Preserving the ligamentum flavum in lumbar discetomy: A new technique that prevents scar tissue formation in the first 6 months postsurgery
Preserving the ligamentum flavum in lumbar discetomy: A new technique that prevents scar tissue formation in the first 6 months postsurgery
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DOI：
10.1227/01.neu.0000220078.90175.e6
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发表时间：
2006-07-01
期刊：
影响因子：
4.8
通讯作者：
Sarioglu, Ali C.
中科院分区：
文献类型：
--
作者：
Ozer, Ali F.;Oktenoglu, Tunc;Sarioglu, Ali C.
目的：腰椎间盘术后纤维化是腰椎间盘手术失败综合征的重要原因之一。已经研究了许多天然和合成材料作为预防或减少这些手术后瘢痕形成的手段。为此目的保留黄韧带尚未进行深入研究。进行了一项前瞻性、随机、对照临床研究。目的是提出一种新的技术，保留黄韧带在腰椎间盘切除术，并评估这是否有助于防止或减少术后fibrosis.METHODS：20例单侧L5-S1椎间盘突出症被随机分为两个相等的组。A组患者接受经典的腰椎间盘微创切除术，B组患者接受相同的手术，但保留黄韧带。在术前和术后6个月记录视觉模拟疼痛量表（VAPS）评分、奥斯韦斯特里量表评分和直腿抬高角度。使用Wilcoxon检验对每组术前和术后结果之间的差异进行统计学比较。磁共振成像也在6个月时进行，以评估术后纤维化的程度，并记录每个患者的“瘢痕等级”。结果：术后6个月两组患者的临床指标均明显改善。在A组中，术前和术后平均VAPS评分分别为9.2和3.2（P < 0.05）;相应的平均奥斯韦斯特里量表评分分别为88和28.2（P < 0.05）;相应的平均直腿抬高角分别为290和630（P < 0.05）。在B组中，平均术前和术后VAPS评分分别为9.2和2.6（P < 0.05）;相应的平均奥斯韦斯特里评分分别为85.2和22.2（P < 0.05）;相应的平均直腿抬高评分分别为260和710（P < 0.05）。A、B组瘢痕评分分别为1.8和1.0（P < 0.05）。结论：两组临床疗效均较满意，改善程度相当，但保留黄韧带组术后6个月局部纤维化程度明显减轻。作者推测，这种手术技术提供了一种物理保护屏障，可以减少甚至消除腰椎间盘手术后纤维化相关的并发症。
OBJECTIVE: Postoperative fibrosis is one of the most important causes of failed back surgery syndrome after lumbar disc surgery. Numerous natural and synthetic materials have been investigated as means to prevent or reduce postoperative scarring after these operations. Preservation of the ligamentum flavum for this purpose has not been studied in depth. A prospective, randomized, controlled clinical study was conducted. The aim was to present a new technique for preserving the ligamentum flavum during lumbar discectomy, and to evaluate whether this helps prevent or diminish postoperative fibrosis.METHODS: Twenty patients with unilateral L5-S1 disc herniation were randomly divided into two equal groups. Group A patients underwent classic microlumbar discectomy, and Group B patients underwent the same procedure but with preservation of the ligamentum flavum. Visual analog pain scale (VAPS) scores, Oswestry scale scores, and straight-leg raising angles were recorded preoperatively and at 6 months postoperatively. Differences between the preoperative and postoperative findings for each group were statistically compared using the Wilcoxon test. Magnetic resonance imaging was also done at 6 months to assess the extent of postoperative fibrosis, and a "scarring grade" was recorded for each patient. The group findings for this were analyzed with Levene's test.RESULTS: Both groups' clinical parameters were significantly improved at 6-months postsurgery. In Group A, the mean pre- and postoperative VAPS scores were 9.2 and 3.2, respectively (P < 0.05); the corresponding mean Oswestry scale scores were 88 and 28.2, respectively (P < 0.05); and the corresponding mean straight-leg raising angles were 290 and 630, respectively (P < 0.05). In Group B, the mean pre- and postoperative VAPS scores were 9.2 and 2.6, respectively (P < 0.05); the corresponding mean Oswestry scores were 85.2 and 22.2, respectively (P < 0.05); and the corresponding mean straight-leg raising scores were 260 and 710, respectively (P < 0.05). The scarring grades mean in Groups A and B were 1.8 and 1.0, respectively (P < 0.05).CONCLUSION: The groups both showed satisfactory clinical outcomes and the improvements were comparable; however, the group with preserved ligamentum flavum showed significantly less local fibrosis at 6 months postoperatively. The authors speculate that this surgical technique provides a physical protective barrier that can reduce or even eliminate fibrosis-related complications after lumbar disc surgery.