UTPAL K. DHAR ¹ Emma Lilly Menzer ^1* Maohua Lin ¹ Timothy O'connor ^2* Nischal Ghimire ^3* Elias Dakwar ^2* IOANNIS PAPANASTASSIOU ⁴ Kamran Aghayev ^5* Chi-Tay Tsai ¹ Frank D. Vrionis ^2*

• ¹ Florida Atlantic University, Boca Raton, United States
• ² Boca Raton Regional Hospital, Boca Raton, Florida, United States
• ³ Tribhuvan University Teaching Hospital, Kathmandu, Nepal
• ⁴ General Oncological Hospital of Kifisia Oi Agioi Anargyroi, Athens, Greece
• ⁵ Biruni University, Istanbul, Türkiye

Lumbar Spinal stenosis (LSS) refers to a narrowing of the space within the spinal canal, which can occur at any level but is most common in the lumbar spine. Open laminectomy and minimally invasive laminectomy (MIL) procedures are the most common surgical gold standard techniques for treating LSS. This study aims to review clinical and biomechanical literature to draw comparisons between open laminectomy and various MIL techniques. The MIL variation comprises microendoscopic decompression laminotomy, unilateral partial hemilaminectomy, microendoscopic laminectomy, etc.A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We reviewed 25 clinical, six finite elements, and three cadaveric studies associated with treating LSS. We reviewed literature that discusses factors such as operation time, length of hospital stays, postoperative complications, re-operation rate, effect on elderly patients, patients' satisfaction, and adjacent segment disease degeneration for the clinical studies, whereas the range of motion (ROM), von Mises stresses, and stability was compared in biomechanical studies.MIL involves less bone and ligament removal, resulting in shorter hospital stays and lower re-operation and complication rates than open laminectomy. They have also been shown to improve the quality of health-related living standards and reduce post-operative pain. Biomechanical studies suggested that laminectomy and facetectomy increase annulus stress and ROM, leading to segmental instability.Although theoretically, MIL means less tissue injury, pain, and faster recovery in the short term, the long-term results depend on the adequacy of the decompression procedure and tend to be independent of MIL or open laminectomy.