Unilateral Laminactomy for Bilateral Decompression by UBE/BESS -Techniques for Ligamentum Flavum Resection-

DOI
  • Yoshimizu Takaki
    Department of Orthopedic Surgery, Seirei Hamamatsu General Hospital
  • Miyake Hiroteru
    Department of Spine and Bone Tumor, Seirei Hamamatsu General Hospital
  • Mizuno Tetsutaro
    Department of Spine and Bone Tumor, Seirei Hamamatsu General Hospital
  • Nosaka Ushio
    Department of Spine and Bone Tumor, Seirei Hamamatsu General Hospital
  • Ishii Keisuke
    Department of Spine and Bone Tumor, Seirei Hamamatsu General Hospital
  • Watanabe Mizuki
    Department of Spine and Bone Tumor, Seirei Hamamatsu General Hospital
  • Sasaki Kanji
    Department of Orthopedic Surgery, Seirei Hamamatsu General Hospital

Bibliographic Information

Other Title
  • UBE/BESSによる片側進入両側除圧術―黄色靱帯切除の工夫―

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Description

<p>Introduction: Unilatearal Biportal Endoscopy (UBE) and Biportal Endoscopic Spine Surgery (BESS) is an endoscopic spine surgery technique performed using two portals under perfusion. Endoscopic lumbar decompression surgery is prone to complications such as dural tears and insufficient decompression due to poor operability and narrow field of view. UBE/BESS, with its high operability, has the potential to reduce problems associated with endoscopic lumbar decompression surgery. We present a method of handling the ligamentum flavum in lumbar decompression surgery.</p><p>Technical Note: Unilateral laminectomy for bilateral decompression was performed using UBE/BESS. Osteotomy of the caudal margin of upper lamina was performed to identify the midline of the ligamentum flavum. The contralateral lamina and the ligamentum flavum were detached and we performed osteotomy of the ventral portion of the lamina. The superficial layer of contralateral ligamentum flavum was resected and the deep layer was thinned to identify the margins of the contralateral superior articular process. The deep layer of ligamentum flavum was then used as a cushioning over the nerve root to drill out the bony spar of the lateral recess. The ligamentum flavum was split in the middle and only the contralateral ligament was resected, following which an additional bony resection of the incursive ipsilateral lamina was performed, the ligament was resected, and decompression was completed.</p><p>Conclusions: UBE/BESS provides a magnified field of view and allows for microdissection of the ligamentum flavum. The yellow ligament can be thinned for more precise contralateral decompression.</p>

Journal

  • Journal of Spine Research

    Journal of Spine Research 15 (8), 1120-1125, 2024-08-20

    The Japanese Society for Spine Surgery and Related Research

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