Laminectomy Decompression Of Nerve Root Canal Exploration To Expand The Clinical Observation Of Bone Graft Treatment Of Lumbar Disc Herniation

Objective:lumbar disc herniation( LDH )is an ancient disease, but it was diagnosised firstly until 1932, now it has become one of the most common causes which lead to low back pain. For the failure of a strict system conservative treatment of the lumbar disc herniation(LDH), lumbar disc surgery is undoubted one of the most effective and reliable method for lumbar disc herniation(LDH). The metheds of the treatment of lumbar disc herniation(LDH) which is from the traditional full-laminectomy to the microendosocpic diseectomy(MED), and so on, are all kinds of advantages and disadvantages .Considerating technical and economic factors, they are all not easy to make more widespread. The purpose of this study is to conclud a positive healing method which is effective and suitable widely. The specific purpose of the study are as follows:(1)Introduced on a surgical methods of treating lumbar disc herniation (LDH): Fenestration , posterolateral sacralization after nerve root canal's check and decompression.(2)To explore the healing effect of nerve root canal decompression and posterolateral fusion of the lumbar disc surgery in short-term and near future.(3)To explore wheather make the nerve root canal exploration and posterolateral bone grafting surgery as a conventional steps in lumbar disc herniation surgery.Methods:Retrospectively summarying 28 patients cases collected in the study when I had been internship between 2006 and 2008 in the People's Hospital of Hubei Province, who aged from 33 years old to 70 years old, clinical diagnosis is lumbar disc herniation (LDH). Acquisition cases, according to incorporative criteria and exclusive criteria. Each case makes conventional nerve root canal's exploration after laminectomy and decompression, if its nerve root horizontal movement <1cm, or nerve root canal is narrow compression between the entrance and the bone or soft tissues (such as the proliferation ligamentum flavum), we will fully remove the oppression, make the bone of creeping expansion of osteal nerve root canal expand sneakedly, and then grafting the artificial bone and bitted bone into the transverse process, between processus articular superior and processus articularis inferior which were bitted in surgery. Evaluating the functional recovery in long-term accordings to Nakai's evaluative criteria. By the short-term respondents (1 months) and long-term (more than one year) following-up and referral observating, to get a overall of the efficent evaluation for this operation.Results:In this study ofn 28 patients cases, 24 patients were found that their nerve root canals were stenosed (accounting for 85.7%) during the opration,which were all made nerve root canal's decompression and posterolateral sacralization.The longest follow-up is 18 months, the shortest one is six months, the average is 12.6 months.After surgery the short-term (one month) efficiency of clinical symptoms improvement is 100%,of whose symptoms completely or basic improvement within a week is 21 cases, accounting for 75 percent.Follow-up of 28 cases,there were 20 cases reviewed X-ray in outpatient service , which have shown that bone graft is in good condition ; In addition, there are eight cases did not review X-ray films because of personal reasons.Conclusion:Nerve root canal deocmpression Besides fenestration diskectomy and ipsilateral lateral mixed bone graft operation brings together the advantages of fenestration, minoring trauma to the surrounding bone and soft tissue, damaging to the structure of posterior spinal smaller;Furthermore, through the nerve root canal's check and decompression, we can avoid that the effect of single discectomy is not satisfactory because of neglecting nerve root canal stenosis, and guarantee the effectiveness of the operation and the value of the operation;through the appropriate corresponding posterolateral fusion, we can take precautions against instablility of vertebral column which results from gnawing processus articular superior and processus articularis inferior off in excess,and ensure the long-term effect of the surgery. The operation is a relatively simple and easy method to master for clinicians, and has significant effect, so it is easy to spread.This opration can be used as a routine step in lumbar disc herniation surgery.