To explore the application of the whole exposure technique of the ligamentum flavum in the treatment of central lumbar spinal stenosis by percutaneous minimally invasive decompression.

A retrospective analysis was conducted on the clinical data of 24 patients with central lumbar spinal stenosis treated with bilateral decompression using percutaneous minimally invasive channel through unilateral paravertebral approach from March 2019 to June 2020 at the Department of Neurosurgery, the 904^th Hospital of Joint Logistic Support Force of the PLA. The technique of whole exposure of the ligamentum flavum was used for all patients during the operation. We documented the changes of the facet joints and the transverse and sagittal diameters of dural sac after the operation. At 1 d, 7 d, 1 month, 3 months, and 6 months post operation, the improvement of Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS), and Oswestry disability index (ODI) compared with presurgical conditions were assessed.

None of the 24 patients had nerve damage, cerebrospinal fluid leakage, or infection related to surgery. The operation time for a single segment of the lumbar spine was 72.0±16.1 min. Postoperative CT showed that the facet joints were well protected. MRI showed that the ligamentum flavum was completely removed, the transverse diameter of the dural sac increased from 9.4±2.6 mm before the operation to 16.0±3.0 mm, the sagittal diameter of the dural sac was increased from 10.2±1.9 mm before the operation to 15.1±1.9 mm, and the differences were statistically significant (all P<0.05). At 6-month follow-up post operation, the JOA score changed from 14.8±3.6 before surgery to 26.9±1.3, the VAS score decreased from 7.1 ±1.5 before surgery to 0.5±0.2, and the ODI decreased from preoperative 68.4 ± 11.8% to 12.7 ± 7.5%, and the differences were statistically significant (allP<0.05).

Microscopic percutaneous minimally invasive bilateral decompression through unilateral paravertebral approach using the whole exposure technique of the ligamentum flavum has a definite effect in the treatment of central lumbar spinal stenosis, which is associated with sufficient decompression of the spinal canal, small damage to the facet joints, and no impact on postoperative lumbar stability or mobility.

Lumbar vertebrae; Spinal stenosis; Microsurgery; Whole exposure ligamentum flavum; Microchannel; Bilateral decompression