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

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.