| Object:Lumbar disc herniation is based on the degeneration of intervertebral disc, The nucleus pulposus protrusion or breakthrough in the fiber ring, secondary compression of nerve root and concomitant nerve root inflammation, waist and leg pain symptoms in clinic. According to the prominent position can be divided into: central type, the side central type, the extreme lateral type. Among them, L5-S1, L4-5 accounted for about 90%. Cause lateral recess stenosis, The pathologic findings were fiber ring fracture, The nucleus pulposus is still connected to the intervertebral disc, across the intervertebral space. Cause limitations and strction compression contact with the nerve root zone. The main involvement of the sinus nerve and sciatic nerve, partial involvement of the Cauda equina, lead to low back pain, lower limb radiation pain, limb temperature drop, subjective numbness, sphincter dysfunction and other clinical symptoms. The traditional surgical treatment of lumbar disc herniation(including semi or total laminectomy), fenestration decompression, interbody fusion, It has the disadvantages such as surgical trauma, bleeding, long recovery time and so on. While to remove the nucleus pulposus accurately through the minimally invasive technique Under the intervertebral foramen mirror, can handle almost all types of lumbar disc herniation, with less trauma, less bleeding, faster recovery and so on. This study was to investigate the clinical effect of the treatment of lumbar disc herniation by observing the improvement of clinical symptoms after operation. Method:From May 2013 to September 2014, 39 cases of lumbar disc herniation patients in our hospital for the operation of the nucleus pulposus removal underwent transforaminal endoscopic discectomy. Including L4-5 segment 27 cases, 12 cases of L5-S1 segment, All patients underwent MRI and CT examination before operation,Improve the relevant examination and then the operation of the intervertebral foramen mirror. Surgical position with lateral decubitus or prone position, positioning responsibility vertebra clearance and the needle position under C arm, L4-L5 and L5-S1 level, the next to the center line 12-14 cm for the point of the needle. Make a straight line to the center line of the needle point, through the small joints of the upper edge, the intersection point is the puncture point. The use of methylene blue for discography, clear the type of disc herniation and spinal canal. Along the guide wire needle progressive expansion operation channel after the arrival of the intervertebral disc, using trephine drill or power drill enlargement of intervertebral foramen. Work properly placed into the casing, endoscope, under the mirror use rongeur to remove the nucleus, releasing nerve root compression, and finally the use of bipolar radiofrequency to repair the rupture of annulus. The patients in this group were 39 cases, 23 males and 16 females. The age ranged from 32 to 65 years. The average age was 48.5 years. Using the visual analogue scale(VAS), JOA low back pain scoring method to assess the efficacy of pain. Results:This group of 39 patients, 37 cases of patients with good effect and follow-up, follow-up time of 3 months, Patients with preoperative and postoperative 3 months, compared with the VAS score, there were significant differences(p<0.01), Patients with preoperative and postoperative 3 months, compared with the JOA score, there were significant differences(p<0.01). There was no infection of intervertebral space and the increase of the preoperative nerve injury in this group. There were 2 patients who had recurrence after 3 months of operation. Conclusion:it is effective and safe to treat lumbar intervertebral disc herniation through the percutaneous lumbar intervertebral foramen mirror. The recent curative effect is satisfactory. It is the key to grasp the operation indications strictly... |
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