Table 1

Summary features of lumbar decompression techniques.19–32

Procedure	Summary Features
Laminectomy	Indications ● Symptomatic spinal canal stenosis that does not respond to conservative treatment ● Rapidly progressing neurological deficits or intolerable pain ● Cauda equina syndrome
	Contraindications ● Patients with multiple medical comorbidities including depression ● Scoliosis ● Spondylolysthesis ● Lateral listhesis
	Approaches ● Open
	Advantages ● High success rate with significant alleviation of preoperative symptoms ● Low rate of postoperative complications that continues to reduce with the implementation of less invasive approaches
	Disadvantages ● Potential iatrogenic disruption of posterior structures and anatomy/biomechanics of spine ● May require concomitant fusion
Laminoplasty	Indications ● Symptomatic stenosis without any signs of significant instability
	Contraindications ● Severe osteoporosis or active infection ● Significant instability requiring fusion
	Approaches ● Open
	Advantages ● Posterior spinal structures preserved ● Reduced risk of postoperative spinal instability and deformity
	Disadvantages ● Limited literature looking at long-term outcomes of lumbar laminoplasty compared to other procedures ● Greater risk for nerve root injury intraoperatively ● Longer operative time
Laminotomy	Indications ● Spinal stenosis with neurological symptoms ● Multilevel spondylotic lateral canal stenosis ● Lateral recess stenosis secondary to disc herniation
	Contraindications ● Severe instability necessitating fusion ● Pan-canal or central stenosis ● Severe facet joint arthritis or osteoporosis
	Approaches ● Open, minimally invasive, endoscopic (includes inside-out, outside-in, contralateral techniques) ● Unilateral and bilateral
	Advantages ● Reduced risk for iatrogenic mechanical instability and prolonged recovery when compared to laminectomy ● Superior preservation of posterior spinal structures
	Disadvantages ● Limited extent of decompression when compared to laminectomy ● May not fully alleviate central canal stenosis
Foraminotomy	Indications ● Foraminal stenosis with compression of neural structures
	Contraindications ● Severe spinal instability (e.g., scoliosis, spondylolisthesis, kyphosis) necessitating fusion ● Significant neurological deficits requiring more extensive decompression ● Active infection or severe osteoporosis
	Approaches ● Open, minimally invasive, endoscopic (includes transforaminal and laser assisted endoscopic foraminotomies)
	Advantages ● Preserves lamina integrity ● Potential postoperative improvement of both foraminal diameter and height
	Disadvantages ● Risk of nerve injury ● Reduced access to central canal leading to potential risk for incomplete decompression and symptom recurrence
Percutaneous Minimally Invasive Lumbar Decompression (MILD)	Indications ● Stenosis secondary to ligamentum flavum hypertrophy ≥2.5 mm ● Typically reserved for patients with multiple medical comorbidities making them high-risk candidates for traditional procedures
	Contraindications ● Previous spinal surgery ● Infection at the site of potential surgery
	Approaches ● Percutaneous approach through a small incision ● Performed utilizing local anesthesia with the assistance of fluoroscopic guidance
	Advantages ● Is safe for patients with comorbidities that make it challenging to tolerate traditional spinal surgery such as laminectomy and laminotomy ● Does not require general anesthesia ● Minimally invasive, avoiding large incisions and lamina removal
	Disadvantages ● Limited decompression compared to traditional surgical method ● Limited evidence and literature available showing long-term efficacy