Aim: To determine the efficacy, safety, and clinical value of a novel surgical procedure involving the blunt perforation of the ligamentum flavum (LF) during endoscopic interlaminar lumbar discectomy.
Material and methods: This was a prospective study of 50 patients (27 males, 17-51 years of age) undergoing lumbar discectomy for single segment L4/L5 or L5/S1 disk herniation were grouped into the control (cutting of the LF; n=28) and test (blunt perforation; n=22) groups. Intraoperative injury to the LF was evaluated by electrophysiological monitoring. The time required for perforation, total surgical time, and proportion of epidural sac and nerve root injury were assessed.
Results: Among the enrolled patients, 90% showed herniation of the L4/5 segment and 10% of the L5/S1 segment. The success rate for the perforation of the LF was 93%. The intraoperative observation showed mild self-closing injury to the LF tissue. The test group showed shorter overall surgical time (43 vs. 56 min) and shorter duration to go through the LF (1 vs. 13 min, p 0.001). No dural sac or nerve root injury resulting from blunt perforation of the LF was observed.
Conclusion: Compared to cutting, blunt perforation of the LF could reduce surgical time and injury to LF and surrounding tissues. Thus, it could be a safe and efficient surgical technique for patients undergoing intralaminar lumbar discectomy.