Revisiting Ligament-Sparing Lumbar Microdiscectomy: When to Preserve Ligamentum Flavum and How to Evaluate Radiological Results for Epidural Fibrosis
| Autor: | Zeki Sekerci, Erhan Turkoglu, Rafet Özay, Sahin Hanalioglu, Torel Ogur, Mehmet Sorar, Yusuf Sukru Caglar, Hasan Ali Durmaz |
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| Přispěvatelé: | Ozay, Rafet, Turkoglu, Erhan, Sorar, Mehmet, Hanalioglu, Sahin Univ Hlth Sci, Diskapi Yildirim Beyazit Training & Res Hosp, Dept Neurosurg, Ankara, Turkey, Ogur, Torel Univ Hlth Sci, Dr Abdurrahman Yurtaslan Oncol Training & Res Hos, Dept Radiol, Ankara, Turkey, Durmaz, Hasan Ali Univ Hlth Sci, Diskapi Yildirim Beyazit Training & Res Hosp, Dept Radiol, Ankara, Turkey, Caglar, Yusuf Sukru Ankara Univ, Sch Med, Dept Neurosurg, Ankara, Turkey, Sekerci, Zeki Medipol Univ Hosp, Dept Neurosurg, Istanbul, Turkey, Hanalioglu, Sahin -- 0000-0003-4988-4938 |
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Adult
Epidural Space Male medicine.medical_specialty Visual Analog Scale Visual analogue scale medicine.medical_treatment Lumbar vertebrae Laminotomy 03 medical and health sciences 0302 clinical medicine Magnetic resonance imaging medicine Humans Microdiscectomy Diskectomy Aged Retrospective Studies Disc herniation Epidural fibrosis Lumbar Vertebrae medicine.diagnostic_test business.industry Retrospective cohort study Middle Aged Fibrosis Epidural space Surgery Treatment Outcome medicine.anatomical_structure Lumbar spine 030220 oncology & carcinogenesis Ligament Ligamentum flavum Female Neurology (clinical) business Intervertebral Disc Displacement 030217 neurology & neurosurgery |
| Popis: | WOS: 000432959600042 PubMed ID: 29530695 OBJECTIVE: Preserving the ligamentum flavum (LF) during lumbar spine surgery can help to limit the extent of postoperative epidural fibrosis (EF), which is a potential cause of persistent leg pain. We present a retrospective analysis of microdiscectomy with preservation of the LF 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 years; 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 1 (n = 42), and patients whose LF was preserved by mobilizing it medially (n = 31) or inferiorly (n = 20) were assigned to groups 2 and 3, 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 1 than in groups 2 (P = 0.012) and 3 (P = 0.001). Likewise, postoperative VAS scores in group 1 were also significantly higher than in groups 2 (P = 0.009) and 3 (P = 0.044). CONCLUSIONS: Our results demonstrate that 1) preserving the LF during lumbar microdiscectomy reduces the formation of postoperative EF and improves clinical outcomes; 2) EF in the anterior, rather than the posterior epidural space, is correlated with clinical results; and 3) the ligament mobilizing technique used should be individually tailored on the basis of the features of disc herniation. |
| Databáze: | OpenAIRE |
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