Short-term Effect Of PELD Via Transforaminalapproach In The Treatment Of Youthful Giant Lumbar Disc Herniation

Objective:Giant lumbar disc herniation(GLDH)has been rare in the past,but its incidence has gradually increased in recent years,and it gradually appears in young people.At present,there are few cases of young people diagnosed with giant lumbar disc herniation clinically.Reports about the treatment of young people with GLDH by percutaneous endoscopic lumbar discectomy(PELD)via transforaminal approach are rare.From May 2016 to April 2017,this article has collected 20 cases of young patients diagnosed with giant lumbar disc herniationour treated by PELD via transforaminal approach.To evaluate the short-term efficacy about the treatment of young patients with giant lumbar disc herniationour,through comparative analysis of the symptoms before and after operation of these 20 patients.Methods: From May 2016 to April 2017,20 cases of young people diagnosed with GLDH were treated with percutaneous endoscopic lumbar discectomy,of which 13 were male and 7 were female,aged between 22 and 39 years.The course of the disease is between 1 months and 1 years.All patients were treated with conservative treatment without obvious effect and required for surgical treatment.Among them,1 case of L3-4section,12 cases of L4-5 section and 7 cases of L5-S1 section.Made sure that the imaging data are consistent with the symptoms.Excluded other diagnosis such as spinal infection、tumor site and femoral head necrosis so on.All the patients underwent the operation named PELD via transforaminal approach under local anesthesia.The lumbar MRI was reviewed on the first day after operation,and the operative segment was compared with preoperative lumbar MRI.Compared preoperative VAS scores of waist and lower limbs with 3 days and 3 months after operation,and ODI score before operation with at the last follow up.Observed the postoperative complications after operation.The clinical efficacy was evaluated by modified Mac Nab score at the last follow-up.Results:All 20 patients underwent the operation successfully.The average time of operation was 60-110 min.The average intraoperative bleeding was 10~20 ml.All 20 patients were followed up for 3 months.The average length of stay was 5~8 days.There were no postoperative complications such as incision infection、nerve injury and so on after operation.Postoperative symptoms of 18 patients were significantly better before.Postoperatively,2 patients got symptoms of numbness and discomfort in the old area of lower extremities.Considering that the nerve root was under pressure for a long time and stimulated during the operation.After giving symptomatic treatment such as swelling and nutrition to the patient,they were gradually improved.The symptomatic treatment such as swelling and nutritional nerves is gradually improved.Lumbar MRI was performed on the first day of operation in all patients.The degree of disc compression was obviously reduced or disappeared in 19 cases.In only 1 case,the compression was still present,but the invasion was less than 50% of spinal canal.The VAS scores of waist pain before operation,3 days and 3 months after operation were 4.0±1.05,2.1±0.99 and 1.4±0.96 respectively.The VAS scores of lower limbs pain before operation,3 days and 3 months after operation were 6.4±0.97,2.5±0.85 and 1.9±1.13 respectively.ODI score was(52.23±18.56)% before operation and ODI score was(13.45±4.97)% for3 months after operation.The postoperative indexes were significantly lower than those before operation,and the difference was statistically significant(P<0.001).According to the modified Mac Nab score,in the last follow-up,the numbers of patients who were evaluated as excellent,good,fair at 3 months after operation were 15(75%),3(15%)and2(10%)respectively and overall good rate was 90%.Lumbar MRI was performedon the first day after operation in all patients.The degree of disc protrusion was obviously reduced or disappeared in 19 cases.In only 1case,the prominent disc was still present,but less than 50% of sagittal diameter of the spinal canal,and the symptoms were reduced before surgery.Conclusion:After the treatment of PELD via transforaminal approach,the youthful giant lumbar disc herniation achieved a better short-term outcomes.