Saving Ligamentum Flavum in One Day Care Microscopic Lumbar Disc Surgery

Background Data Decompression discectomy is a common procedure for treatment of sciatica caused by lumbar disc herniation. Conventional discectomy may damage many important motion segment structures. Microscopic lumbar disc surgery can offer better visualization, magnification and illumination that lead to less invasive disc surgery. Shorter hospital stay, rapid recovery, and decrease the surgical cost is a trend to broaden the types of procedures that can be safely performed as one day care procedure.Purpose: To assess the safety and efficacy of microscopic lumbar discectomy with partial ligamentum flavum preservation in treating L5-S1 lumbar disc herniation as outpatient procedure in one day care hospital.Study design: Prospective clinical case study.Patients and Methods: Between the period of 2012 and 2015 seventy cases were treated for prolapsed L5-S1 disc after failure of conservative treatment. All patients were operated by microscopic lumbar discectomy with partial preservation of the ligamentum flavum as outpatient one day surgery. Visual analogue scale (VAS), Oswestry Disability Index (ODI), and patient satisfaction questionnaire were used to assess the safety and efficacy of our procedure. Preoperative and postoperative MRI was done to confirm ligamentum flavum preservation.Results: At the last follow up, VAS improved from 7.29±0.89 to 1.8±0.93 with P value P<0.002. ODI was improved from 42.01±6.77 to 13.4±4.72 with P value<0.002. One cases had pseudomeningeocele treated conservatively; three patients suffered paresthesia improved with medical conservative  treatment. Two patients had limited postoperative superficial infections. Recurrence of lumbar disc herniation was reported in one case 1.5 years after surgery.Conclusion: According to the result, one day microscopic L5-S1 lumbar discectomy with partial ligamentum flavum preservation is possible with favorable clinical outcomes. (2017ESJ132)