Abstract

Spinal canal is narrower in upper lumbar levels than those of lower lumbar levels. Due to these reasons, selection of surgical approach is difficult. Fenestration discectomy at this level is more prone for neurological injury in most cases. Wide laminectomy or Transforaminal approach is commonly used in upper lumbar disc surgeries. Surgical procedures using wide laminectomy & facetectomy gives wide decompression but causes instability and needs surgical fusion in most cases. We discuss an alternative approach for high lumbar disc disease using spinous process osteotomy, where minimally invasive non fusion spine surgery is done with preservation of posterior spinal elements. Spinous process osteotomy also minimizes the injury to the tissues, by preserving the paraspinal musculature as well as the interspinous, supraspinous ligament complex and facets. Spinous process osteotomy can be considered as a modality of treatment for high lumbar disc disease in young patients, without the need for spinal fusion.