Dr Luis Lombardi- Non-Traumatic, Trans-Ligamentum Flavum Approach
Presentation @ Annual Meeting of the AANS/CNS Section on Disorders of the Spine and Peripheral Nerves, Feb 2010.
INTRODUCTION
With typical laminotomy/discectomy, including the so-called minimally invasive techniques, bone and ligamentum flavum need to be removed in order to access the spinal canal and the pathology. Depending on the size and location of the extruded fragment/s, the amount of bone removal ranges from a conservative laminotomy to a wider laminectomy with or without hemi-facetectomy. In either case, once the normal anatomy has been altered the possibility of failed back surgical syndrome increases dramatically.
The use of a non-traumatic, small-sized, access tubular system allows for excellent visualization via scope viewing and working simultaneously in order to part through the ligamentum flavum. There is no internal cutting, bone or joint removal. Lack of bleeding virtually eliminates the risk of new scar tissue.
METHODS
A retrospective analysis from 2002 through the present was performed. The results are reported utilizing the MacNab criteria. The study population includes 111 patients with L5/S1 extruded disc herniations/free fragments into the spinal canal; 74% males and 26% females, ages ranging from 17 to 58 years old. The mean follow up was 6 weeks.
RESULTS
Statistical analysis showed the following results: Excellent: 57.65% (n=64), Good: 35.13% (n=39), Fair: 3.60% (n=4) and Poor: 3.60% (n=4). The overall success rate was 93%, or if the Fair result group is also included with modified MacNab criteria, it is 96%. One COMPLICATION was a small dural sac leak which occurred indirectly after removal of free fragments that were plastered against the dura. This was successfully treated with an epidural blood patch placed by the anesthesiologist; this patient was not hospitalized, had headaches with standing for two days that disappeared completely with the blood patch and the patient had an excellent outcome..
CONCLUSIONS
This method achieves better success rates and avoids the potentially deleterious long term ill effects of trauma that occur with typical procedures.