Endoscopic Lumbar Laminoplasty In The Treatment Of Lumbar Disc Herniation And Spinal Stenosis

BackgroundLumbar degenerative diseases mainly include lumbar disc herniation,lumbar spinal stenosis,degenerative scoliosis,lumbar degenerative spondylolisthesis,and a series of lumbar and leg pain syndromes caused by lumbar degeneration^[1].Among them,lumbar disc herniation and lumbar spinal stenosis are frequent diseases in orthopedic degenerative diseases.Reasonable and effective treatment of these diseases has become the focus of attention of doctors.At present,the surgical methods for the treatment of lumbar disc herniation and lumbar spinal stenosis mainly include traditional open lumbar posterior surgery,interventional surgery,intervertebral disc mirror,and intervertebral foramen mirror.The refinement and minimally invasive surgery is the main theme of surgical development.It is also the pursuit of surgeons^[2].With the advancement of science and technology,many ideas of doctors have been made possible,and medical technology has made rapid progress.The birth of endoscopic system has made spine surgery an important step towards minimally invasive surgery.The clinical application of 3D printing technology has left a deep impression on the accuracy of spine surgery^[3-4].A perfect surgery consists of the formulation of the plan,preoperative preparation,fine intraoperative operation,and postoperative care.Endoscopic lumbar laminoplasty inherits the advantages of traditional surgical decompression,which is completely fixed and reliable.It also follows the development trend of minimally invasive lumbar spine surgery recommended by discectomy and transforaminal endoscopic surgery.Thorough decompression,fusion and reliable treatment^[5].In the treatment of lumbar degenerative diseases using endoscopic pedicle screw fixation,this medical group found that although the pedicle screw fixation under the endoscope minimizes the trauma on the premise of ensuring complete decompression,the vertebra Plate removal has a more or less psychological effect on the patient’s structural integrity and stability of the spine.Yucesoy et al^[6]carried out animal experimental studies on rats,and removed the lamina of 7 rats and then replanted them.It was found that there was no significant fiber scar formation after laminectomy.Adachi et al.^[7]also pointed out that Plate resection and replantation canal enlargement surgery can improve the stability of the spine,so the modified implementation of endoscopic lumbar laminoplasty,along with the application of 3D printing^[8-10]in orthopedics,if reasonable combination of 3 D The printing technology can be used to design the patient for individual surgery.Through the analysis of the data,it is possible to accurately select the internal fixation objects or custom internal fixation objects,and to estimate the lumbar lordosis angle and the horizontal angle of the sacrum.Through the simulation operation,the operation can be further improved accurate.PurposeTo compare the efficacy of endoscopic lumbar laminoplasty and traditional open lumbar posterior fusion for lumbar disc herniation and lumbar spinal stenosis.MethodPatients with lumbar disc herniation and lumbar spinal stenosis admitted to the five wards of the First Affiliated Hospital of Zhengzhou University from June 2016 to December 2016 were divided into two groups on a voluntary basis.One group of patients underwent endoscopic lumbar laminoplasty（Endoscopic group）and the other group underwent lumbar posterior fusion（Open group）.There were 36 cases of endoscopic lumbar laminoplasty and 40 cases of traditional open lumbar posterior fusion.Preoperative and routine examinations were performed in both groups.The incision length,intraoperative blood loss,operation time,and postoperative bed rest time were compared between the two groups.The preoperative and postoperative 2weeks were recorded and compared between the two groups.The visual pain simulation score（VAS）,Oswestry dysfunction index（ODI）score,and Japan Orthopedic Association（JOA）score were evaluated in March and June.ResultThere were 36 patients in the endoscopic group,15 males and 21 females,aged 18 to 68 years,with an average of 41.50 years.40 patients were open,18 males and 22 females,aged 17 to 72 years,with an average of 41.05 years.All patients in the group successfully completed surgery and follow-up.Compared with the open group,the endoscopic group had shorter surgical incisions,less blood loss during operation,shorter bed rest time after operation,and lower incidence of postoperative low back pain.There was no significant difference in the operation time between the two groups.Early postoperative VAS scores and JOA scores There was no significant difference in ODI scores.No serious complications occurred in either group.ConclusionEndoscopic lumbar laminoplasty is a minimally invasive surgical approach compared to traditional open lumbar posterior fusion with advantages such as small incision length,less blood loss,and shorter postoperative bed rest.Endoscopic lumbar laminoplasty to achieve laminectomy can reduce the incidence of low back pain in patients.