Full Endoscopic Ligamentum Flavum Sparing Unilateral Laminotomy for Bilateral Recess Decompression: Surgical Technique and Clinical Results

Woo-Keun Kwon; Katherine A Kelly; Malia McAvoy; Sananthan Sivakanthan; John Ogunlade; Natalie Kai Yi Yap; Sharon Durfy; Christoph P Hofstetter

doi:10.14245/ns.2244344.172

Full Endoscopic Ligamentum Flavum Sparing Unilateral Laminotomy for Bilateral Recess Decompression: Surgical Technique and Clinical Results

Neurospine. 2022 Dec;19(4):1028-1038. doi: 10.14245/ns.2244344.172. Epub 2022 Dec 31.

Authors

Woo-Keun Kwon¹, Katherine A Kelly², Malia McAvoy², Sananthan Sivakanthan², John Ogunlade², Natalie Kai Yi Yap², Sharon Durfy², Christoph P Hofstetter²

Affiliations

¹ Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
² Department of Neurological Surgery, University of Washington, Seattle, WA, USA.

Abstract

Objective: Interlaminar endoscopic spine surgery has been introduced and utilized for lumbar lateral recess decompression. We modified this technique and utilized it for bilateral lateral recess stenoses without significant central stenosis. Here we present the surgical details and clinical outcome of ligamentum flavum sparing unilateral laminotomy for bilateral recess decompression (ULBRD).

Methods: Prospectively collected registry for full-endoscopic surgeries was reviewed retrospectively. One hundred eighty-two consecutive cases from a single center between September 2015 and March 2021 were reviewed and 57 of them whom underwent ULBRD were enrolled for analysis. Basic patient demographic data, perioperative details, surgeryrelated complications, and clinical outcome were reviewed. The detailed surgical technique is presented as well.

Results: Among the 57 patients enrolled, 37 were males while the other 20 were females. The mean age was 58.53 ± 14.51 years, and a bimodal age distribution at the age of mid-fifties and mid-sixties or older was noted. The later age-peak was related to coexistence of degenerative scoliosis. The average operative time per lamina was 70.34 ± 20.51 minutes and mean length of stay was 0.56 ± 0.85 days. Four perioperative complications were reported (7.0%) and the overall reoperation rate at the index level within 1 year was 8.8%. The preoperative back/leg visual analogue scale scores and functional outcome scales including EuroQol-5 dimension questionnaire, Oswestry Disability Index presented significant improvement immediately after surgery and were maintained until final follow-up.

Conclusion: ULBRD for bilateral lateral recess stenoses without significant central stenosis resulted in good clinical outcomes with acceptably low perioperative complications rates. Sufficient decompression was achieved with the central ligamentum flavum being preserved.

Keywords: Endoscopic spine surgery; Interlaminar endoscopic lateral recess decompress; Lateral recess stenosis; Minimally invasive spine surgery; Radiculopathy.