2024 Volume 15 Issue 8 Pages 1120-1125
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.
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.
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.
