{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T17:05:29Z","timestamp":1794503129547,"version":"4.9.1"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T00:00:00Z","timestamp":1760918400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the Open Funds for Shaanxi Provincial Key Laboratory of Infection and Immune Diseases","award":["2024-KFZD-3"],"award-info":[{"award-number":["2024-KFZD-3"]}]},{"name":"the Key Research and Development Program in Social Development Field of Shaanxi Provincial Science and Technology Department","award":["2024SF-YBXM-362"],"award-info":[{"award-number":["2024SF-YBXM-362"]}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Unilateral biportal endoscopic (UBE) surgery provides benefits like reduced invasiveness and swift recovery after surgery for individuals with lumbar disc herniation. A key factor in minimizing postoperative complications is the reduction of iatrogenic injury. This study retrospectively evaluates the effectiveness of the ligamentum flavum preservation technique during UBE for lumbar disc herniation and examines its technical application and clinical significance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>From November 2023 to April 2024, 68 patients with lumbar disc herniation underwent unilateral biportal endoscopic (UBE) surgery via a single-side approach. Patients were allocated to either the conventional UBE group (Group T, <jats:italic>n<\/jats:italic>\u2009=\u200938) or the ligamentum flavum preservation group (Group P, <jats:italic>n<\/jats:italic>\u2009=\u200930) based on the surgical technique. Clinical outcomes were assessed using the Visual Analog Scale (VAS) for low back and leg pain, and the Oswestry Disability Index (ODI) at preoperative, postoperative 1, 3, 6 and 12 months. Operative time, length of hospitalization, postoperative drainage, the modified MacNab criteria, and complications were also recorded.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Postoperative VAS and ODI scores demonstrated significant improvement in both groups; however, no statistically significant differences were observed between them at 1 day, 1 month, 3 months, 6 months, or 12 months following surgery. At 6 months postoperatively, the incidence of epidural fibrosis was significantly lower in the ligamentum flavum preservation group (Group P) compared to the conventional UBE group (Group T). In Group T, one case of cerebrospinal fluid leakage and two cases of nerve root injury were reported; all complications were transient and resolved within three months. Overall, the complication rates during follow-up showed no significant intergroup differences (<jats:italic>P<\/jats:italic>\u2009&amp;gt;\u20090.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The ligamentum flavum preservation technique applied during unilateral biportal endoscopic surgery enables effective removal of herniated disc material in cases of lumbar disc herniation, thereby relieving lower back pain and sciatica, enhancing lumbar function, reduce postoperative dural adhesions, and minimizing the risk of dural injury, cerebrospinal fluid leakage, epidural hematoma associated with ligamentum flavum resection.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2025.1627051","type":"journal-article","created":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T05:23:35Z","timestamp":1760937815000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Efficacy analysis of ligamentum flavum preservation technique under unilateral biportal endoscopic in the treatment of lumbar disc herniation"],"prefix":"10.3389","volume":"12","author":[{"given":"Wen-Bo","family":"Wei","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sha-Jie","family":"Dang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Wei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Da-Peng","family":"Duan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1016\/j.amjmed.2023.03.024","article-title":"Lumbar disc herniation: diagnosis and management","volume":"136","author":"Zhang","year":"2023","journal-title":"Am J Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"440","DOI":"10.3238\/arztebl.m2024.0074","article-title":"Lumbar disc herniation\u2014the significance of symptom duration for the indication for surgery","volume":"121","author":"K\u00f6gl","year":"2024","journal-title":"Dtsch Arztebl Int"},{"key":"B3","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1177\/0269215517719952","article-title":"Surgical versus non-operative treatment for lumbar disc herniation: a systematic review and meta-analysis","volume":"32","author":"Chen","year":"2018","journal-title":"Clin Rehabil"},{"key":"B4","doi-asserted-by":"publisher","first-page":"e012938","DOI":"10.1136\/bmjopen-2016-012938","article-title":"Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study","volume":"6","author":"Gugliotta","year":"2016","journal-title":"BMJ Open"},{"key":"B5","doi-asserted-by":"publisher","first-page":"E305","DOI":"10.36076\/ppj.2024.27.E305","article-title":"A comparison of minimally invasive surgical techniques and standard open discectomy for lumbar disc herniation: a network meta-analysis","volume":"27","author":"Qin","year":"2024","journal-title":"Pain Physician"},{"key":"B6","doi-asserted-by":"publisher","first-page":"869","DOI":"10.1007\/s00264-019-04312-2","article-title":"Lumbar disc herniation: long-term outcomes after mini-open discectomy","volume":"43","author":"Benzakour","year":"2019","journal-title":"Int Orthop"},{"key":"B7","doi-asserted-by":"publisher","first-page":"917","DOI":"10.1007\/s00264-018-4256-5","article-title":"Minimally invasive discectomy for lumbar disc herniation: current concepts, surgical techniques, and outcomes","volume":"43","author":"Kanno","year":"2019","journal-title":"Int Orthop"},{"key":"B8","doi-asserted-by":"publisher","first-page":"635","DOI":"10.1111\/os.13216","article-title":"Global and current research trends of unilateral biportal endoscopy\/biportal endoscopic spinal surgery in the treatment of lumbar degenerative diseases: a bibliometric and visualization study","volume":"14","author":"Chu","year":"2022","journal-title":"Orthop Surg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"873691","DOI":"10.3389\/fsurg.2022.873691","article-title":"The learning curve of unilateral biportal endoscopic (UBE) spinal surgery by CUSUM analysis","volume":"9","author":"Chen","year":"2022","journal-title":"Front Surg"},{"key":"B10","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1016\/j.wneu.2022.10.038","article-title":"Complications of unilateral biportal endoscopic lumbar discectomy: a systematic review","volume":"168","author":"Li","year":"2022","journal-title":"World Neurosurg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"600","DOI":"10.1097\/AJP.0b013e3181a5b665","article-title":"Postoperative epidural fibrosis","volume":"25","author":"Masopust","year":"2009","journal-title":"Clin J Pain"},{"key":"B12","doi-asserted-by":"publisher","first-page":"ONS126","DOI":"10.1227\/01.NEU.0000220078.90175.E6","article-title":"Preserving the ligamentum flavum in lumbar discectomy: a new technique that prevents scar tissue formation in the first 6 months postsurgery","volume":"59","author":"Ozer","year":"2006","journal-title":"Neurosurgery"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1132","DOI":"10.4184\/asj.2016.10.6.1132","article-title":"Analysis of the re- lationship between ligamentum flavum thickening and lumbar segmental instability, disc degeneration, and facet joint osteoarthritis in lumbar spinal stenosis","volume":"10","author":"Yoshiiwa","year":"2016","journal-title":"Asian Spine J"},{"key":"B14","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1016\/j.jocn.2020.06.013","article-title":"Dose preservation of ligament flavum really help prevent postoperative epidural fibrosis and improve outcome in microdiscectomy?","volume":"80","author":"Li","year":"2020","journal-title":"J Clin Neurosci"},{"key":"B15","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1016\/j.neuchi.2021.09.005","article-title":"Pathogenesis, etiology and treatment of failed back surgery syndrome","volume":"68","author":"Alizadeh","year":"2022","journal-title":"Neurochirurgie"},{"key":"B16","doi-asserted-by":"publisher","first-page":"797","DOI":"10.23736\/S0375-9393.22.16405-9","article-title":"Anatomical changes of the ligamentum flavum and the epidural space after spinal surgery: a retrospective magnetic resonance imaging study","volume":"88","author":"Song","year":"2022","journal-title":"Minerva Anestesiol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"3804","DOI":"10.1038\/s41598-023-30928-x","article-title":"Ligamentum flavum analysis in patients with lumbar discus hernia and lumbar spinal stenosis","volume":"13","author":"Aleksi\u0107","year":"2023","journal-title":"Sci Rep"},{"key":"B18","doi-asserted-by":"publisher","first-page":"773","DOI":"10.31616\/asj.2020.0041","article-title":"Morphological changes in the ligamentum flavum in degenerative lumbar canal stenosis: a prospective, comparative study","volume":"14","author":"Hulmani","year":"2020","journal-title":"Asian Spine J"},{"key":"B19","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1016\/s0090-3019(01)00677-2","article-title":"Clinical and radiological results of lumbar microdiskectomy technique with preserving of ligamentum flavum comparing to the standard microdiskectomy technique","volume":"57","author":"Aydin","year":"2002","journal-title":"Surg Neurol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1016\/j.jocn.2019.02.010","article-title":"Surgical outcome and efficacy of lumbar microdiscectomy technique with preserving of ligamentum flavum for recurrent lumbar disc herniations","volume":"63","author":"Y\u00fcce","year":"2019","journal-title":"J Clin Neurosci"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1889","DOI":"10.1007\/s00701-022-05262-2","article-title":"Accidental dural tear in lumbar spine surgery","volume":"164","author":"Tsitsopoulos","year":"2022","journal-title":"Acta Neurochir (Wien)"},{"key":"B22","doi-asserted-by":"publisher","first-page":"918","DOI":"10.5137\/1019-5149.JTN.14065-15.2","article-title":"Dural tear: a feared complication of lumbar discectomy","volume":"26","author":"Albayrak","year":"2016","journal-title":"Turk Neurosurg"},{"key":"B23","doi-asserted-by":"publisher","first-page":"E155","DOI":"10.1097\/BRS.0000000000003213","article-title":"The true effect of a lumbar dural tear on complications and cost","volume":"45","author":"Alluri","year":"2020","journal-title":"Spine (Phila Pa 1976)"},{"key":"B24","doi-asserted-by":"publisher","first-page":"224","DOI":"10.3171\/spi.2006.5.3.224","article-title":"Predictive factors for dural tear and cerebrospinal fluid leakage in patients undergoing lumbar surgery","volume":"5","author":"Sin","year":"2006","journal-title":"J Neurosurg Spine"},{"key":"B25","doi-asserted-by":"publisher","first-page":"115","DOI":"10.17116\/neiro2016806115-117","article-title":"Prevention and treatment of postoperative epidural scar adhesions. Profilaktika i lechenie posleoperatsionnogo rubtsovo-spaechnogo \u00e9pidurita","volume":"80","author":"Zav\u2019yalov","year":"2016","journal-title":"Zh Vopr Neirokhir Im N N Burdenko"},{"key":"B26","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1016\/j.clineuro.2015.08.018","article-title":"Retrospective analysis on correlation factors of preserving the ligamentum flavum in microendoscopic discectomy","volume":"139","author":"Li","year":"2015","journal-title":"Clin Neurol Neurosurg"},{"key":"B27","doi-asserted-by":"publisher","first-page":"e378","DOI":"10.1016\/j.wneu.2018.02.186","article-title":"Revisiting ligament-sparing lumbar microdiscectomy: when to preserve ligamentum flavum and how to evaluate radiological results for epidural fibrosis","volume":"114","author":"\u00d6zay","year":"2018","journal-title":"World Neurosurg"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-025-08960-4","article-title":"Protection of the ligamentum flavum reduces epidural fibrosis formation in endoscopic lumbar discectomy","author":"Merter","year":"2025","journal-title":"Eur Spine J"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1028","DOI":"10.14245\/ns.2244344.172","article-title":"Full endoscopic ligamentum flavum sparing unilateral laminotomy for bilateral recess decompression: surgical technique and clinical results","volume":"19","author":"Kwon","year":"2022","journal-title":"Neurospine"},{"key":"B30","doi-asserted-by":"publisher","first-page":"E385","DOI":"10.1097\/01.BRS.0000085100.10349.15","article-title":"A ligamentum flavum-preserving approach to the lumbar spinal canal","volume":"28","author":"Askar","year":"2003","journal-title":"Spine (Phila Pa 1976)"},{"key":"B31","doi-asserted-by":"publisher","first-page":"1896","DOI":"10.1007\/s11999-014-3674-y","article-title":"How should we grade lumbar disc herniation and nerve root compression? A systematic review","volume":"473","author":"Li","year":"2015","journal-title":"Clin Orthop Relat Res"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2025.1627051\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T05:23:35Z","timestamp":1760937815000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2025.1627051\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,20]]},"references-count":31,"alternative-id":["10.3389\/fsurg.2025.1627051"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2025.1627051","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,20]]},"article-number":"1627051"}}