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Facet-sparing Decompression With a Minimally Invasive Flexible Microblade Shaver: A Prospective Operative Analysis

Dickinson, Lawrence D. MD*; Phelps, Jeffery MD; Summa, Christopher D. MD; Vanichkachorn, Jed S. MD§; Jeshuran, Winston R. MD; Randall, Jeffrey B. MD*; Mimran, Ronnie I. MD*; Mitchell, Michelle MSN, FNP-BC*; Macenski, Mitchell M. PhD; Lauryssen, Carl MD#

Journal of Spinal Disorders & Techniques:
doi: 10.1097/BSD.0b013e318290fc62
Original Articles
Abstract

Study Design: This is a detailed description of a facet-sparing decompression technique and a prospective observational study of 59 subjects.

Objective: To describe a facet-sparing decompression technique, quantify operative parameters, adverse events, and anatomic changes following decompression with a flexible microblade shaving system.

Summary of Background Data: Decompression in patients with lumbar spinal stenosis is a common surgical procedure. However, obtaining a thorough decompression while leaving enough tissue to avoid destabilization can be challenging. Decompression with a flexible, through-the-foramen system may mitigate some of these challenges.

Materials and Methods: Fifty-nine subjects diagnosed with lumbar spinal stenosis were recruited into this study. Subjects underwent decompression with a flexible, microblade decompression system at a total of 88 levels between L2 and S1. Subject demographics, details of the procedure, and operation, including adverse events were collected. Preoperative and postoperative computed tomography scans and plain radiographs were obtained from a subset of 12 subjects and quantitatively assessed for bone removal and preservation of stabilizing structures.

Results: Fifty-nine subjects had 88 levels treated, 51% single-level and 49% 2-level with L4–L5 being the most commonly decompressed level. Operative time, blood loss, and length of stay were similar to or less than that seen in the historical control. The system was successfully used for decompression in 95.8% of the attempted foramina. Three operative complications were reported, all dural tears (5.1%). These dural tears occurred before introduction of the flexible decompression system. Computed tomography scans from 12 subjects demonstrate access to the lateral recess and foramen with removal of <6% of the superior facet cross-sectional area.

Conclusions: The flexible microblade shaving system provided thorough decompression with few intraoperative complications. Operative variables were favorable compared to the literature and radiographic decompression was achieved to a great extent while allowing for the preservation of the facet joints and midline structures.

Author Information

*Pacific Brain and Spine, Castro Valley, CA

Spine Works Institute, North Richland Hills, TX

Spine Clinic of Monterey Bay, Soquel, CA

§Tuckahoe Orthopaedics, Richmond, VA

OrthoGeorgia, Macon, GA

Masonovations, Minneapolis, MN

#Tower Orthopaedics and Neurological Spine Institute, Beverly Hills, CA

L.D.D. is currently receiving consulting fees, travel support, and holds stock or stock options from Baxano; J.P. is currently receiving consulting fees from Baxano; C.D.S. is currently receiving consulting fees and holds stock or stock options from Baxano; J.S.V. is currently receiving consulting fees from Baxano; J.B.R. has received consultant fees, speaker fees, and stock or stock options from Baxano; R.I.M. is currently receiving consulting fees and has received stock or stock options from Baxano; M.M. has received travel support from Baxano; M.M.M. is currently receiving consulting fees from Baxano; C.L. is currently receiving consulting fees, travel support, and holds stock or stock options from Baxano. All investigators are receiving compensation for study conduct. W.R.J. declares no conflict of interest.

Reprints: Lawrence D. Dickinson, MD, Pacific Brain and Spine, 20055 Lake Chabot Rd. Suite 110, Castro Valley, CA, 64546 (e-mail: administrator@pacbrain.com).

Received November 15, 2012

Accepted March 4, 2013

© 2013 by Lippincott Williams & Wilkins, Inc.