Two Cases of Lumbar Spinal Canal Stenosis with Dorsal Meningovertebral Ligaments: Potential Risk of Dural Laceration

Abstract

Dural laceration is a critical complication in full endoscopic spinal surgery. We need to recognize precise surgical anatomy to avoid it. Recently identified dorsal meningovertebral ligaments, connecting the dorsal spinal dura mater to the ligamentum flavum, may contribute to this risk, but their role remains unclear. We present 2 cases of lumbar spinal canal stenosis treated with full endoscopic laminectomy. In both cases, dorsal meningovertebral ligaments anchored the dura to the ligamentum flavum and were visible through high-resolution endoscopy. Attempts to remove ligamentum flavum fragments caused dural traction via the dorsal meningovertebral ligament, nearly resulting in laceration. We modified our approach by detaching the dorsal meningovertebral ligament before flavectomy, preventing dural injury and ensuring uneventful recoveries. These cases highlight the importance of recognizing dorsal meningovertebral ligament as a potential risk factor for dural laceration during full endoscopic laminectomy. Although the presence of dorsal meningovertebral ligament cannot be predicted preoperatively, the enhanced visualization provided by full endoscopic spinal surgery allows for intraoperative identification. We recommend careful inspection for dorsal meningovertebral ligament before flavectomy during full endoscopic laminectomy. If identified, these ligaments should be detached prior to ligamentum flavum removal to minimize the risk of dural injury. This approach can significantly enhance the safety of the full endoscopic laminectomy procedure and potentially reduce the incidence of dural complications in full endoscopic spinal surgery.