Clin Orthop Surg.  2015 Dec;7(4):470-475. 10.4055/cios.2015.7.4.470.

Semi-Circumferential Decompression: Microsurgical Total en-bloc Ligamentum Flavectomy to Treat Lumbar Spinal Stenosis with Grade I Degenerative Spondylolisthesis

• Lee YS
• Choi JC
• Oh SH
• Park SR
• Park SJ
• Cho NI

• KMID: 2360261
• DOI: http://doi.org/10.4055/cios.2015.7.4.470

Abstract

BACKGROUND
To describe and assess clinical outcomes of the semi-circumferential decompression technique for microsurgical en-bloc total ligamentum flavectomy with preservation of the facet joint to treat the patients who have a lumbar spinal stenosis with degenerative spondylolisthesis.
METHODS
We retrospectively analyzed the clinical and radiologic outcomes of 19 patients who have a spinal stenosis with Meyerding grade I degenerative spondylolisthesis. They were treated using the "semi-circumferential decompression" method. We evaluated improvements in back and radiating pain using a visual analogue scale (VAS) and the Oswestry Disability Index (ODI). We also evaluated occurrence of spinal instability on radiological exam using percentage slip and slip angle.
RESULTS
The mean VAS score for back pain decreased significantly from 6.3 to 4.3, although some patients had residual back pain. The mean VAS for radiating pain decreased significantly from 8.3 to 2.5. The ODI score improved significantly from 25.3 preoperatively to 10.8 postoperatively. No significant change in percentage slip was observed (10% preoperatively vs. 12.2% at the last follow-up). The dynamic percentage slip (gap in percentage slip between flexion and extension X-ray exams) did not change significantly (5.2% vs. 5.8%). Slip angle and dynamic slip angle did not change (3.2° and 8.2° vs. 3.6° and 9.2°, respectively).
CONCLUSIONS
The results suggested that semi-circumferential decompression is a clinically recommendable procedure that can improve pain. This procedure does not cause spinal instability when treating patients who have a spinal stenosis with degenerative spondylolisthesis.

Keyword

Degenerative spondylolisthesis; Semi-circumferential decompression; Total ligamentum flavectomy

MeSH Terms

Aged
Back Pain
Decompression, Surgical/adverse effects/*methods
Female
Humans
Lumbar Vertebrae/*surgery
Male
Pain Measurement
Retrospective Studies
Spinal Stenosis/*surgery
Spondylolisthesis/*surgery
Treatment Outcome

Figure

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  Fig. 1 (A) Preoperative state of ligamentum flavum. (B, C) Ligamentum flavum is detached from the lamina using a currette. (D) After en-bloc ligamentum flavectomy, dura mater is exposed.

• 

  Fig. 2 The ligamentum flavum, which is in the shape of a butterfly, was removed en-bloc. (A) Dorsal surface, (B) ventral surface, (C) distal border, and (D) proximal border.

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  Fig. 3 Preoperative (A, C) and postoperative (B, D) axial computed tomography scans and magnetic resonance images show the facet joint at the spondylolisthesis level in a representative patient who underwent semicircumferential decompression preserving the facet joints. A bilateral laminotomy and total ligamentum flavectomy were performed, and the facet joint was completely preserved.

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