P42. Full-endoscopic circumferential ligamentum flavum resection: ensuring safety and effectiveness with clinical and radiological comparisons to conventional techniques

Abstract

BACKGROUND CONTEXT

In spine surgery, minimally invasive techniques have advanced rapidly, with endoscopic spine surgery gaining global recognition due to significant improvements in endoscopic technology and surgical tools. These advancements have led to favorable surgical outcomes, yet considerable efforts continue to focus on minimizing complications such as dural tears.

PURPOSE

We developed the Circumferential Ligamentum Flavum Resection, which maximizes the use of drills to minimize dural tears and neural structure damage, one of the most serious complications. Through radiological and clinical comparisons with the traditional Kerrison’s punch method, we evaluated the safety and efficiency of this endoscopic surgical technique for lumbar central stenosis.

STUDY DESIGN/SETTING

Retrospective, cohort study.

PATIENT SAMPLE

Patients included in the study were those treated between August 2023 and August 2024, with indications such as back pain, radicular leg pain, and neurogenic intermittent claudication. Circumferential resection was initiated in March 2024. The prior cohort of 84 patients (127 segments) underwent punch resection, while the subsequent cohort of 80 patients (139 segments) underwent circumferential resection. A comparison was made between these two groups. Exclusion criteria included lumbar disc herniation, segmental instability, grade II or higher spondylolisthesis, infection, and a history of previous lumbar spine surgeries.

OUTCOME MEASURES

N/A

METHODS

All patients underwent preoperative X-rays and MRIs, with a follow-up MRI at 6 months post-surgery. Perioperative MRI were compared to assess the cross-sectional area of the dural space and the angle of the facet joints, ensuring that the surgery was both sufficient and minimally invasive. The frequency of dural tears and clinical recovery after surgery were evaluated through the patient’s medical records, including surgical notes and outpatient records.

RESULTS

Both the CR group and the PR group demonstrated adequate decompression and clinical improvement. There were no significant differences between the two groups in terms of dural sac expansion or facet joint preservation. Surgical time and the degree of clinical improvement were also comparable. However, the incidence of dural tears and neural structure injury was higher in the PR group (3.2%) compared to the CR group (0.5%).

CONCLUSIONS

Circumferential Ligamentum Flavum Resection offers a safer and more efficient approach compared to the traditional punch method, with the potential for significant radiological and clinical improvement.

FDA Device/Drug Status

This abstract does not discuss or include any applicable devices or drugs.