Lumbar spinal stenosis remains the most common indication for spinal surgery in elderly patients [1
]. Lumbar spinal stenosis is a pathologic state where the dural sac and nerve roots are compressed by a combination of degenerative features including bulging of the intervertebral discs, hypertrophy of the facet joints, and thickening/buckling of the ligamentum flavum. The clinical symptoms of this condition include back and leg pain, muscular weakness, sensory disturbance, and/or problems with ambulation [9
]. Although the severity of clinical symptoms varies widely, some patients may experience disabling symptoms which required medical intervention [1
]. The traditional surgical approach for lumbar stenosis has been to perform a wide, bilateral decompressive laminectomy along with resection of the medial portion of the facet joints to decompress the affected neural elements [7
]. Although this approach can successfully alleviate nerve compression symptoms, there are drawbacks of the open approach, including amount of soft tissue dissection, blood loss, postoperative pain, and the potential for iatrogenic instability of the spinal segment [14
]. These concerns are magnified when treating an elderly fragile patient.
The use of a tubular retractor system for lumbar surgery was popularized by Foley and Smith [15
]. As experience has grown with this surgical approach, surgeons are routinely treating patients with lumbar stenosis using a combination of a tubular retractor system and an operative microscope. This approach requires less soft tissue destruction compared to an open lumbar decompression [9
]. As a result, the surgeon can expect less bleeding, less postoperative pain, and a reduced risk of iatrogenic instability. Surgery with a tubular retractor system is especially beneficial in elderly patients where there are concerns regarding the physiologic stress and risks of a traditional open surgical approach [2
This paper will review the operative techniques for treating lumbar stenosis with a tubular retractor system and operative microscope.