BACKGROUND: The ligamentum flavum is the anatomic plane between the epidural
and laminar-extralaminar spaces, which should be meticulously preserved for
a possible reoperation. Preservation of the ligamentum flavum together with
other epidural anatomic structures, such as epidural fat tissue and venous
plexuses, and limited removal of the lamina are important components in
preventing epidural fibrosis that may be the cause of failed back surgery
syndrome. METHODS: One thousand five hundred patients underwent
microdiskectomy with preservation of the ligamentum flavum over an 8-year
period. This technique was performed with a small incision using an 18
mm-width mini Taylor retractor. The ligamentum flavum was released and
preserved as a 3-sided flap. The disk content was totally removed and a
pediculated fat graft was used to cover the root at the end. Four hundred
patients operated on with the ligamentum flavum preserving technique were
randomly selected for this study (Group 1). Their results were compared with
those of 200 patients who were operated on with the standard microdiskectomy
(Group 2). Standard microdiskectomy technique was performed with
fenestration and foraminotomy and the ligamentum flavum was partially or
totally excised. Early clinical outcome was classified as excellent, good,
fair, poor, or failure. The clinical mean follow-up period in Group 1 was
36.8 months and in Group 2 it was 32.4 months. One hundred patients from
each group had computed tomographic scans with contrast administration
performed at least one year after the operation to examine late epidural
fibrosis. A questionnaire was given to all patients at least 3 times during
the late follow-up period. The questionnaire required patients to describe
their relief of pain, job performance, and abstinence from narcotic
analgesic use. RESULTS: Early clinical outcome (fourth postoperative week)
in Group 1 was satisfactory in 96.75% of the patients, whereas it was
satisfactory in only 81.5% in Group 2 (p < 0.001). The radiological
examinations revealed fibrosis in 18% of the patients in Group 1 and 37% in
Group 2 (p < 0.001). None of the patients in Group 1 were readmitted because
of fibrosis-related symptoms. The reoperation rate in Group 1 was 4.5%. The
recurrence rate was 1.75% and disc at another level was 2.5%. One patient
was reoperated because of a suture granuloma. In Group 2, the reoperation
rate was 9% (p < 0.05). The recurrence rate was 4.5%, disc at another level
was 3.5% and extensive epidural fibrosis was 1%. Two patients who underwent
surgery for epidural fibrosis in this group had disappointing outcomes.
Overall success rate based on the questionnaire was 91% in Group 1 and 76%
in Group 2 (p < 0.001). CONCLUSIONS: The ligamentum flavum preserving
technique is useful in achieving a favorable long-term outcome, and
reoperation, if necessary, is easier and safer.

Now, all that being said, if you can decifer it let me know!! lol

I think it means if they removed the ligamentum flavum during one of the
surgeries it could prevent reoperation.

GaryZ

not that i really know anything, gary, but it sounds to me like they
preserved the/her ligmentum flavum as a 3-sided epidural flap, like she was
in study group 1.  but how old is the information you offered here?  and i
wonder how long ago, sj's friend had the flap procedure and if she were part
of the study.

 since it was preserved as a flap and not excised, with excision being the
standard diskectomy procedure, the only reason i can conclude is that they
"can't" operate on her or "do anything", because she's part of a study group
(which sounds crazy to me, as if the study had proprietary rights over her
well-being.). in what you posted, gary, what's being studied is the flap, to
determine whether over time the flap procedure will prevent epidural
fibrosis and surgical failure syndrome.  but it sounds ludicrous to me,
being that she is apparently in distress and young, that they would deny her
help, because of a study group.  and at the same time, that group 1
ligmentum flavum saving procedure (the flap) ironically, is supposed to make
reoperation easier and safer.

my gut feeling is that somebody is stonewalling her.  if i were her, i'd
want a thorough explanation about "why" they can't do anything to help me,
and not mumbo jumbo about it being because of the flap itself.  if she is in
study group 1, the study might be the issue and not the flap.  in which
case, i guess she'd have to drop out of the study group.

of course, all of this is conjecture on my part and probably not the whole
story.

kate

Thank you guys for this info. I am forwarding it on the Stacy to see if it
will help her out.