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
- 1Department of Spine Surgery, Changde Hospital, Xiangya School of Medicine, Central South University (The First People’s Hospital of Changde City), Changde, China
- 2Division of Spine, Department of Orthopedics, Shenzhen People’s Hospital (The First Affiliated Hospital, Southern University of Science and Technology; The Second Clinical Medical College, Jinan University), Shenzhen, China
Abstract
BackgroundTo compare ligamentum flavum preservation vs. resection during AUSS for single-level lumbar disc herniation and evaluate the clinical value of preservation in this setting.MethodsThis 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).ResultsOperative 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.ConclusionIn 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.
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BibTeX
@article{jiang2026shortterm,
title = {{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}},
author = {Yuan Jiang and Shijie Fan and Tianyu Qin and Haoxiang Chen and Bo Wang and Feng Hu and Jialin Chen and Yumeng Du and Jie He and Houqing Long and Wei Guo},
journal = {Frontiers in Surgery},
year = {2026},
month = oct,
doi = {10.3389/fsurg.2026.1964665},
url = {https://doi.org/10.3389/fsurg.2026.1964665},
note = {CC BY},
}
RIS
TY - JOUR
TI - 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
AU - Yuan Jiang
AU - Shijie Fan
AU - Tianyu Qin
AU - Haoxiang Chen
AU - Bo Wang
AU - Feng Hu
AU - Jialin Chen
AU - Yumeng Du
AU - Jie He
AU - Houqing Long
AU - Wei Guo
PY - 2026
DA - 2026/10/23
JO - Frontiers in Surgery
DO - 10.3389/fsurg.2026.1964665
UR - https://doi.org/10.3389/fsurg.2026.1964665
AB - BackgroundTo compare ligamentum flavum preservation vs. resection during AUSS for single-level lumbar disc herniation and evaluate the clinical value of preservation in this setting.MethodsThis 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).ResultsOperative 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.ConclusionIn 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.
SN - 2296-875X
ER -