of dural injury and cerebrospinal fluid (CSF) leak. A standardized, stepwise technique that reduces these risks, promotes operative efficiency, and provides a teachable framework for neurosurgical residents has not been widely described. We present a reproducible six-step lumbar laminectomy technique centered on bilateral troughing with a 3-mm matchstick burr, progressive eggshell thinning with a 5-mm diamond burr, and en bloc lamina removal, with intraoperative navigation used at defined checkpoints to confirm the medial facet border, pedicle proximity, trough depth, and final decompression extent. The technique is illustrated with a case of a 70-year-old man with multilevel lumbar stenosis (Schizas grade C-D at L3-5) and a prior L4-5 discectomy who underwent L3-L5 laminectomy using this approach; the estimated blood loss was 30 mL, the troughing and en bloc removal were completed in approximately 15 minutes, and the patient was discharged on postoperative day three without complication. The staged matchstick-to-diamond burr sequence reduces the risk of inadvertent dural injury while maintaining operative efficiency, and navigation serves as a confirmatory adjunct rather than a primary guide. The technique is designed to be learned by neurosurgical residents, with each step building anatomical understanding and safeguarding against dural injury and facet violation, and merits prospective evaluation in larger cohorts.

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