What it is
Decompression performed through a series of dilators that gently part the back muscles, with a tubular retractor holding a working channel open. The bone and ligament crowding the nerves are removed under magnification through that channel.
Who it is for
Lumbar spinal stenosis at one or two levels, recurrent or contained disc herniations, and nerve exit narrowing — particularly in patients where limiting muscle disruption matters, such as older patients or those with other medical problems.
How it works
A small incision is made to one side of the midline. Dilators pass between muscle fibers down to the lamina and a tube is docked on the bone. Working down the tube under a microscope or endoscope, the surgeon removes the bone and thickened ligament compressing the nerves. The opposite side can often be decompressed through the same incision by angling across the midline.
Recovery
Often home the same day. Less postoperative back pain than open decompression and a quicker return to walking. Desk work commonly within one to two weeks; the nerves themselves settle over weeks to months.
Risks and alternatives
Dural tear, incomplete decompression, infection, bleeding, nerve injury, and the possibility of needing to convert to an open approach if visualisation is inadequate. Alternatives are open decompression, endoscopic decompression, or decompression with fusion where the level is unstable.