by AceMedEd

Teach card · keep it in your scrub pocket

Lumbar decompression

Ask during the case

  1. With the localizing film up: "Count up from the sacrum for me. Which spinous process is the marker on, and what could make that count wrong?"
  2. Once the ligamentum flavum is off: "Which root is this, where does it exit, and which way are we retracting it?"
  3. Undercutting the facet: "How much facet and pars can we take here, and what happens if we take too much?"

Point at: the traversing L5 root as it's retracted medially, and the medial edge of the facet as it's undercut, while they name each one.

End of day: "Redraw the L4–5 slice with today's decompression and what's at risk, then the posterior view with the pars we kept." Two minutes, no notes.

Where this kit and your technique differ, yours wins.

Send this to your students

The night before. They prep alone, redraw at turnover, and get a cold check tomorrow morning. They won't see these questions.

Open the student page

Reviewed by Mehdi “AC” Talle, D.O., November 2026. Sources: Netter, Gray's Anatomy and Hoppenfeld's surgical exposures. Teaching schematic, not to scale; anatomy and technique vary. Management and indications are left to you on purpose.