How I Do It: Mini-Open Decompression for Lumbar Spinal Stenosis Using the Quadrant Retractor System Without Fusion - 03/11/25

Doi : 10.1016/j.neuchi.2025.101742

Hamad Almarzouki Abuhussain ^a,⁎ , Kaissar Farah ^b , Mikael Meyer ^b , Stéphane Fuentes ^b
^a Department of Surgery, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
^b Department of Neurosurgery, Aix Marseille University, Assistance Publique des Hôpitaux de Marseille, La Timone Hospital, Marseille, France

^⁎Corresponding author.

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Highlights

•	Mini-open decompression preserves muscles in lumbar stenosis surgery.
•	Quadrant retractor adapted for non-fusion spinal decompression.
•	Wiltse approach spares midline ligaments and reduces soft tissue damage.
•	Multilevel decompression feasible via sequential unilateral access.
•	Ideal for elderly patients unsuitable for instrumentation or fusion.

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Abstract

Background

Minimally invasive techniques for lumbar spinal stenosis (LSS) aim to reduce soft-tissue injury while achieving adequate neural decompression. Traditional open decompression remains effective but is associated with extensive muscle dissection and prolonged recovery. Although the Quadrant retractor system is commonly used in transforaminal lumbar interbody fusion (TLIF), its application for non-fusion decompression has been seldom reported [1].

Objective

To describe a reproducible, muscle-sparing decompression technique using the Quadrant system for central and lateral recess stenosis without instrumentation or fusion. Technique Summary: Through a paramedian Wiltse approach and a 4–5 cm vertical incision, the Quadrant retractor is docked on the facet-laminar junction [1,2]. Microscopic decompression is performed including ipsilateral laminotomy, medial facetectomy, and undercutting of the contralateral side. The technique preserves midline structures and avoids unnecessary tissue trauma [2,3].

Conclusion

The Quadrant-assisted decompression technique offers a safe, efficient, and minimally invasive alternative to conventional laminectomy for LSS in appropriately selected patients [10].

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Keywords : Lumbar spinal stenosis, Mini-open decompression, Wiltse approach, Quadrant