Hemipartial Laminectomy and Bilateral Flavectomy Technique With Unilateral Approach in Patients With Cervical Spinal Stenosis Due to Ligamentum Flavum Hypertrophy: A Technique Note

Abstract

The aim of this procedure is to widen the spinal canal by using minimally invasive techniques to do hemipartial laminectomy and bilateral flavectomy in patients with cervical spinal stenosis due to ligamentum flavum hypertrophy. A 66-year-old man presented with increasing neck and right shoulder pain for one year to Koç University Hospital. He reported a three-month history of numbness in his hands. The Japanese Orthopedic Association (JOA) and Visual Analogue Scale (VAS) scores were 15 and 8, respectively. Preoperative magnetic resonance imaging (MRI) revealed spinal canal stenosis at the C3-4 level secondary to ligamentum flavum hypertrophy. Hemi-partial laminectomy at the C3 level, flavectomy, and bilateral decompression were performed using the right unilateral approach. The patient's complaints of symptoms considerably decreased three months later. The VAS and JOA scores were 2 and 16, respectively. This minimally invasive approach can be an alternative to classic laminectomy in patients who have radiculopathy and myelopathy due to posterior origin spinal stenosis in order to safely resolve pain and neurologic dysfunction.

Keywords: flavectomy; hemipartial laminectomy; ligamentum flavum hypertrophy.

Figure 1. (A) Preoperative MRI T2-sagittal and (B) T2-axial sequences, blue arrows show the C3-4 spine canal stenosis.

Figure 2. The lamina of the level above the stenotic level was thinned from two-thirds of the inferior side towards the midline without touching the stenotic zone using a drill.

Figure 3. The lamina of the level below the stenotic level was also thinned from one-quarter of the superior side. On the lateral side, the lamina was thinned approximately 2 mm from the lamina mass junction using a drill.

Figure 4. (A) Postoperative MRI T2-sagittal and (B) T2-axial sequences; blue arrows show the region after surgery (ULBD)

ULBD: unilateral approach and bilateral decompression