Lumbar Decompression Using a Tubular Retractor System

  • Mark A. Shapses
  • Arjun Balakumar
  • D. Greg AndersonEmail author


Spinal stenosis and lumbar disc herniation often cause nerve root compression with radiculopathy or neurogenic claudication. The resulting symptoms can vary widely from patient to patient ranging from asymptomatic to debilitating back and leg pain. Surgical decompression is generally effective at improving the condition when nonoperative treatments have not been effective. Minimally invasive techniques have the potential to decrease certain perioperative complications and shorten patient recovery time. This chapter will review the technique of minimally invasive lumbar decompression using a tubular retractor system.


Lumbar decompression Minimally invasive Perioperative complications Spinal stenosis Tubular retractor system 



No funds were received in support of this work. No benefits in any form have been or will be received from any commercial party related directly or indirectly to the subject of this manuscript.


  1. 1.
    Atlas SJ, Keller RB, Robson D, Deyo RA, Singer DE. Surgical and nonsurgical management of lumbar spinal stenosis: four-year outcomes from the main lumbar spine study. Spine (Phila Pa 1976). 2000;25(5):556–62. Epub 2000/04/05.CrossRefGoogle Scholar
  2. 2.
    Khoo LT, Fessler RG. Microendoscopic decompressive laminotomy for the treatment of lumbar stenosis. Neurosurgery. 2002;51(5 Suppl):S146–54. Epub 2002/09/18.PubMedGoogle Scholar
  3. 3.
    Atlas SJ, Keller RB, Wu YA, Deyo RA, Singer DE. Long-term outcomes of surgical and nonsurgical management of lumbar spinal stenosis: 8 to 10 year results from the main lumbar spine study. Spine (Phila Pa 1976). 2005;30(8):936–43. Epub 2005/04/19CrossRefGoogle Scholar
  4. 4.
    Turner JA, Ersek M, Herron L, Deyo R. Surgery for lumbar spinal stenosis. Attempted meta-analysis of the literature. Spine (Phila Pa 1976). 1992;17(1):1–8. Epub 1992/01/01CrossRefGoogle Scholar
  5. 5.
    Asgarzadie F, Khoo LT. Minimally invasive operative management for lumbar spinal stenosis: overview of early and long-term outcomes. Orthop Clin North Am. 2007;38(3):387–99; abstract vi–vii. Epub 2007/07/17CrossRefGoogle Scholar
  6. 6.
    Palmer S, Turner R, Palmer R. Bilateral decompression of lumbar spinal stenosis involving a unilateral approach with microscope and tubular retractor system. J Neurosurg. 2002;97(2 Suppl):213–7. Epub 2002/09/26.PubMedGoogle Scholar
  7. 7.
    Johans SJ, Amin BY, Mummaneni PV. Minimally invasive lumbar decompression for lumbar stenosis: review of clinical outcomes and cost effectiveness. J Neurosurg Sci. 2015;59(1):37–45. Epub 2014 Nov 5.PubMedGoogle Scholar
  8. 8.
    Rasouli MR, Rahimi-Movaghar V, Shokraneh F, Moradi-Lakeh M, Chou R. Minimally invasive discectomy versus microdiscectomy/open discectomy for symptomatic lumbar disc herniation. Cochrane Database Syst Rev. 2014;9:CD010328.Google Scholar
  9. 9.
    Anderson DG, Patel A, Maltenfort M, Vaccaro AR, Ratliff J, Hilibrand A, Harrop JS, Sharan AD, Ponnappan RK, Rihn J, et al. Lumbar decompression using a traditional midline approach versus a tubular retractor system: comparison of patient-based clinical outcomes. Spine (Phila Pa 1976). 2011;36:E320–5.CrossRefGoogle Scholar
  10. 10.
    Hsieh PC, et al. Maximizing the potential of minimally invasive spine surgery in complex spinal disorders. Neurosurg Focus. 2008;25(2):E19.CrossRefGoogle Scholar
  11. 11.
    McLoughlin GS, Fourney DR. The learning curve of minimally-invasive lumbar microdiscectomy. Can J Neurol Sci. 2008;35(1):75–8.CrossRefGoogle Scholar
  12. 12.
    Neal CJ, Rosner MK. Resident learning curve for minimal-access transforaminal lumbar interbody fusion in a military training program. Neurosurg Focus. 2010;28(5):E21.. Epub 2010/06/24CrossRefGoogle Scholar
  13. 13.
    Stadler JA 3rd, Wong AP, Graham RB, Liu JC. Complications associated with posterior approaches in minimally invasive spine decompression. Neurosurg Clin N Am. 2014;25(2):233–45. Epub 2014/01/25.CrossRefGoogle Scholar
  14. 14.
    Wang M, Zhou Y, Wang J, Zhang Z, Li C. A 10-year follow-up study on long-term clinical outcomes of lumbar microendoscopic discectomy. J Neurol Surg A Cent Eur Neurosurg. 2012;73(4):195–8. Epub 2012/05/03.CrossRefGoogle Scholar
  15. 15.
    Chou D, Wang VY, Khan AS. Primary dural repair during minimally invasive microdiscectomy using standard operating room instruments. Neurosurgery. 2009;64(5 Suppl 2):356–8; discussion 8–9. Epub 2009/05/07PubMedGoogle Scholar
  16. 16.
    Ikuta K, Arima J, Tanaka T, Oga M, Nakano S, Sasaki K, et al. Short-term results of microendoscopic posterior decompression for lumbar spinal stenosis. Technical note. J Neurosurg Spine. 2005;2(5):624–33. Epub 2005/06/11CrossRefGoogle Scholar
  17. 17.
    O’Toole JE, Eichholz KM, Fessler RG. Surgical site infection rates after minimally invasive spinal surgery. J Neurosurg Spine. 2009;11(4):471–6.CrossRefGoogle Scholar
  18. 18.
    Yagi M, Okada E, Ninomiya K, Kihara M. Postoperative outcome after modified unilateral-approach microendoscopic midline decompression for degenerative spinal stenosis. J Neurosurg Spine. 2009;10(4):293–9. Epub 2009/05/16CrossRefGoogle Scholar
  19. 19.
    Skovrlj B, Gilligan J, Cutler HS, Qureshi SA. Minimally invasive procedures on the lumbar spine. World J Clin Cases. 2015;3(1):1–9. Epub 2015/01/16.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Mark A. Shapses
    • 1
  • Arjun Balakumar
    • 2
  • D. Greg Anderson
    • 3
    Email author
  1. 1.Department of OrthopedicsRothman Institute, Thomas Jefferson UniversityPhiladelphiaUSA
  2. 2.Department of OrthopedicsThomas Jefferson University HospitalPhiladelphiaUSA
  3. 3.Departments of Orthopaedic Surgery and Neurological SurgeryRothman Institute, Thomas Jefferson UniversityPhiladelphiaUSA

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