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J Neurol Surg A Cent Eur Neurosurg 2024; 85(02): 195-201
DOI: 10.1055/a-1715-3958
Technical Note

Lumbar Spinous Process–Splitting Technique for Ligamentum Flavum Cyst Removal

Santino Ottavio Tomasi
1   Department of Neurosurgery, Paracelsus Medical Private University, Salzburg, Austria
,
Giuseppe Emmanuele Umana 
2   Department of Neurosurgery, Cannizzaro Hospital, Catania, Italy
,
Gianluca Scalia 
3   Department of Neurosurgery, National Specialist Hospital Garibaldi, Catania, Italy
,
Giuseppe Raudino
4   Department of Neurosurgery, Humanitas Centre of Oncology of Catania, Catania, Sicilia, Italy
,
Vlado Stevanovic
5   Department of Neuroradiology, Paracelsus Medical Private University, Salzburg, Austria
,
Herbert Krainz
1   Department of Neurosurgery, Paracelsus Medical Private University, Salzburg, Austria
,
Michael Kral
1   Department of Neurosurgery, Paracelsus Medical Private University, Salzburg, Austria
,
Giovanni Federico Nicoletti
3   Department of Neurosurgery, National Specialist Hospital Garibaldi, Catania, Italy
,
Peter A. Winkler
6   Department of Neurosurgery, Paracelsus Medical University Salzburg, Salzburg, Salzburg, Austria
› Author Affiliations Funding None.
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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 uni- or bilateral paraspinal muscle detachment, together with injury of the supra- and interspinous ligaments, can lead to postoperative pain. In the literature, the application of a minimally invasive technique, the lumbar spinous process–splitting (LSPS) technique, has been reported.

Methods In this study, we present a case series of 12 patients who underwent LSPS from September 2019 to April 2020. Two patients had a cyst of the ligamentum flavum, eight a single-level lumbar canal stenosis (LCS), and two a two-level LCS. Moreover, we propose a novel morphological classification of postoperative muscle atrophy and present volumetric analysis of the decompression achieved.

Results There were no complications related to this technique. In all patients, the vertebral canal area was more than doubled by the procedure. The muscle sparing showed grade A, according to our classification.

Conclusion To 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 have not yet been reported.

Keywords

lumbar stenosis - laminectomy - laminotomy - flavectomy back pain - lumbar muscles sparing - ligamentum flavum cyst removal

Ethical Approval

Ethics approval was not required for this type of study.


Informed Consent

The study was performed under an appropriate informed consent.




Publication History

Received: 28 December 2020

Accepted: 02 December 2021

Accepted Manuscript online:
07 December 2021

Article published online:
07 June 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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