A novel method for treatment of lumbar spinal stenosis in high-risk surgical candidates: pilot study experience with percutaneous remodeling of ligamentum flavum and lamina

J Neurosurg Spine. 2011 Jan;14(1):46-50. doi: 10.3171/2010.9.SPINE091012. Epub 2010 Dec 10.


Object: treatment of lumbar spinal stenosis (LSS) in chronically ill or debilitated patients is challenging. The percutaneous remodeling of ligamentum flavum and lamina (PRLL) technique is a novel method for decompression of the hypertrophic ligamentum flavum component of LSS that is performed using a fluoroscopically guided percutaneous approach, local anesthesia, and minimal sedation.

Methods: fourteen patients deemed to be at high risk for complications related to open spine surgery and general anesthesia were treated using the PRLL technique. Prospectively collected visual analog scale (VAS) and Oswestry Disability Index (ODI) data were analyzed at the most recent follow-up. The average follow-up duration was 23.5 weeks.

Results: a statistically significant improvement in VAS scores was observed, with a reduction in pain of 53% compared with preoperative levels. In contrast, the ODI scores failed to improve.

Conclusions: this pilot series points to a potential new therapeutic option for LSS in high-risk surgical patients.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anesthesia, Local
  • Comorbidity
  • Conscious Sedation
  • Decompression, Surgical / instrumentation*
  • Disability Evaluation
  • Equipment Design
  • Female
  • Fluoroscopy
  • Follow-Up Studies
  • Humans
  • Ligamentum Flavum / surgery*
  • Lumbar Vertebrae / surgery*
  • Male
  • Middle Aged
  • Minimally Invasive Surgical Procedures / instrumentation*
  • Pain Measurement
  • Pilot Projects
  • Postoperative Complications / diagnosis
  • Postoperative Complications / prevention & control*
  • Prospective Studies
  • Risk Factors
  • Spinal Stenosis / surgery*