Spinal Stenosis Surgery Without Screws (Minimally Invasive Surgery / UBL)

Transcript translated from Turkish (video audio remains in Turkish)

Micro-lumbar laminoplasty for spinal canal stenosis is a minimally invasive technique that has become popular in recent years. After a skin incision of approximately 3 centimetres, a retractor is used to reach the bone. Some bone is removed to decompress the compressed nerve root.

The retractor is then directed to the opposite side. The spinal canal is shaved from within to reach the nerve root on that side. Some bone is removed to decompress that nerve root as well.

The operation takes approximately two to two and a half hours. The hospital stay is two days.

Compared with conventional laminectomy, long used for spinal canal stenosis, this technique uses a smaller skin incision and cuts less muscle. Only the lamina on one side is removed; on the other side, only the front surface of the lamina is shaved to widen the spinal canal. This causes minimal damage to the patient's anatomy, and the patient's recovery after the operation is therefore much shorter.

What Is Spinal Stenosis Surgery Without Screws?

Surgery without screws (UBL) is a minimally invasive operation that relieves nerves on both sides of the canal through a one-sided approach without requiring screws or fusion.

How Does Surgery Without Screws Differ from Conventional Laminectomy?

Only one side is approached and the posterior supporting structures are preserved; conventional open lumbar laminectomy removes the entire lamina forming the roof of the canal. This conventional method has long been widely used around the world for spinal stenosis. In conventional surgery:

• A substantial amount of bone and the strong ligaments supporting the spine may be sacrificed.
• Extensive removal of bone and ligaments can increase the later risk of vertebral slippage (spondylolisthesis) in some patients.
• If considered necessary in this situation, instrumented spondylolisthesis surgery (fusion surgery) is performed.

How Is Spinal Stenosis Surgery Without Screws Performed?

It is performed microsurgically under general anaesthesia.

• Access Through a Minimal Incision: A much smaller skin incision than in the conventional method is used, with minimal interference with surrounding muscles.
• Bilateral Widening Through One-Sided Access: Only one side of the lamina at the back of the spine is removed.
• Undercutting from Within: A high-resolution surgical microscope allows access to the opposite side, where only the inner (front) surface of the bone is shaved precisely.
• Operation Time: Depending on the number of levels, it takes an average of 1–2 hours.
• Hospital Stay and Recovery: The stay is generally one night. Preserving muscle and bone reduces early postoperative lower back pain and facilitates return to daily life.

What Is the Success Rate of Spinal Stenosis Surgery Without Screws?

Of patients, 84% were satisfied after surgery without screws (versus 75% after open surgery), and the reoperation rate was 1.6% (versus 5.8%) [4]. In suitable patients, surgery without screws is as successful as surgery with fusion and screws: at two- and five-year follow-up, daily limitations and walking distance did not differ [1, 3]. In patients with mild spondylolisthesis, however, quality of life was better in the group receiving screws [5]; the decision is individualised.

What Are the Risks and Side Effects of Spinal Stenosis Surgery Without Screws?

The risks of surgery without screws are lower than with open laminectomy: blood loss and hospital stay are lower, while the risk of tearing the membrane around the nerves (dural tear) is similar [4]. Without screws, there are no screw-loosening or implant problems; new narrowing at the adjacent level is more common in patients undergoing fusion [2]. Dural tear, nerve damage, infection, bleeding and a need for repeat surgery may occur. A dural tear identified during the operation is repaired.

🩺 Physician’s Insight & Clinical Experience

“My goal in surgery is to adequately relieve pressure on the nerves while preserving as much of the spine’s supporting structures as possible. An important advantage of UBL is that the opposite side can also be decompressed through a one-sided approach, allowing sufficient canal widening with more limited bone and muscle dissection. In appropriately selected patients, fusion and screws may not be needed because the supporting structures are largely preserved.”

Frequently Asked Questions

What Is Screw-Free Spinal Stenosis Surgery, and How Is It Performed?

It is a microsurgical operation that widens both sides of the canal by removing the bony roof on one side and undercutting the opposite side from within.

What Is the Success Rate of Screw-Free Spinal Stenosis Surgery?

Of patients, 84% were satisfied after this operation (versus 75% after open surgery) [4]; in suitable patients, results are the same as with surgery using screws [1, 3].

Does Screw-Free Spinal Stenosis Surgery Have Risks or Side Effects?

Yes, but they are lower than in open surgery: blood loss and hospital stay are reduced, and dural-tear risk is similar. Because no screws are inserted, risks such as screw loosening do not occur [2, 4].

How Long Does Spinal Stenosis Surgery Without Screws Take?

Depending on the number of levels, the operation takes 1–2 hours.

How Long Must I Stay in Hospital Afterwards?

The hospital stay is generally one night.

When Can I Get Up After Screw-Free Spinal Stenosis Surgery?

Our patients can stand and walk approximately 4–6 hours after surgery once the anaesthetic has worn off.

Will My Symptoms Disappear Immediately After Screw-Free Spinal Stenosis Surgery?

For many patients, yes: leg pain and cramps during walking decrease markedly early on. Numbness and tingling from prolonged compression may take several weeks or months to disappear completely.

Can I Bend Over After Screw-Free Spinal Stenosis Surgery?

During the first 4–6 weeks, patients may bend down by bending their knees, but should avoid sudden bending, twisting and heavy lifting. Squatting by bending the knees or moving as demonstrated by the doctor is possible.

When Can I Return to Work After Screw-Free Spinal Stenosis Surgery?

Our patients with desk jobs generally return within 10–15 days; for physically demanding work, this is 4–6 weeks. Gentle walks early in recovery make returning to work easier.

Is This Method Suitable for Every Patient with Spinal Stenosis?

No, UBL or screw-free decompression is not automatically suitable for everyone. Suitability depends on the anatomical type and level of narrowing, spinal stability, existing spondylolisthesis/deformity, neurological findings and the extent of decompression required.

Which Specialist Performs Screw-Free Spinal Stenosis Surgery in Istanbul?

One of the physicians performing this operation in Istanbul is M. Levent Deniz, MD, a specialist in neurosurgery.

How Much Does Screw-Free Spinal Stenosis Surgery Cost?

As treatment costs vary according to the patient and hospital conditions, a definite fee can only be determined after examination and review of imaging.

References

1. Försth P, Ólafsson G, Carlsson T, et al. A Randomized, Controlled Trial of Fusion Surgery for Lumbar Spinal Stenosis. N Engl J Med. 2016;374(15):1413-1423. PMID: 27074066. PubMed
2. Karlsson T, Försth P, Skorpil M, et al. Decompression alone or decompression with fusion for lumbar spinal stenosis: a randomized clinical trial with two-year MRI follow-up. Bone Joint J. 2022;104-B(12):1343-1351. PMID: 36453045. PubMed
3. Austevoll IM, Hermansen E, Fagerland MW, et al. Decompression with or without Fusion in Degenerative Lumbar Spondylolisthesis. N Engl J Med. 2021;385(6):526-538. PMID: 34347953. PubMed
4. Phan K, Mobbs RJ. Minimally Invasive Versus Open Laminectomy for Lumbar Stenosis: A Systematic Review and Meta-Analysis. Spine (Phila Pa 1976). 2016;41(2):E91-E100. PMID: 26555839. PubMed
5. Ghogawala Z, Dziura J, Butler WE, et al. Laminectomy plus Fusion versus Laminectomy Alone for Lumbar Spondylolisthesis. N Engl J Med. 2016;374(15):1424-1434. PMID: 27074067. PubMed

• 👨‍⚕️ Author and medical reviewer of this content: M. Levent Deniz, MD – Neurosurgery Specialist
• ⚠️ Medical Disclaimer: This page is for information only; consult your doctor for diagnosis and treatment.