[Prevention of dura adherence in spinal canal after microendoscopic discectomy by different methods: a clinical study
Hai-Bin Lin1, Jian-Hui Dai, Xian-Wei Wu
1Department of Orthopedics, Affiliated Hospital of Putian University, Putian 351100, China.
Objective:
To evaluate the effects of different methods in prevention of post-operational scar formation and dura adherence in the spinal canal after microendoscopic discectomy (MED).
Methods:
165 patients undergoing MED were randomly divided into 3 equal groups: Group A, with the yellow ligament dissected and with the space between vertebral laminae sprinkled with sodium hyaluronate before the closing of the incision; Group B, with the yellow ligament reserved; and Group C, with the yellow ligament reserved and with the space between vertebral laminae sprinkled with sodium hyaluronate before the closing of the incision. All the patients were followed up 2, 4, and 8 weeks, and 1 and 2 years after the operation. Japanese Orthopedic Association (JOA) scoring system was used to evaluate the outcomes.
Results:
The JOA scores 2 weeks after MED were not significantly different among the 3 groups; and from then on the JOA scores of Groups B and C were all higher than those of group A (A and B: t(4w) = 0.602, t(8w) = 0.701, t(1y) = 0.623, t(2y) = 0.654; A and C: t(4w) = 0.833, t(8w) = 0.759, t(1y) = 0.714, t(2y) = 0.771, all P < 0.05), however, there were not significantly differences at all time points between Groups B and C (B and C: t(2w) = 0.041, t(4w) = 0.135, t(8w) = 0.980, t(1y) = 0.530, t(2y) = 0.103, all P > 0.05). CT showed that a great amount of scar was seen, surrounding the dura mater sac and nerve roots in Group A, and there was a great amount of scar outside the yellow ligament and no remarkable compression of dura mater sac and nerve roots in Groups B and C.
Conclusion:
Reservation of yellow ligament effectively prevents scar adhesion inside the vertebral canal after MED. Sprinkling of sodium hyaluronate is also effective, however, its effect only lasts a short time.
Insights
Preserving the yellow ligament during microendoscopic discectomy effectively prevents spinal scar adhesion. Sodium hyaluronate offers temporary benefits, but ligament preservation provides superior long-term outcomes for spinal canal healing.
Area of Science:
- Spinal Surgery
- Neurosurgery
- Orthopedic Surgery
Context:
- Post-operative complications following microendoscopic discectomy (MED) can include scar formation and dura adherence.
- These complications may lead to persistent pain and neurological deficits, impacting patient recovery and outcomes.
Purpose:
- To compare the efficacy of preserving the yellow ligament versus dissecting it, with or without sodium hyaluronate application, in preventing post-operative scar formation and dura adherence after MED.
- To evaluate the long-term effects of these methods on patient outcomes using the Japanese Orthopedic Association (JOA) scoring system.
Summary:
- A study involving 165 patients undergoing MED evaluated three groups: ligament dissection with sodium hyaluronate (Group A), ligament preservation (Group B), and ligament preservation with sodium hyaluronate (Group C).
- Results showed significantly better Japanese Orthopedic Association (JOA) scores in Groups B and C compared to Group A from 4 weeks to 2 years post-operation.
- CT scans revealed less scar formation and nerve root compression in Groups B and C, indicating that preserving the yellow ligament is crucial for preventing adhesions.
Impact:
- Preserving the yellow ligament is a highly effective strategy for minimizing scar tissue and adhesions within the spinal canal after microendoscopic discectomy.
- While sodium hyaluronate shows some short-term benefit, its long-term impact is limited compared to ligament preservation.
- These findings offer valuable insights for optimizing surgical techniques to improve patient recovery and reduce the risk of re-operation due to adhesions.
