Flavectomy (Ligamentum Flavum Resection)
The procedure for stripping down or removing the ligamentum flavum is called flavectomy (or ligamentectomy). This term specifically refers to the surgical excision of the ligamentum flavum, which can be performed as a standalone procedure or as part of a broader decompressive operation 1.
Terminology and Context
Flavectomy is the precise term for removal of the ligamentum flavum, whether it is hypertrophied, ossified, or causing neural compression 1, 2.
This procedure is distinct from but often performed during laminectomy (removal of the lamina) or laminoforaminotomy (removal of lamina and foramen enlargement) 3.
When the ligamentum flavum becomes ossified, the condition is termed ossification of the ligamentum flavum (OLF), and its removal still constitutes flavectomy 4, 5.
Surgical Approaches
The ligamentum flavum can be removed through several technical approaches:
Bilateral flavectomy via unilateral laminotomy (ULBD): A minimally invasive technique where bilateral ligamentum flavum is removed through a single-sided approach, preserving the contralateral facet joint and midline structures 4, 2.
Open flavectomy: Traditional posterior approach where the insertions of the flaval ligaments are cut at the superior vertebral lamella border, then lifted and removed from the anterior side 1.
Minimally invasive flavectomy: Using expandable tubular retractor systems and ultrasonic osteotomes for OLF removal, particularly in thoracic spine 5, 6.
Clinical Applications
Flavectomy is indicated when the ligamentum flavum causes:
Spinal canal stenosis from ligamentum flavum hypertrophy (cross-sectional area >150 mm²) 2.
Neural compression in cervical, thoracic, or lumbar spine with corresponding radiculopathy or myelopathy 1, 4.
Central cord syndrome where buckled ligamentum flavum contributes to spinal cord compression during hyperextension injuries 3.
Important Technical Considerations
The procedure requires careful dissection to avoid dural laceration, which occurred in 2 of 25 cases in one series when cervical vertebrae were in hyperflexion 1.
Complete removal should result in visible dural sac inflation, confirming adequate decompression 1.
When performed correctly via unilateral approach, flavectomy preserves posterior tension band and avoids kyphotic deformity complications associated with extensive laminectomy 4, 5.