Figure 17
The interlaminar approach, whether uniportal or biportal, allows for contralateral decompression to be readily achieved through the over-the-top technique. The cannula is angled dorsally and medially to expose the base of the spinous process and ligamentum flavum. The ligamentum flavum is separated from the dural tube using curved probes. The ligament is excised using rongeurs and YAG-Holmium laser all the way to the contralateral recess, which seems more anterior than expected. Curettes and probes are used to elevate the dense ligamentous tissue from the dural tube, which can then be further resected with rongeurs. Again, probes should readily pass to the contralateral side, and any other pathology areas, without impediment, and confirmed with intra-operative imaging, either C-arm or navigation (C). Upon completion of the endoscopic procedure, the individual stab incisions are closed with a single subdermal bioabsorbable stitch, skin glue, and a small dressing (D).
