Another Question

Has anyone ever heard of this.

Stacey, Drews girlfriend was telling me this is what they told her.

They said there is nothing they can do for her back because she has an
epidural flap. Something to do with the surgeries she has had on her back.

Does anyone know what this is and if this is true. She is too too young to
have nothing done for her.

--

Love and hugs Jo

(\__/) .~ ~. ))
/O O ./ .'
{O__, \ {
/ . . ) \
|-| '-' \ } )) Warning: squirrels.
.( _( )_.'
'---.~_ _ _&

got me! that's a new one i've never heard. now, you've got me curious and
waiting to hear the answer.

kate

"Squirrely" <sqjo@sonic.net> wrote in message
news:459f382f$0$80061$742ec2ed@news.sonic.net...
Has anyone ever heard of this.

Stacey, Drews girlfriend was telling me this is what they told her.

They said there is nothing they can do for her back because she has an
epidural flap. Something to do with the surgeries she has had on her back.

Does anyone know what this is and if this is true. She is too too young to
have nothing done for her.

--

Love and hugs Jo

(\__/) .~ ~. ))
/O O ./ .'
{O__, \ {
/ . . ) \
|-| '-' \ } )) Warning: squirrels.
.( _( )_.'
'---.~_ _ _&

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

"GARY Z" <dadandone@verizon.net> wrote in message
news:4ENnh.134$Mf2.81@trndny01...
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

Surg Neurol. 2002; 57(1):5-13; discussion 13-4 (ISSN: 0090-3019)

http://www.medscape.com/medline/abstract/11834260

Don't know much myself. The question had me curious and this is the only
pertinent sounding thing I could find on Medscape. Too little information to
do any better and I'm no doctor to begin with.....
GaryZ (practicing to be a t.v. doctor)


"d'huit" <threecedars1@comcast2.net> wrote in message
news:LfmdnQUZyoR0VwLYnZ2dnUVZ_vKunZ2d@comcast.com. ..
>
> 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
>
>
>

Great Gary...Can we call you "House"Oh wait that name is already taken...how
about "Garage"...Hmmm...
Gotta love that guy...We get to see this week what happens to someone if
they leave a rectal thermometer up the wrong persons butt...LOL...

"GARY Z" <dadandone@verizon.net> wrote in message
news:FRTnh.1279$312.891@trndny02...
> Surg Neurol. 2002; 57(1):5-13; discussion 13-4 (ISSN: 0090-3019)
>
> http://www.medscape.com/medline/abstract/11834260
>
> Don't know much myself. The question had me curious and this is the only
> pertinent sounding thing I could find on Medscape. Too little information
to
> do any better and I'm no doctor to begin with.....
> GaryZ (practicing to be a t.v. doctor)
>
>
> "d'huit" <threecedars1@comcast2.net> wrote in message
> news:LfmdnQUZyoR0VwLYnZ2dnUVZ_vKunZ2d@comcast.com. ..
> >
> > 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.


--

Love and hugs Jo

(\__/) .~ ~. ))
/O O ./ .'
{O__, \ {
/ . . ) \
|-| '-' \ } )) Warning: squirrels.
.( _( )_.'
'---.~_ _ _&
"GARY Z" <dadandone@verizon.net> wrote in message
news:4ENnh.134$Mf2.81@trndny01...
> 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
>
>