Endoscopic Bilateral Decompression for Cervical Stenosis Caused by Calcification of Ligamentum Flavum Through Unilateral Approach: Technical Note.

STUDY DESIGN Technical report. OBJECTIVE The aim was to present a full endoscopic technique for bilateral decompression of cervical stenosis caused by calcification of ligamentum flavum through a unilateral approach. SUMMARY OF BACKGROUND DATA The minimally invasive surgical technique aims to preserve muscle and posterior structures to prevent iatrogenic instability and axial pain. Endoscopic resection of calcification of ligamentum flavum in the cervical spine has shown effectiveness. However, the removal of bilateral calcification lesions through a unilateral approach has been reported as an inadequate and technical demanding method. METHODS The illustrative case showed myelopathy caused by bilateral calcification of ligamentum flavum in the C5/C6 segment. A spinal multichannel endoscope with a rigid rod-lens was used to the operation under saline media. After a laminotomy was performed on the ipsilateral side, both the ipsilateral and the contralateral calcified lesions were resected through the same bone window. RESULTS The patient's hand function and walk ability were found significantly improved the next day after surgery. Complete removal of calcified lesions was confirmed by postoperative imaging studies. CONCLUSIONS Removal of bilateral calcification lesions in the cervical spine through a unilateral approach is possible with a spinal endoscope.