Work

Short-term clinical and radiographic outcomes of arthroscopic-assisted uni-portal spinal surgery discectomy with versus without ligamentum flavum preservation: a retrospective comparative cohort study

Year: 2026

Type: article

Abstract: Background To compare ligamentum flavum preservation vs. resection during AUSS for single-level lumbar disc herniation and evaluate the clinical value of preservation in this setting. Methods This retrospective comparative cohort study included 65 patients (Sept 2024–Sept 2025): Group A (preservation, n = 30) and Group B (resection, n = 35). Both underwent AUSS-assisted nucleotomy. Outcomes included operative parameters, complications, VAS for low back and leg pain, ODI, modified MacNab criteria, and imaging parameters (spinal canal cross-sectional area and sagittal and transverse diameters). Assessments were VAS preoperatively and at day 2; ODI preoperatively and at day 2, 1 month, and 3 months; MacNab at 3 months; disc height preoperatively and at 3 months; and CT preoperatively and at 3 and 6 months (65/65/65). Results Operative time, blood loss, and hospital stay did not differ significantly ( P > 0.05). Both groups showed significant postoperative improvements in VAS and ODI vs. baseline ( P < 0.05), with no intergroup differences ( P > 0.05). At 3 months, good/excellent MacNab rates were 96.7% in Group A vs. 88.6% in Group B ( P = 0.396). Both groups had significant increases in all canal dimensions vs. preoperative values ( P < 0.05). At 3 months, Group A had larger postoperative cross-sectional area and transverse diameter than Group B ( P = 0.047 and P = 0.002); these represented between-group differences in postoperative values, not improvement magnitude. At 6 months, Group A had larger cross-sectional area (320.6 vs. 233.7; unadjusted P < 0.001, Holm-adjusted P = 0.002) and transverse diameter (22.7 vs. 17.3 mm, P < 0.001), whereas Group B's transverse diameter fell below preoperative level. Sagittal diameter showed no intergroup difference (all P > 0.05). Complications occurred in 1/30 (3.3%) and 2/35 (5.7%) patients (Fisher exact P = 1.000); revision surgery was a subsequent intervention in one of the two patients with complications. Conclusion In this single-center retrospective cohort, both preservation and resection during AUSS were accompanied by postoperative improvement in clinical scores; short-term clinical outcomes were broadly similar, with differences only in CT-measured canal dimensions at some time points. The clinical relevance of these radiographic differences remains uncertain, and the study cannot establish equivalence, long-term efficacy, or a specific pathological mechanism.

Source: Frontiers in Surgery

DOI: 10.3389/fsurg.2026.1964665