Revisiting ligament-sparing lumbar microdiscectomy: when to preserve ligamentum flavum and how to evaluate radiological results for epidural fibrosis.

Revisiting ligament-sparing lumbar microdiscectomy: when to preserve ligamentum flavum and how to evaluate radiological results for epidural fibrosis.

World Neurosurg. 2018 Mar 09;:

Authors: Ozay R, Ogur T, Durmaz HA, Turkoglu E, Caglar YS, Sekerci Z, Sorar M, Hanalioglu S

Abstract
OBJECTIVE: Preserving the ligamentum flavum (LF) during lumbar spine surgery may help limit the extent of postoperative epidural fibrosis (EF), a potential cause of persistent leg pain. We present a retrospective analysis of microdiscectomy with preservation of the LF in order to evaluate the effects of the two LF mobilizing techniques (reflecting inferiorly or medially vs. removing completely) on EF and clinical outcomes.
METHODS: Microdiscectomy was performed through a unilateral laminotomy in 93 patients (52 male, 41 female; mean age 46; range 25-65 years) with L3-L4 (n=3), L4-L5 (n=40), and L5-S1 (n=50) lumbar disc herniation. Patients whose LF was removed were assigned to Group I (n=42), and patients whose LF was preserved by mobilizing it medially (n=31) or inferiorly (n=20) were assigned to Groups II and III, respectively. Follow-up visual analog scale (VAS) scores and magnetic resonance images were evaluated.
RESULTS: EF scores, particularly for the anterior quadrants, were significantly higher in Group I than in Groups II (p = 0.012) and III (p = 0.001). Likewise, postoperative VAS scores in Group I were also significantly higher than in Groups II (p = 0.009) and III (p = 0.044).
CONCLUSIONS: Our results demonstrate that (i) preserving the LF during lumbar microdiscectomy reduces the formation of postoperative EF and improves clinical outcomes, (ii) that EF in the anterior, rather than the posterior epidural space, is correlated with clinical results, (iii) and that the ligament mobilizing technique used should be individually tailored based on the features of disc herniation.

PMID: 29530695 [PubMed - as supplied by publisher]

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