PARTIAL PEDICULECTOMY IN THE TREATMENT OF LUMBAR SPINAL STENOSIS - TECHNICAL NOTE

OBJECTIVE: We note an additional pathological condition associated wit h lumbar spinal stenosis that may be responsible for significant posto perative pain. Recognizing that nerve roots are stretched around hyper trophic pedicles in some cases of spinal stenosis, we have altered our surgical management of these cases to address what may be a previousl y unrecognized but significant anatomic pathological finding. SURGICAL TECHNIQUE: After ipsilateral posterior bony decompression of the spin al canal, the nerve root is examined as it courses around the pedicle. If the root appears stretched, the medial part of the pedicle is remo ved using first a diamond bit and then a curet. The nerve root is retr acted and protected during this procedure. RESULTS: Inspection of the root after partial pediculectomy frequently reveals lateral movement o f the root into space previously occupied by the pedicle. Anatomically , the nerve is better decompressed and free of obstruction. This techn ique adds little time to the overall duration of the operation. CONCLU SION: Anatomic evidence obtained through intraoperative examination an d preoperative imaging techniques indicates that partial pediculectomy may play a role in the treatment of some cases of lumbar stenosis.