<p>CT-Guided Percutaneous Lumbar Ligamentum Flavum Release by Needle Knife for Treatment of Lumbar Spinal Stenosis: A Case Report and Literature Review</p>

Abstract

Point your mobile at the code above. If you have a QR codereader, the video abstract will appear. Or use: https://youtu.be/xUgzwLiZT5c Case: The patient was a 62-year-old woman presenting with low-back pain of 3 years' duration and numbness in the right leg. Diagnosis: She was diagnosed with lumbar spinal stenosis based on combined magnetic resonance imaging, physical examination, and symptoms. Interventions: Treatment with computed tomography-guided percutaneous release of the ligamentum flavum was delivered. Outcomes: Relief of symptoms immediately after treatment and complete resolution of symptoms after 1 month were achieved. At follow-up, there was no recurrence of symptoms after 2, 4, 6, and 12 months. Conclusion: Lumbar ligamentum flavum hypertrophy is an important cause of degenerative lumbar spinal stenosis. The hypertrophic ligamentum flavum can directly compress the spinal canal, squeeze the cauda equina, and simultaneously lead to a reduction in the anteroposterior diameter of the intervertebral foramen, which compresses the nerve roots and causes numbness and other symptoms of lower extremities. In clinical practice, doctors should combine imaging findings with patient symptoms for diagnosis and an individualized treatment plan for each patient with lumbar spinal stenosis, and conduct gradual stepwise treatment using conservative minimally invasive surgery to prevent excessive surgery.

Effectiveness and Safety of Acupotomy on Lumbar Spinal Stenosis: A Pragmatic, Pilot, Randomized Controlled Trial

“…Middle-and old-age patients with LSS may have thickened ligamentum flavum of the lumbar spine. A study on the effective acupotomy depth for LSS 24 showed that the sufficient depth to treat the ligamentum flavum should be approached to an average depth of ≥5 cm. The length of the acupotomy used in this study was 5 cm, indicating that the depth of stimulation around the spine was shallow.…”

Nonsurgical therapy for lumbar spinal stenosis caused by ligamentum flavum hypertrophy: A review

“…[29] TGF-β1 has been reported to be one of the most prominent molecules causing collagen deposition, [30] while angiopoietin-like protein 2 is closely associated with chronic inflammation in LF fibroblasts. [31] Zhu et al [32] treated an elderly patient with LSS due to LFH by needle knife under CT-guidance. The symptoms were relieved immediately after treatment, completely disappeared after 1 month, and did not recur during the one-year follow-up.…”

Load-Bearing Shifts in Laminar and Ligament Morphology: Comparing Spinal Canal Dimensions Using Supine versus Upright Lumbar MRI in Adults without Back Pain

“…10,11 Studies have shown that ligamentum flavum hypertrophy (LFH), mostly resulting from facet degenerative changes, or its anterior buckling into the spinal canal as leading causes of spinal canal stenosis and disc space narrowing. [12][13][14] On the other hand, spine instability and instrumented laminectomies are also linked to LFH and canal narrowing at the segments adjacent to the intervention. [15][16][17][18][19] Mechanistically, LFH is implicated in degenerative lumbar spinal stenosis resulting from direct compression of the spinal canal involving the cauda equina, reduction in the anteroposterior diameter (APD) of the intervertebral foramen, squeezing of the nerve roots with numbness and LBP symptoms, and painful lower extremities.…”