| Objective:To compare the clinical efficacy of Isobar TTL dynamic non-fusion internal fixation and Simple Discectomy in the treatment of single-segment lumbar disc herniation and its effect on upper adjacent segment disc degeneration.Methods:The clinical data of patients with single segmental lumbar disc herniation who were hospitalized in the Department of Spinal surgery of the first affiliated Hospital of Soochow University from December 2015 to December 2018 were collected.According to the inclusion and exclusion criteria,78 patients were followed up,including 38 patients with Isobar TTL dynamic non-fusion internal fixation(dynamic group)and 40 patients with simple nucleus pulposus extraction(single extraction group).After admission,the X-ray,CT and MRI,imaging parameters of anterior and lateral position and dynamic position of lumbar spine were improved,including total range of motion of lumbar spine,range of motion of operative segment,range of motion of adjacent superior segment,height of intervertebral space of operative segment and height of adjacent superior segment.UCLA system and modified Pfirrmann grading system were used to evaluate intervertebral disc degeneration in superior adjacent segments.The hospitalization time,operation time,intraoperative blood loss,postoperative recovery and perioperative complications were recorded.The treatment score(JOA),pain visual analogue score(VAS)and lumbar vertebra dysfunction index(ODI)were used to evaluate the curative effect.Through the analysis of clinical and imaging,the advantages and disadvantages of the two methods were comprehensively evaluated.Results:The follow-up period ranged from 24 to 32 months(mean 28.7 months).There was no significant difference in sex,age,body mass index and basic diseases between the dynamic group and the single extraction group(P>0.05).The results of the last follow-up showed that the VAS score of dynamic group decreased from 7.92±2.37 to 27.37±1.51,and that of simple extraction group decreased from 7.88±2.26 to 23.88±3.81 and from 41.47±4.64 to 11.16±2.72%,respectively.The VAS score of simple extraction group decreased from 7.88±2.26 to 23.88±3.81.The VAS score of simple extraction group decreased from 40.78±5.69 to 12.93±4.59.The score of the dynamic group decreased from 7.88±1.21 to 0.89±0.82.The score of the dynamic group decreased from 41.47±4.64 to 11.16±2.72%,and that of the simple extraction group decreased from 7.88±2.26 to 23.88±3.81.The postoperative clinical scores of the two groups were significantly higher than those before operation,and there were significant differences in JOA score and ODI index between the two groups.In the single extraction group,the average hospital stay was 7.48±1.67 days,the operation time was 78.68±13.01 minutes,and the intraoperative blood loss was 136.68±22.64ml.In the dynamic group,the average hospital stay was 9.26±2.16d,the operation time was 96.42±17.37min,and the intraoperative blood loss was 169.08±30.58ml.The results of the last follow-up showed that in the dynamic group,the total range of motion of lumbar vertebrae decreased from 35.84±3.82°to 35.79±3.64°,the range of motion of the operative segment decreased from 6.79±1.54°to 5.74±1.80°,the range of motion of the upper adjacent segment decreased from 7.37±1.74° to 7.24±1.77°,the height of the intervertebral space of the upper adjacent segment decreased from 8.34±1.95mm to 7.6±1.46mm,and the height of the intervertebral space of the upper adjacent segment decreased from 9.63±1.88mm to 9.29±1.93mm.In the single excision group,the total range of motion of lumbar vertebrae decreased from 35.53±3.68°to 35.28±2.83°,the range of motion of the operative segment decreased from 6.73±1.58°to 5.63±1.81°,the range of motion of the superior adjacent segment increased from 7.38±1.61° to 8.18±1.78 °,the height of the intervertebral space of the upper adjacent segment decreased from 9.88±1.91mm to 8.23±1.57mm,and the height of the intervertebral space of the upper adjacent segment decreased from 8.38±1.96mm to 6.28±1.36mm.There were significant differences in postoperative imaging scores between the two groups(P<0.05).There were significant differences in the range of motion and the height of intervertebral space between the two groups(P<0.05).The results of UCLA classification and modified Pfirrmann classification showed that the degeneration rate of superior adjacent segments in the dynamic group was much lower than that in the single extraction group.In addition,no related complications such as screw loosening and fracture,recurrence of lumbar disc herniation and other related complications were found in all patients in the dynamic group during the follow-up period.There were 3 cases of recurrence of lumbar disc herniation in the single extraction group,and there was significant difference in the recurrence rate of postoperative LDH between the two groups(P<0.05).Conclusion:Isobar TTL dynamic non-fusion internal fixation has a good clinical effect in the treatment of single-segment lumbar disc herniation.Compared with simple removal of nucleus pulposus,this method can effectively improve the postoperative physiological function of lumbar vertebrae,reduce the recurrence rate of postoperative lumbar disc herniation,and delay the degeneration of adjacent segments. |
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