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Micro discectomy system in the treatment of lumbar disc and the curative effect of lateral recess stenosis

Chinese papers League finishing. Of: Jiang Yu, Ye Zhengyun,jimmy choo south africa, Wu Xiaosong, YANG Shuhua Abstract [Objective] To analyze the system micro lumbar discectomy (MED) in the treatment of lumbar disc herniation and lateral recess stenosis of the technical characteristics and efficacy. [Method] 45 cases of lumbar disc herniation in our hospital and lateral recess stenosis were used MED surgery and conventional open surgery, a comparative study of two groups of patients. [Results] were followed up for 6 to 18 months, according to Macnab criteria: MED surgical group of 23 patients were excellent in 17 cases, good in 4 cases, good rate of 91.3%; conventional open surgery group, 22 cases were excellent in 15 cases, good in 5 cases, good rate 90.9% clinical efficacy was no significant difference (P> 0.05). Two groups of blood loss, operation time and hospital stay were significantly different (P <0.05). [Conclusion] MED for patients with disc herniation and lateral recess stenosis, but also surgical trauma, less bleeding, rapid postoperative recovery advantages. Key words lumbar; disc; micro discectomy system; lateral recess stenosis side of the lumbar disc and recess stenosis surgical treatment in the past advocated more than open surgery. Although traditional open surgery is effective, but more often due to bleeding, operation time and postoperative length of stay in bed for a long time to be most difficult patients. With minimally invasive spinal surgical techniques become more sophisticated, using minimally invasive surgical treatment of lumbar disc and lateral recess stenosis has been more and more attention. Hospital from January 2005 ~ June 2006 lumbar disc herniation were treated, and lateral recess stenosis in 45 cases, posterior application of micro discectomy system (microendoscopic discectomy, MED) and conventional open surgery, and its operative characteristics Clinical analysis and comparison, the report is as follows. 1 clinical data 1.1 General Information were treated lumbar disc and lateral recess stenosis in 45 cases, including 31 males and 14 females; aged 38 to 61 years, mean 43.5 years old. No previous surgical history of the segment, no other system disorders. All patients had obvious physical signs of nervous system damage, the patient underwent preoperative CT or MRI examination and lumbar dynamic digital X-ray examination, measurement of disc height and sagittal diameter of lateral recess confirmed lumbar disc herniation and lateral recess stenosis and exclusion of lumbar instability. MED in 23 patients underwent surgery, while the other 22 patients served as control with conventional open surgery. The two groups were bleeding, operation time and hospital stay. 1.2 MED surgical operation group: all take the prone position, prone on the overhead rack spinal surgery, abdominal vacant. Epidural anesthesia. Kirschner wire with a fine level in the corresponding disc space into the spinal midline, C-arm X-ray machine positioning. Used in the adjacent segment disease or after the median sternotomy incision about 2 cm, according to the order of the expansion pipe into the muscle, to establish a working channel, and fixed. Endoscope and cold light source connected, adjust the focus and direction. Determine the laminar space, biting yellow ligament and part of lamina than to expose the dura and nerve roots, exploration herniated disc, cut the fibrous ring, highlight the nucleus removed. Detect nerve root canal, lateral recess of the narrow line of the full expansion of decompression, nerve root activity until well so far. To a large number of sterile saline irrigation and surgical incision intervertebral space, sodium hyaluronate into the prevention of postoperative adhesions. Postoperative wound drainage tube set, 24 h extraction. For the first 3 d after mannitol 250 ml + 5 mg of dexamethasone intravenously, 2 / d. Conventional open surgery group routine fenestration (or semi laminectomy) + + crypt expansion discectomy surgery, surgery after treatment with the MED group. 1.3 OUTCOME MEASURES effect according to Macnab criteria 〔1〕 into excellent, good, fair, and poor in 4. Good: signs completely disappeared, restoring the original work; good: symptoms and signs disappeared, sometimes a sense of low back pain or leg soreness, recovery work; to: improve symptoms, left with mild back pain or leg discomfort; difference: Symptoms and signs no improvement, can not engage in normal work and life. The two groups were also recorded blood loss, operative time, postoperative hospital stay (Table 1). 2 results 45 patients were stage Ⅰ incisions healed without complication. All patients received postoperative visit, followed up for 6 to 18 months, an average of 10 months. Two groups were age, duration and imaging data by t test, no significant difference (P> 0.05). MED surgery group according to Macnab criteria, 23 cases excellent in 17 cases, good in 4 cases, 2 cases, the fine rate was 91.3%; conventional open surgery group, 22 cases were excellent in 15 cases, good in 5 cases, 2 cases, good rate of 90.9%. The two groups had no significant clinical differences (P> 0.05). Two groups of blood loss, operation time and hospital stay (Table 1) were significantly different (P <0.05). Table 1 groups the amount of bleeding, surgical time, postoperative hospital stay compared (omitted)