To compare the long-term results of post-op back pain in patient undergoing ligamentum flavum sparing microdiscectomy vs conventional microdisecectomy

Abstract

Objective: To Compare the Long-term Results of Post op Back Pain In Patient Undergoing Ligamentum flavum Sparing Microdiscectomy Vs Conventional Microdisecectomy.

Methods: This is an Prospective study. The patients who were diagnosed clinically and confirmed by mri with disc prolapseand not responds to conservative treatment willing for microdiscectomy were prospectively enrolled in this study.

Relevant history and demographic details of the patient were recorded in the patients performa. A total of 30 patient were included in the study and were divided into 2 groups; one group of 15 patients underwent ligamentum flavum sparing microdiscectomy and in the other group of 15 patients, conventional microdiscectomy (ligamentum flavum sacrificing) was done.

Result: There was an almost comparable proportion of male and female patients in the two groups. the proportion of patients reporting radiculopathy on either side was the same, with more patients reporting radiculopathy in the left leg in both groups. all cases in both groups had a positive finding on SLRT, Bowstring and Bragard test. No difference in the ODI parameters between the two groups before and after the procedure was seen. In ligament sparing group, three patients reported having very severe pain before the procedure, compared to conventional group in which only one patient reported as having very severe pain. Seven cases each in conventional group reported having moderate and severe pain on VAS. In contrast, six cases each in ligament sparing group reported the same grade.

Discussion: Preserved flavum act as barrier between fibrosis and neural structure which prevents secondary neural compression as well as in case of revision surgery it decreases the chance of injury to dura or other neural structures. The ligamentum flavum (LF) has previously been indicated as an excellent barrier between hematoma organisation and the dural surface, and that severe bone structure removal may not be required to protect the LF. Surgical options that preserve both the bony structures and the LF can help overcome the challenges of revision surgery.

Conclusion: The findings of this study show that both conventional microdiscectomy and ligamentum flavum sparing microdiscectomy are both safe and effective surgical methods for the treatment of LDH. There is no significant difference in post operative back pain in patients undergoing microdiscectomy with and without preserving ligamentum flavum and there are no such additional benefits at ligamentum sparing technique as compare to conventional techniques.