OBJECTIVETo explore operative method and clinical effect of selective fenestration of cervical vertebral lamina to excise ligamentum flavum for treating hypertrophic ligamentum flavum (HLF).

METHODSFrom March 1998 to May 2007, 21 patients (14 males and 7 females) with HLF were reviewed retrospectirely, whose age was from 37 to 76 years with an average of 52.2 years. The history of HLF was from 5 h to 25 years with an average of 3 years and 10 months. Reason of onset: 4 cases were no inducement, 10 cases were slow-moving,and 7 cases caused by injury. The operative effect was assessed according to JOA scores and radiologic results.

RESULTSAll patients were followed up with an average of 2.5 years(ranging from 3 months to 7.5 years). Radiologic results: sagittal diameter of vertebral canal and trans.sec.area increased and spinal cord were well than preoperative status. The majority of cases got stronger in the walking, improvement in the fingers mobility and holding power and using chopsticks, abatement in the limbs numb and thoracic waist zonesthesia, amelioration in the urination and defecation functional disturbance than preoperative symptom. The JOA scoring was 5-16 scores with an average of 11.48 +/- 2.94 before operation,and 7-17 scores with an average of 13.81 +/- 2.98 after operation. That results had statistical significance between before and after operation (t = 3.51, P < 0.05). There were 13 cases excellent (improvement rate more than 75%), 5 cases good (improvement rate in 50%-74%), 2 cases fair (improvement rate in 25%-49%), 1 case poor (improvement rate less than or equal to 24%) with an average improvement rate of 85.2%.

CONCLUSIONIt is simple in the operative procedure and tiny in trauma in treatment for hypertrophic ligamentum flavum with selective fenestration of cervical vertebral lamina to excise ligamentum flavum. The method can obtain effective decompression for vertebral canal but choice of indication must be reasonable.