Clinical Efficacy Of Microendoscopic Lumbar Discectomy Combined With Annulus Repair In The Treatment Of Lumbar Disc Herniation

Objective:1、To investigate influential factors related to recurrence after microendoscopic discectomy(MED)for lumbar disc heniation.2、This paper aims to investigate the safety and clinical efficacy of Microendoscopic lumbar discectomy(MED)combined with annulus suture in the treatment of lumbar disc herniation,and whether it can significantly reduce the recurrence rate after operation.Methods:A total of 213 patients with lumbar disc herniation treated with MED in Department of Spinal Surgery from June 2011 to March 2014,There were 118 males and 95 females,with a mean age of 38.07±13.23 years.The risk factors such as age,body mass index,Intervertebral disc degeneration、Operative vertebra and types were recorded and measured。A total of 290 patients with lumbar disc herniation treated with MED in Department of Spinal Surgery from March 2012 to March 2014,who met the inclusion criteria,were followed-up and analyzed.There were 160 males and 130 females,with a mean age of 38.13±12.08 years.This study included 118 cases of microendoscopic discectomy combined with annulus suture(suture group)and 172 cases of microendoscopic discectomy(control group).The height of disc space were recorded and measured,together with operation time and blood loss.The clinical outcomes were then evaluated by Oswestry disability index(ODI)and Visual analogue scale(VAS).The single factor chi-squared and multiple logistic regression analysis were used to evaluate the relationships between the recurrent LDH and the influential factorsincluding age,BMI,postoperative activity level,and degenerative level,type of LDH.Results:All cases have been followed-up for an average of 28.35±5.08 months(range from 24 to 32 months).And there was no significant difference between the two groups in the average operation time and blood loss.In both groups the Oswestry disability index(ODI)and visual analog scale(VAS)scores were significantly decreased in the pre-operation and follow-up after 3 months and the last follow up,which is statistically significant(P<0.05);but no significant simultaneous difference was observed(P>0.05).On average,disc height reduced by 19.83%(8.29±1.43 mm vs.10.34±1.74 mm)in the last follow-up in control group.In the suture group the disc height reduced by 14.53%(8.94±1.35mm vs.10.46±1.55mm),while the difference was not statistically significant between the two groups(F=1.461,P=0.230).There were 14 cases of recurrence after operation in the control group and 3 cases in suture group,Control group of 6 patients received surgery again and 1 case in suture group.The recurrence rate was 8.14%in the control group and 2.54%in the suture group.The reoperation rate was 3.49%in the control group and 0.85%in the suture group.The two groups displayed significant difference in the recurrence rate(χ2=3.973,P=0.046)and reoperation rate.Single factor chi-squared analysis and Muhivariate analysis revealed intervertebral disc degeneration degree,herniation type and postoperative activity level were risk factors for recurrent LDH.Conclusions:1.These findings indicate that microendoscopic discectomy combined with annulus repair is simple in operation,safe and feasible.Compared with discectomy alone,additional annulus repair can obtain equivalent and remarkable clinical outcomes,however it cannot alleviate the back pain in general.The recurrent rate and reoperation rate can be reduced significantly if the procedure is performed in patients with certain surgical indications.2.The intervertebral disc degeneration degree,herniation type and postoperative activity level were risk factors for recurrent LDH.