Interlaminar Decompression of the Spine

Interlaminar Decompression of the Spine is as much a concept as it is any specific device. It seeks to decompress the nerves of the spine in the central canal and foramena by inserting devices between the spinal processes of adjacent vertebrae. It uses a posterior approach, which avoids the anterior/ventral approach, which some surgeons are uncomfortable employing. There are other posterior approaches to decompression such posterior fusions of the facets, 360 fusions and Dorsal Pedical Implants (DPI), which involve screws into the pedicles for the anchoring of associated instrumentation. DPI can be used for a posterior fusion or preserve motion.

Indications for Interlaminar Decompression are lumbar stenosis, degenerative disc disease, hypertrophied ligamentum flavectum, and decompression of the spinal nerves. Contraindication would be hypertrophied facet joints in the level of concern.

More and more patients are rejecting fusion techniques and seeking to preserve the motion of their backs. Spine device makers and surgeons are responding to their patient wishes with new devices. One of the most promising devices is the Coflex intraspinous device shown below. This device also has a fusion version, which is next to it on the right.
coflex_two_level_adj.jpgcoflex2.jpg One might notice the pins in the fusion device.

For a list of more Interlaminar devices please see

It should be noted that interlaminar devices should be used with great care, as they shift the loading of the spine considerable posteriorly. Normally, it is the intervertebral discs, which bear the weight of the body. Many surgeons prefer to use Interlaminar Decompression only in elderly patients.

If one is considering such a procedure, one should consider a surgeon with many years of experience with many of these devices and other approaches. Spine surgery is as much an engineering exercise as a surgical procedure.
