Comparison Of The Effects Of Posterior Interbody Fusion And Modified Endoscopic Interbody Fusion In The Treatment Of Multi-segment Lumbar Disc Herniation

Research BackgroundLumbar disc herniation is one of the common diseases in spine surgery.In recent years,the incidence has gradually increased,and it has attracted more and more attention from orthopedic surgeons.The intervertebral disc is a bony structure located between the vertebral bodies,which continuously transmits the load generated by gravity and muscle movement.Due to the particularity of the structure and location,the lumbar intervertebral disc is more prone to disc herniation.When the lumbar intervertebral herniated tissue compresses the adjacent spinal nerve roots,the corresponding nerve compression symptom occurs,which is called lumbar disc herniation.These symptoms cause severe pain in patients,greatly affect the quality of life of patients,and seriously endanger the physical and mental health of patients.For most patients,non-surgical treatment is the preferred treatment.90%of patients can relieve pain after non-surgical treatment.After non-surgical treatment fails,you can choose surgery to treat lumbar disc herniation.The surgical treatment of lumbar disc herniation has been relatively mature.For single-segment lumbar disc herniation,the herniated nucleus pulposus is usually used to relieve the symptoms of nerve compression,but the incidence of postoperative low back pain is high.For multi-segment lumbar disc herniation,the traditional method is PLIF treatment.However,PLIF will damage the spinous process,vertebral arch,interspinous and supraspinous ligament,and then damage the posterior midline structure of the spine,which will cause more serious iatrogenic damage.The probability of postoperative complications is higher,and postoperative pain and postoperative bleeding also occur more frequently.In recent years,with the development of endoscopic technology,a variety of endoscopic surgical methods have been proposed,which has become a treatment method with less trauma.Inspired by these surgical methods,we designed an improved endoscopic intervertebral fusion to treat multi-segment lumbar disc herniation.In clinical treatment,this operation is effective for postoperative bleeding and postoperative complications of multi-segment lumbar disc herniation.The symptoms are significantly less,the postoperative incision is small and the recovery is quick,and the effect is obvious.This study retrospectively analyzed and compared the effects of modified endoscopic interbody fusion and traditional PLIF surgery in the treatment of multi-segment lumbar disc herniation.ObjectiveTo explore the comparison of the effects of traditional posterior interbody fusion and modified endoscopic interbody fusion in the treatment of multi-segment lumbar disc herniation,and to provide new methods and evidence for the treatment of lumbar disc herniation.MethodsSelected 62 patients with multi-segment lumbar disc herniation who were admitted to the fifth ward of orthopedic surgery of The First Affiliated Hospital of Zhengzhou University from September 2017 to September 2019,and divided them into traditional groups according to the surgical methods adopted by different patients(31 cases)and the modified group(31 cases).The traditional group was treated with traditional posterior lumbar interbody fusion(PLIF),and the modified group was treated with modified endoscopic interbody fusion.Sort out the operation time,intraoperative bleeding,and postoperative incision length of all patients for comparison.The visual analog scale(VAS)of the two groups of patients before operation,7 days after operation,3 months,and 1 year were collected to assess the improvement of pain,and the Oswestry Dability Index(ODI)at the same time point was collected to compare the degree of quality of life impairment.The Japanese Orthopaedic Association Scores(JOA)were used to evaluate the long-term clinical efficacy before the operation and the last follow-up.ResultsThe operation time and intraoperative blood loss of the modified group were lower than those of the traditional group,and the incision length and bed time were shorter than those of the traditional group.The difference was statistically significant(p<0.05).The VAS score and ODI index of the traditional group and the modified group were lower than those before the operation at each time point after operation,and the difference was statistically significant(p<0.05).There was no significant difference between the two groups of patients in preoperative VAS score and ODI index(p>0.05);the VAS score and ODI index at 7 days and 3 months after surgery were lower in the observation group than in the control group,and the difference was statistically significant(P<0.05);At 1 year,the difference between the two groups of patients’ VAS score and ODI index was not statistically significant(p>0.05).ConclusionsModified endoscopic interbody fusion and traditional posterior interbody fusion have good clinical effects in the treatment of patients with multi-segment lumbar disc herniation.However,compared with the traditional posterior interbody fusion,the modified endoscopic interbody fusion to treat patients with multi-segment lumbar disc herniation is less traumatic and has a better early recovery effect after surgery.