Does Preservation of Ligamentum Flavum in Percutaneous Endoscopic Lumbar Interlaminar Discectomy Improve Clinical Outcomes?
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 minimi...
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| Format: | Article |
| Language: | English |
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Korean Spinal Neurosurgery Society
2019-03-01
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| Series: | Neurospine |
| Subjects: | |
| Online Access: | http://www.e-neurospine.org/upload/pdf/ns-1938008-004.pdf |
| _version_ | 1797334727407960064 |
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| author | Urim Lee Chi Heon Kim Calvin C. Kuo Yunhee Choi Sung Bae Park Seung Heon Yang Chang-Hyun Lee Kyoung-Tae Kim Chun Kee Chung |
| author_facet | Urim Lee Chi Heon Kim Calvin C. Kuo Yunhee Choi Sung Bae Park Seung Heon Yang Chang-Hyun Lee Kyoung-Tae Kim Chun Kee Chung |
| author_sort | Urim Lee |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-08T08:25:22Z |
| format | Article |
| id | doaj.art-49f67049e7794d129ec116550303e3c9 |
| institution | Directory Open Access Journal |
| issn | 2586-6583 2586-6591 |
| language | English |
| last_indexed | 2024-03-08T08:25:22Z |
| publishDate | 2019-03-01 |
| publisher | Korean Spinal Neurosurgery Society |
| record_format | Article |
| series | Neurospine |
| spelling | doaj.art-49f67049e7794d129ec116550303e3c92024-02-02T04:40:16ZengKorean Spinal Neurosurgery SocietyNeurospine2586-65832586-65912019-03-0116111311910.14245/ns.1938008.004863Does Preservation of Ligamentum Flavum in Percutaneous Endoscopic Lumbar Interlaminar Discectomy Improve Clinical Outcomes?Urim Lee0Chi Heon Kim1Calvin C. Kuo2Yunhee Choi3Sung Bae Park4Seung Heon Yang5Chang-Hyun Lee6Kyoung-Tae Kim7Chun Kee Chung8 Human Brain Function Laboratory, Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea Regional Spine Surgery Department, Kaiser Permanente, Oakland, CA, USA Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea Human Brain Function Laboratory, Department of Neurosurgery, Seoul National University Hospital, Seoul, KoreaObjective 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.http://www.e-neurospine.org/upload/pdf/ns-1938008-004.pdfLigamentum flavumOperationOutcomesPercutaneous discectomySpinelumbar disc herniation |
| spellingShingle | Urim Lee Chi Heon Kim Calvin C. Kuo Yunhee Choi Sung Bae Park Seung Heon Yang Chang-Hyun Lee Kyoung-Tae Kim Chun Kee Chung Does Preservation of Ligamentum Flavum in Percutaneous Endoscopic Lumbar Interlaminar Discectomy Improve Clinical Outcomes? Neurospine Ligamentum flavum Operation Outcomes Percutaneous discectomy Spine lumbar disc herniation |
| title | Does Preservation of Ligamentum Flavum in Percutaneous Endoscopic Lumbar Interlaminar Discectomy Improve Clinical Outcomes? |
| title_full | Does Preservation of Ligamentum Flavum in Percutaneous Endoscopic Lumbar Interlaminar Discectomy Improve Clinical Outcomes? |
| title_fullStr | Does Preservation of Ligamentum Flavum in Percutaneous Endoscopic Lumbar Interlaminar Discectomy Improve Clinical Outcomes? |
| title_full_unstemmed | Does Preservation of Ligamentum Flavum in Percutaneous Endoscopic Lumbar Interlaminar Discectomy Improve Clinical Outcomes? |
| title_short | Does Preservation of Ligamentum Flavum in Percutaneous Endoscopic Lumbar Interlaminar Discectomy Improve Clinical Outcomes? |
| title_sort | does preservation of ligamentum flavum in percutaneous endoscopic lumbar interlaminar discectomy improve clinical outcomes |
| topic | Ligamentum flavum Operation Outcomes Percutaneous discectomy Spine lumbar disc herniation |
| url | http://www.e-neurospine.org/upload/pdf/ns-1938008-004.pdf |
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