Clinical Effect Of Lumbar Nucleus Pulposus Excision Through Small Surgical Incision With Minimally Invasive Retractor

Background:In recent years,the concept of minimally invasive surgery for the treatment of lumbar disc herniation is becoming more and more familiar to doctors and patients.During the past 30 years,surgery technology of minimally invasive has made great progress.But in low level hospital,it seems to be difficult to carry out these advanced technology because of the high learning difficulty,expensive equipment and poor trust of patients.In this study,we used a small incision procedure assisted by a kind of special minimally invasive retractor to perform LNPE(Lumbar Nucleus Pulposus Excision)in the treatment of LDH(Lumbar Disc Herniation).Purpose:To compare the short-term and long-term outcomes of small incision with minimally invasive retractor,Microendoscopy Discectomy(MED)and traditional lumbar nucleus pulposus resection(LNPE)in the treatment of lumbar disc herniation.Methods:The authors performed a retrospective review of 98 individuals with lumbar disc herniation who underwent an one-level lumbar nucleus pulposus resection from January 2010 to January 2017.They were randomly divided into 3 groups,respectively for minimally invasive retractor assisted small incision discectomy(36 cases),microendoscopic discectomy(29 cases)and the traditional open approach discectomy(33 cases).There has no obvious statistical differences in age,proportion of gender,disease duration,preoperative VAS(visual analogue scale)between every groups(P>0.05).The operation time,intraoperative bleeding volume,postoperative hospitalization time,short-term and long-term pain VAS score and JOA(Japanese Orthopedics Association)low back pain score were all compared,as well as the clinical efficacy in the future.Results:The rate of excellent and good of postoperative JOA score in the three groups was 91.7%,93.1%and 90.9%respectively,there was no significant difference.When it comes to incision length,bleeding volume,CRP,postoperative hospitalization time and short term VAS of back pain(1,7 day after operation),minimally invasive incision retractor group was significantly better than the traditional operation group.And the operation time is shorter than that in the MED group with a statistically significant difference.Conclusion:Small incision lumbar discectomy assisted by minimally invasive retractor could made a similar clinical effect compared to traditional operation with smaller invasion.Also it is easy to learn and could be operated with lower risk.And is worth promoting in all levels of hospitals.