CT-Guided Percutaneous Lumbar Ligamentum Flavum Release by Needle Knife for Treatment of Lumbar Spinal Stenosis: A Case Report and Literature Review

Xinyue Zhu,1,2 Zuyun Qiu,1,3 Zixiang Liu,1 Yifeng Shen,4 Qiaoyin Zhou,5 Yan Jia,1,3 Xiaojie Sun,1,3 Shiliang Li1 1Department of Acupuncture and Moxibustion, China–Japan Friendship Hospital, Beijing, People’s Republic of China; 2Department of Rehabilitation Medicine, Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing, People’s Republic of China; 3Graduate School, Beijing University of Traditional Chinese Medicine, Beijing, People’s Republic of China; 4Department of Traditional Chinese Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People’s Republic of China; 5Chinese Medicine College, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, People’s Republic of ChinaCorrespondence: Shiliang Li Department of Acupuncture and Moxibustion, China–Japan Friendship Hospital, 4 Sakura Garden Road, Beijing 100029, People’s Republic of ChinaTel +86-135-8177-6268Email zrlishiliang@163.comCase: The patient was a 62-year-old woman presenting with low-back pain of 3 years’ duration and numbness in the right leg.Diagnosis: She was diagnosed with lumbar spinal stenosis based on combined magnetic resonance imaging, physical examination, and symptoms.Interventions: Treatment with computed tomography–guided percutaneous release of the ligamentum flavum was delivered.Outcomes: Relief of symptoms immediately after treatment and complete resolution of symptoms after 1 month were achieved. At follow-up, there was no recurrence of symptoms after 2, 4, 6, and 12 months.Conclusion: Lumbar ligamentum flavum hypertrophy is an important cause of degenerative lumbar spinal stenosis. The hypertrophic ligamentum flavum can directly compress the spinal canal, squeeze the cauda equina, and simultaneously lead to a reduction in the anteroposterior diameter of the intervertebral foramen, which compresses the nerve roots and causes numbness and other symptoms of lower extremities. In clinical practice, doctors should combine imaging findings with patient symptoms for diagnosis and an individualized treatment plan for each patient with lumbar spinal stenosis, and conduct gradual stepwise treatment using conservative minimally invasive surgery to prevent excessive surgery.Keywords: CT guidance, ligamentum flavum, lumbar spinal stenosis, minimally invasive surgery, needle knife