Success and Complications of Microsurgical Over-Top Decompression for Lumbar Spine Stenosis: Experience in a Limited Resource Center

Objective:  The overtop decompression is also called the outside-in technique or bilateral decompression from the unilateral approach. The objective of the study was to evaluate the success and complications of microsurgical over-top decompression for single-level lumbar spine stenosis. Material and Methods:  This observational study was conducted at the Neurosurgery unit at Lady Reading Hospital Peshawar from Jan 2018 to December 2021. All those patients who had undergone over-top decompression for single-level degenerative lumbar spine stenosis irrespective of age and gender were included in our study. Results:  We had a total of 187 patients who underwent microscopic over-top decompression for lumbar spine stenosis. Four patients lost their final follow-up. The mean age of the patients was 46 years (ranging from 18 – 68 years). Spinal stenosis was more common in men (58.3%) and at L4/5 (51.87%) level. The mean duration of surgery was 56 minutes (range 35-86 minutes). Leg pain improved in 83.1% of the cases with overall patient satisfaction after surgery in 82.5% of the cases. The most common (6.95%) complication of the procedure was iatrogenic durotomy. Most of the complications were minor and treated conservatively. Conclusions:  Overtop decompression is a safe and effective minimally invasive procedure for lumbar spine stenosis. It has good results in symptomatic improvement. There is minimal soft tissue and bony dissection. Therefore, mobility and stability of the spine are preserved. Moreover, the learning curve for microscopic overtop decompression is shallow and surgery time is short.