A new technique of enlargement of the lumbar spinal canal (ELSC) and neural decompression in the treatment of any uni or multilevel segmental pathology causing stenosis with radicular or dural sac compression was performed by a standard laminectomy, posterior osteophytectomy and radical discectomy, leading to a widening of all the saggital and coronal sizes of the spinal canal, including the foraminal outlet of the root. No damage or excessive excision of facet joints are necessary to achieve the wide neural decompression. The outcome of patients that underwent conventional laminectomy and discectomy (Group A) and ELSC ( Group B) was compared. The only objective parameter used to compare between the groups was only the need for reoperation of the patients. The indications for the first surgery or a second reoperation (revision) were identical for both groups. Conventional laminectomy and discectomy (Group A) was performed in 317 patients between 1977 and 1989. In this group 193 (61%) were females and 124 (39%) males. Mean age 42.5 years (range 13 to 72). In this group reoperation at the same level was necessary in 24 patients (8%). ELSC (Group B) was performed in 231 patients between 1990 and 2002. In this group 133 (58%) were females and 98 (42%) males. Mean age 46.5 years (range 17 to 78). Only 3 patients needed reoperation at the same level in this group (1.3%). Using CT-scan cross sectional area measurements , the spinal canal was seen to be enlarged by 217% in average by using the ELSC surgical technique. The follow up for group A was from 1 to 8 years; group B was 3 to 11 years. All patients underwent the operations by the autor. Generous posterior osteophytectomy, scurving the anterior wall of the foramina in both sides, bypasses the pathway of the root, resulting in release of the overtensed, elongated and compressed nerve root at the encroached site of the foraminal outlet. An optimal enlargement of the lumbar spinal canal was achieved without affecting the spinal stability. No symptoms related to perineural scarring were seen in Group B. The ELSC technique can be aplied together with any kind of spinal instrumentation.
