Lumbar Spinous Process–Splitting Technique for Ligamentum Flavum Cyst Removal

Abstract

Background Laminotomy for lumbar stenosis is a well-defined procedure and represents a routine in every neurosurgical department. It is a common experience that the mono- or bilateral paraspinal muscles detachment together with supra and interspinous ligaments injury can lead to postoperative pain. In literature has been reported the application at the level of the lumbar spine of a minimally invasive technique defined as lumbar spinous process-splitting technique (LSPST). Methods In the current study, we present a case series of 12 patients that underwent LSPSL from September 2019 to April 2020. Two patient suffering from ligamentum flavum cyst, 8 patients with single level lumbar canal stenosis (LCS) and two patients with two-level LCS. The approach was mini-open, with reduced soft tissue dissection and without paraspinal muscles injury. Moreover, a novel morphological classification of postoperative muscle atrophy is proposed as well as a volumetric analysis of the decompression achieved. Conclusion At our knowledge, this is the first description of this surgical technique and the first LSPSL case series in Europe. Furthermore, cases of ligamentum flavum cyst removal using this safe and effective technique are not yet reported. Abbreviations Lumbar canal stenosis (LCS), lumbar spinous process-splitting technique (LSPST), minimally invasive spine surgery (MISS)

MRI parameters predict central lumbar spinal stenosis combined with redundant nerve roots: a prospective MRI study

“…At the same time, the results also showed that the ADPS values of the redundant group were smaller than those of the non-redundant group, and this difference was statistically significant. This method of measuring the anterior and posterior diameter values to reflect the condition of nerves within the spinal canal also meets the requirements of clinical spinal decompression procedures, such as the lumbar spinous process-splitting laminectomy (LSPSL) ( 24 , 25 ) and modified LSPSL ( 26 ). Unlike traditional laminectomy procedures, these two types of surgeries involve splitting the spinous process into two halves longitudinally in order to reduce damage to ligaments while performing decompression, preserve bone attached to adjacent ligaments, and improve postoperative stability of small joints.…”

Contralateral approach using microscope and tubular retractor system for ipsilateral decompression of lumbar degenerative lateral recess stenosis associated with narrow spinal canal

“…In addition, the over-the-top technique needs to be highlighted that performing a full-endoscopic decompression is a complex technique which requires advanced endoscopic skills and should only be considered for surgeons that are already familiar with this technique. The splitting technique allows for a satisfying central decompression, with minimal sparing the facet joints and the posterior neural arch, but it is far laterally to reach the foramina and which can be insufficient decompression of lateral recess ( 32 , 33 ).…”