Current approaches, significance and prognostic impact of lumbar ligament flavum preserving surgeries

Year 2024, Volume: 17 Issue: 3, 432 - 439, 05.07.2024

Baran Can Alpergin , Murat Zaimoğlu , Ömer Mert Özpişkin , Elif Gokalp , Murat Buyuktepe , Fatih Yakar , Ümit Eroglu

https://doi.org/10.31362/patd.1420935

Abstract

Purpose: The aim of this study is to evaluate the use of flavum-preserving surgeries in lumbar disc herniation surgery, compare their clinical outcomes with standard microdiscectomy techniques, and demonstrate the transflaval microdiscectomy technique.
Material and methods: Between 2020 and 2023, a total of 48 patients who underwent transflaval microdiscectomy and 48 patients who underwent standard microdiscectomy at a single center were included in the study. Epidemiologic characteristics of the groups were described, and from the preoperative and postoperative 12 months visual analog scale scores for leg pain (LPVAS) and back pain (BPVAS) were retrospectively analyzed.
Results: There is no significant difference between the groups in preoperative mean LPVAS scores (p=0.474) and there is no significant difference between the groups in postoperative mean LPVAS scores (p=0.598). There is no significant difference between the groups in preoperative mean BPVAS scores (p=0.608). However, there is a significant difference between the groups in postoperative mean BPVAS scores (p<0.001). This result indicates transflaval microdiscectomy surgery shows better clinical outcomes in follow-up in terms of back pain compared to standard microdiscectomy surgery. In Group 1 (transflaval group), recurrence occurred in 3 patients, while in Group 2 (microdiscectomy), 4 patients experienced recurrence. During the reoperation of patients with recurrence, none of the patients in Group 1 exhibited epidural fibrosis, whereas all patients in Group 2 showed signs of epidural fibrosis. Additionally, during reoperation, no patient in Group 1 experienced dural injury, while dural injury occurred in 2 patients in Group 2.
Conclusion: Preserving the ligamentum flavum structure and minimizing its damage during lumbar microdiscectomy surgery results in less axial pain and improved clinical outcomes during follow-ups.

Keywords

Ligamentum flavum, ligamentum flavum preserving surgery, transflaval microdiscectomy.

Ethical Statement

This retrospective study was approved by The Clinical Research Ethics Committee on October 18, 2023, with the confirmation number I09-622-23.

Ligament flavum koruyucu cerrahinin güncel yaklaşımları, önemi ve prognoza etkisi

Abstract

Amaç: Bu çalışmanın amacı, lomber disk hernisi cerrahisinde flavum koruyucu cerrahilerin kullanımını değerlendirmek, klinik sonuçlarını standart mikrodiskektomi teknikleri ile karşılaştırmak ve transflaval mikrodiskektomi tekniğini göstermektir.
Gereç ve yöntem: 2020-2023 yılları arasında tek bir merkezde transflaval mikrodiskektomi uygulanan toplam 48 hasta ve standart mikrodiskektomi uygulanan 48 hasta çalışmaya dahil edildi. Grupların yaş ve cinsiyet özellikleri tanımlandı ve bacak ağrısı (LPVAS) ve sırt ağrısı (BPVAS) için ameliyat öncesi ve sonrasındaki 12 ay boyunca izlenerek VAS skorları retrospektif olarak analiz edildi.
Bulgular: Ameliyat öncesi ortalama LPVAS skorlarında gruplar arasında ve ameliyat sonrası ortalama LPVAS skorlarında anlamlı fark bulunamadı (Sırasıyla p=0,474 ve p=0,598). Ameliyat öncesi ortalama BPVAS skorlarında gruplar arasında da anlamlı bir fark gözlenmedi (p=0,608). Ancak ameliyat sonrası ortalama BPVAS skorlarında gruplar arasında anlamlı bir fark saptandı (p<0,001) Bu sonuç, transflaval mikrodiskektomi ameliyatının standart mikrodiskektomi ameliyatına kıyasla bel ağrısı açısından takipte daha iyi klinik sonuçlar gösterdiğini ortaya koymaktadır.
Grup 1’de (transflaval cerrahi grubu) 3 hastada nüks görülürken, Grup 2’de (mikrodiskektomi grubu) 4 hastada nüks görüldü. Nüks görülen hastaların yeniden ameliyatı sırasında, Grup 1'deki hiçbir hastada epidural fibrozis görülmezken, Grup 2'deki tüm hastalarda epidural fibrozis belirtileri görüldü. Ayrıca, yeniden ameliyat sırasında Grup 1'deki hiçbir hastada dural yaralanma görülmezken, Grup 2'deki 2 hastada dural yaralanma meydana gelmişti.
Sonuç: Lomber mikrodiskektomi ameliyatı sırasında ligamentum flavum yapısının korunması ve hasarının en aza indirilmesi, takiplerde daha az aksiyel ağrı ve daha iyi klinik sonuçlarla sonuçlanır.

Keywords

Ligamentum flavum, ligamentum flavum koruyucu cerrahi, transflaval microdiskektomi

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