Clinical analysis of reformed microlumbar discectomy / 中国医师进修杂志

ABSTRACT

Objective To evaluate the clinical outcomes of the reformed microlumbar discectomy preserving partial ligamentum flavum to prevent lumbar spinal instability and .scar tissue oppression and adhesion after operation. Methods A prospective, randomized, controlled clinical study was conducted.The patients with unilateral lumbar disc herniation were randomly divided into two groups. The control group (41 cases) underwent classic mien)lumbar disceetomy,.and the test group (44 cases) underwent the same procedure but with a curved incision on the lumbo-dorsa fascia and with partial preservation of the ligamentum flavum. Visual analog scale (VAS) scores and Oswestry scale scores were used to appraise the outcomes. Results Chnieal parameters were significantly improved after the operation in two groups. In the test group the postoperative VAS scores showed a less intensity of pain after the operation than that in the control group, and this superiority disappeared 1 year after the operation. After the operation, the VAS scores in the test group and contnd group were (1.8±0.6) and (3.8±1.3) scores at 3 days (P <0.05), (1.3±0.6) and (3.5±2.1) scores at 12 weeks (P<0.05), and (1.9±0.6) and (2.8±1.7) scores at 1 year (P>0.05) respectively. After the operation, the Oswestry scale scores in the test group and control group were (18.2±6.6) and (34.4±11.8) scores at 12 weeks (P <0.05), (12.0±9.2) and (22.6±10.0) scores at 1 year (P<0.05) respectively. In both groups, there was no patient who had recurrence of intervertebral disc hernia and reoperation. Conclusions Minimally invasive discectomy has satisfactory clinical outcomes,however, with partial preserved ligamentum flavum shows a less intensity pain and a better lumbar function state. Preserving the ligamentum flavum is helpful to prevent the fibrosis-related complication and to preserve the stabihty of the spine.