ArticleAsian spine journal2025
Three types of ligamentum flavum resections for the treatment of lumbar central canal stenosis: BUTTERFLY retrospective study.
Article in Asian spine journal, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Fully navigated biportal endoscopic lumbar decompression using non-invasive surface registration: a single-institution technical feasibility series.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Article
- Early clinical outcomes of simultaneous biportal endoscopic decompression for tandem spinal stenosis: a single-center retrospective study.Journal of spine surgery (Hong Kong) · 2026Article
- Editorial comment for the special issue on endoscopic spine surgery.Asian spine journal · 2025Article
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5 authors.
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Abstract
STUDY
designRetrospective analysis of a prospective study. PURPOSE: The study aimed to evaluate and compare the clinical results of three surgical techniques for the resection of the hypertrophic ligamentum flavum in patients with lumbar stenosis. OVERVIEW OF LITERATURE: Lumbar spinal stenosis is a common degenerative condition. Biportal endoscopic surgery is a modern technique that has gained popularity in recent years. Although various techniques have been proposed for resecting the ligament, no studies have identified the most superior method.
methodsThis retrospective study enrolled patients with severe lumbar canal stenosis who underwent biportal endoscopic "Z" technique decompression between 2021 and 2023. Patients with any clinical or radiological signs of spondylolisthesis were excluded. The resection of the ligamentum flavum was classified into piecemeal resection, one-piece "butterfly" resection, and the novel variant "two-wings" or two-piece resection. Several demographic and clinical statistical variables were collected, with a specific focus on surgical time, postoperative complications, and clinical outcomes.
resultsNinety lumbar decompression surgeries were performed on 70 patients. The patients were divided into the butterfly group (en bloc) with 27 levels, "two-wings" group with 35 levels, and "piecemeal" group with 28 levels. No significant differences in demographics or clinical variables were found among the three groups. However, piecemeal resection was associated with a higher incidence of dural tears and a longer surgical time (p<0.05). In contrast, en bloc resection, particularly in the two-wing group, demonstrated the best surgical times without an increase in complication rates.
conclusionsThe results revealed that removing the ligamentum flavum en bloc (either in two pieces or one) may reduce the surgical time and incidence of dural tears. Randomized and prospective studies are warranted to establish definitive conclusions.
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