Neurospine.
2019 Mar;16(1):113-119. 10.14245/ns.1938008.004.
Does Preservation of Ligamentum Flavum in Percutaneous Endoscopic Lumbar Interlaminar Discectomy Improve Clinical Outcomes?
- Affiliations
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- 1Human Brain Function Laboratory, Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
- 2Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea. chiheon1@snu.ac.kr
- 3Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
- 4Clinical Research Institute, Seoul National University Hospital, Seoul, Korea.
- 5Regional Spine Surgery Department, Kaiser Permanente, Oakland, CA, USA.
- 6Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea.
- 7Department of Neurosurgery, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Korea.
- 8Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea.
- 9Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea.
- 10Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Korea.
- KMID: 2447816
- DOI: http://doi.org/10.14245/ns.1938008.004
Abstract
OBJECTIVE
Ligamentum flavum (LF) is an important anatomical structure for prevention of postoperative adhesions, but the opening of LF is necessary for percutaneous endoscopic lumbar interlaminar discectomy (PEID). Although the defect in LF is small with conventional PEID, the defect could be minimized with LF splitting technique. The objective of this study was to compare clinical outcomes of PEID with opening of LF versus splitting of LF.
METHODS
A retrospective study was performed for patients underwent PEID for L5-S1. PEID with the opening of LF (open-group) was performed for 55 patients and with splitting of LF (split-group) was performed for 34 patients. The defect of LF in Open-group was 3-5 mm, but the defect was negligible in split-group because the split LF was reapproximated by its elasticity. Clinical outcomes were evaluated with Korean version of the Oswestry Disability Index (K-ODI) and visual analogue pain scores for back (VASB) and leg (VASL). The changes of clinical outcomes during postoperative 24 months between groups were evaluated with linear mixed-effects model.
RESULTS
The clinical outcomes were similar between groups for K-ODI (p=0.98), VASB (p=0.52), and VASL (p=0.59). Each outcome demonstrated significant improvement from preoperative baseline throughout the postoperative 24 months (p<0.05). Complications included recurrence in 4 patients and dural tear in 1 in open-group (9.1%), and residual disc herniation in 2 patients and transient weakness in 1 in split-group (8.8%).
CONCLUSION
Splitting versus opening LF in PEID may be left to the surgeon's discretion. The potential risks and benefits of LF handling should be considered when performing this surgical technique in PEID.
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