{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T11:19:45Z","timestamp":1761823185902},"reference-count":18,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2002,9]]},"abstract":"<jats:p content-type=\"fine-print\"><jats:italic>Object.<\/jats:italic> The authors studied a consecutive series of patients with spinal stenosis in whom surgery was performed by a single surgeon who used a microscopic tubular retractor system (METRx-MD); patients underwent prospective evaluation involving radiography and magnetic resonance (MR) imaging.<\/jats:p>\n<jats:p content-type=\"fine-print\">The objective was to assess the feasibility and surgery-related efficacy of performing unilateral-approach bilateral decompression and utilization of METRx-MD instrumentation in patients with spinal stenosis.<\/jats:p>\n<jats:p content-type=\"fine-print\"><jats:italic>Methods.<\/jats:italic> Seventeen consecutive patients with spinal stenosis underwent bilateral decompression; surgery was performed via a unilateral approach using METRx-MD instrumentation. The procedures were performed on an outpatient basis after induction of general anesthesia. Preoperative and 3-month follow-up plain radiographs with flexion\u2014extension views were obtained. Preoperative and postoperative MR imaging was also performed. All studies were assessed by a single radiologist blinded to the clinical results.<\/jats:p>\n<jats:p content-type=\"fine-print\">Twenty-two levels were surgically decompressed. The mean operative time was 90 minutes and the mean blood loss was 28 ml per level. Preoperatively stenosis was severe at 13 levels, moderate\/severe at eight, and moderate at one. Postoperatively stenosis was absent at 13 levels, mild at seven, mild\/moderate at one, and moderate at one. Preoperatively degenerative spondylolisthesis was documented in eight patients, with flexion\u2014extension radiography revealing motion in three cases. On early (3-month) postoperative x-ray films there was no evidence of progression in any case. Grade I spondylolisthesis developed postoperatively in one patient, who remained asymptomatic.<\/jats:p>\n<jats:p content-type=\"fine-print\"><jats:italic>Conclusions.<\/jats:italic> Minimally invasive bilateral decompression and instrumentation-assisted fusion can be successfully performed via a unilateral approach in patients with acquired spinal stenosis; the procedure can be undertaken on an outpatient basis, with reasonable operative times, minimal blood loss, and acceptable morbidity rates.<\/jats:p>","DOI":"10.3171\/spi.2002.97.2.0213","type":"journal-article","created":{"date-parts":[[2009,5,7]],"date-time":"2009-05-07T15:52:47Z","timestamp":1241711567000},"page":"213-217","source":"Crossref","is-referenced-by-count":50,"title":["Bilateral decompression of lumbar spinal stenosis involving a unilateral approach with microscope and tubular retractor system"],"prefix":"10.3171","volume":"97","author":[{"given":"Sylvain","family":"Palmer","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Turner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosemary","family":"Palmer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1227\/00006123-199003000-00009","article-title":"Multilevel lumbar laminotomies: an alternative to laminectomy in the treatment of lumbar stenosis.","volume":"26","author":"Aryanpur","year":"1990"},{"key":"b2","series-title":"J Nerv Ment Dis","doi-asserted-by":"publisher","first-page":"588","DOI":"10.1097\/00005053-191110000-00002","article-title":"Osteoarthritis of the spine as a cause of compression of the spinal cord and its roots.","volume":"38","author":"Bailey","year":"1911"},{"key":"b3","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"771","DOI":"10.1056\/NEJM198709173171217","article-title":"Percutaneous laser nucleolysis of lumbar disks.","volume":"317","author":"Choy","year":"1987"},{"key":"b4","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"166","DOI":"10.3171\/jns.1996.84.2.0166","article-title":"Treatment of lumbar spinal stenosis by extensive unilateral decompression and contralateral autologous bone fusion: operative technique and results.","volume":"84","author":"DiPierro","year":"1996"},{"key":"b5","series-title":"Semin Spine Surg","first-page":"138","article-title":"Microendoscopic and open laminotomy and discectomy in lumbar disc disease.","volume":"11","author":"Dirksmeier","year":"1999"},{"key":"b6","series-title":"Neurosurgery","first-page":"632","article-title":"Comment. Relief of lumbar canal stenosis using multilevel subarticular fenestrations as an alternative to wide laminectomy: preliminary report.","volume":"23","author":"Fager","year":"1988"},{"key":"b7","series-title":"Techn Neurosurg","first-page":"301","article-title":"Microendoscopic discectomy.","volume":"3","author":"Foley","year":"1997"},{"key":"b8","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"204","DOI":"10.3171\/jns.1968.28.3.0204","article-title":"Abnormal myelograms in asymptomatic patients.","volume":"28","author":"Hitselberger","year":"1968"},{"key":"b9","series-title":"Clin Neurosurg","first-page":"275","article-title":"Acquired lumbar spinal stenosis.","volume":"43","author":"Jane","year":"1996"},{"key":"b10","series-title":"Clin Orthop","first-page":"150","article-title":"Arthroscopic microdiscectomy and selective fragmentectomy.","volume":"347","author":"Kambin","year":"1998"},{"key":"b11","series-title":"J Bone Joint Surg (Am)","doi-asserted-by":"publisher","first-page":"1184","DOI":"10.2106\/00004623-199173080-00007","article-title":"Long-term roentgenographic and functional changes in patients who were treated with wide fenestration for central lumbar stenosis.","volume":"73","author":"Nakai","year":"1991"},{"key":"b12","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1227\/00006123-199002000-00007","article-title":"Automated percutaneous discectomy: a prospective multi-institutional study.","volume":"26","author":"Onik","year":"1990"},{"key":"b13","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1227\/00006123-199508000-00025","article-title":"Central lumbar stenosis caused by ligamentum flavum: unilateral laminotomy for bilateral ligamentectomy: preliminary report of two cases.","volume":"37","author":"Poletti","year":"1995"},{"key":"b14","series-title":"J Nerv Ment Dis","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/00005053-190001000-00001","article-title":"Progresive ankylotic rigidity of the spine (spondylose rhizomelique).","volume":"27","author":"Sachs","year":"1900"},{"key":"b15","series-title":"JAMA","first-page":"137","article-title":"Enzyme dissolution of the nucleus pulposus in humans.","volume":"187","author":"Smith","year":"1964"},{"key":"b16","series-title":"Neurosurgery","first-page":"567","article-title":"Quantitative outcome and radiographic comparisons between laminectomy and laminotomy in the treatment of acquired lumbar stenosis.","volume":"41","author":"Thomas","year":"1997"},{"key":"b17","series-title":"J Bone Joint Surg (Br)","first-page":"181","article-title":"Results of surgical treatment of idiopathic developmental stenosis of the lumbar vertebral canal. 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