E-ISSN: 1019-5157
ISSN: 2651-5024
Research
Association of a Tissue-Preserving Technique Incorporating Annular Sealing and Ligamentum Flavum Preservation with Early Recurrence After Interlaminar Full-Endoscopic L5–S1 Discectomy: A Comparative Study and Risk Factor Analysis
ismail istemen✉ ,
Durdu Mehmet Babaoğlan ,
Mahmut Ferat ,
Omer Emre Yagli ,
ERENCAN KILCI
Neurosurgery, Adana City Training and Research Hospital, University of Health Sciences; Neurosurgery, Manisa Grandmedical Hospital
Accepted: 12/09/2026
Article in Press
Corresponding Author:
ismail istemen (drismailistemen@gmail.com)
Abstract
Aim
To compare a tissue-preserving interlaminar full-endoscopic discectomy technique incorporating ligamentum flavum preservation and annular sealing with the conventional technique in terms of recurrent lumbar disc herniation (rLDH), clinical outcomes, radiological changes, and risk factors for recurrence after L5–S1 discectomy.
Material and Methods
A total of 286 patients who underwent L5–S1 interlaminar full-endoscopic discectomy between 2021 and 2024 and had a minimum follow-up of 2 yr were retrospectively reviewed. Group 1 (n = 157) underwent the conventional technique without annular sealing, whereas Group 2 (n = 129) underwent the tissue-preserving technique incorporating ligamentum flavum preservation and annular sealing. Clinical outcomes, radiological parameters, recurrence rates, and risk factors for recurrence were evaluated.
Results
Both techniques significantly improved back pain, leg pain, and functional disability, with no significant between-group differences. The tissue-preserving group demonstrated significantly less postoperative disc height loss, smaller postoperative annular defects, and less progression in Pfirrmann grade. Early recurrence occurred less frequently in Group 2 than in Group 1 (0.8% vs. 5.1%, p = 0.044). However, because only nine early recurrence events occurred, this finding should be interpreted cautiously. No significant between-group differences were observed in late or overall recurrence rates. Multivariate analyses consistently identified preoperative Modic changes as an independent predictor of recurrence. Lower preoperative disc height index and higher preoperative Pfirrmann grade were identified as independent predictors in separate parsimonious models. A larger postoperative annular defect width was associated with recurrence in the univariable analysis.
Conclusion
The tissue-preserving technique incorporating ligamentum flavum preservation and annular sealing was associated with a lower observed rate of early recurrence while providing clinical outcomes comparable to those of the conventional technique. However, no significant reduction in late or overall recurrence was demonstrated, and the finding regarding early recurrence should be interpreted cautiously because of the limited number of events. Prospective studies are warranted to confirm these findings.
To compare a tissue-preserving interlaminar full-endoscopic discectomy technique incorporating ligamentum flavum preservation and annular sealing with the conventional technique in terms of recurrent lumbar disc herniation (rLDH), clinical outcomes, radiological changes, and risk factors for recurrence after L5–S1 discectomy.
Material and Methods
A total of 286 patients who underwent L5–S1 interlaminar full-endoscopic discectomy between 2021 and 2024 and had a minimum follow-up of 2 yr were retrospectively reviewed. Group 1 (n = 157) underwent the conventional technique without annular sealing, whereas Group 2 (n = 129) underwent the tissue-preserving technique incorporating ligamentum flavum preservation and annular sealing. Clinical outcomes, radiological parameters, recurrence rates, and risk factors for recurrence were evaluated.
Results
Both techniques significantly improved back pain, leg pain, and functional disability, with no significant between-group differences. The tissue-preserving group demonstrated significantly less postoperative disc height loss, smaller postoperative annular defects, and less progression in Pfirrmann grade. Early recurrence occurred less frequently in Group 2 than in Group 1 (0.8% vs. 5.1%, p = 0.044). However, because only nine early recurrence events occurred, this finding should be interpreted cautiously. No significant between-group differences were observed in late or overall recurrence rates. Multivariate analyses consistently identified preoperative Modic changes as an independent predictor of recurrence. Lower preoperative disc height index and higher preoperative Pfirrmann grade were identified as independent predictors in separate parsimonious models. A larger postoperative annular defect width was associated with recurrence in the univariable analysis.
Conclusion
The tissue-preserving technique incorporating ligamentum flavum preservation and annular sealing was associated with a lower observed rate of early recurrence while providing clinical outcomes comparable to those of the conventional technique. However, no significant reduction in late or overall recurrence was demonstrated, and the finding regarding early recurrence should be interpreted cautiously because of the limited number of events. Prospective studies are warranted to confirm these findings.
Keywords
Annular sealing
Full-endoscopic discectomy
Interlaminar approach
Lumbar disc herniation
Recurrent lumbar disc herniation
Ligamentum flavum preservation