Clinical Study Of Improved Spinal Endoscopy In The Treatment Of Lumbar Disc Herniation

Background and Objective:With the development of technology,rapid update of endoscopic equipment,the emergence of spinal endoscopy provides a new minimally invasive surgical plan for the treatment of lumbar disc herniation.Compared with open surgery,traditional spinal minimally invasive surgery microendoscopic discectomy,Quadrant expandable channel system for the treatment of lumbar disc herniation,percutaneous spinal endoscopy is a more minimally invasive spinal surgery technique,Theoretically,the percutaneous spinal endoscopy surgical effect is significant.Percutaneous spinal endoscopy with nucleus pulposus removal has minimally invasive features and benefits,such as light structural interference in the lumbar spine,spinal stability is not affected,scar adhesion is very light,with minimal incision,minimal damage,minimal bleeding,fast recovery after surgery and low recurrence rate.Percutaneous spinal endoscopy has become the development trend of minimally invasive treatment of lumbar disc herniation.In our studies,we use CT three-dimensional reconstruction to obtain the related data of lumbar intervertebral foramen and analyze them.Which can provide a safe and convenient anatomical basis for endoscopic posterolateral approach,provides theoretical support for safe puncture and tube Placement,and also provide reference for targeted puncture or tube placement and modified the approach in theoretical.A Clinical effect Analysis and Follow up Study on The modified targeted transforaminal endoscopic and posterior expand interlaminoplasty for lumbar disc herniation can provide evidence for the clinical promotion of the above two methods.First partMethods:Data were collected from 50 patients who underwent lumbar CT scan and bone three-dimensional reconstruction in the Second Affiliated Hospital of Nanchang University from December 2016 to December 2017,including 30 males and 20 females.The data of the left and right upper intervertebral foramen width,the middle width of the intervertebral foramen,the lower width of the intervertebralforamen,the height of the intervertebral foramen,and the distance from the lower edge of the nerve root to the midline of the intervertebral disc were collected from the three-dimensional CT of the L3-S1-section.The differences between the data were analyzed and compared with the diameter of the spinal endoscopic working channel.The feasibility of posterior lateral approach for endoscopic surgery was analyzed.Results:There was no significant difference in the width of upper intervertebral foramen,the width of the middle of the intervertebral foramen,the width of the lower intervertebral foramen,the height of the intervertebral foramen,and the distance from the lower edge of the nerve root to the midline of the intervertebral disc of the left and right intervertebral foramen of the same lumbar segment(P>0.05).The left and right width of the upper intervertebral foramen,the width of the middle of the intervertebral foramen,the width of the lower part of the intervertebral foramen,and the height of the intervertebral foramen gradually decreased from L3-S1.and from L3-S1,the width of the middle part of the intervertebral foramen was greater than 0.7cm,The working channel can be directly placed without the need for articular formation.The distance from the lower edge of the nerve root to the midline of the intervertebral disc is about 0.5 cm,which is greater than 0.35 cm(the radius of the working channel of the spinal endoscope).If tube placement is used for targeting,No effect on nerve roots and facet joints.Conclusion : The middle of the intervertebral foramen(the plane of the intervertebral disc)has a large width,which is very suitable for the endoscopic surgery of the spinal canal,away from the nerve root,and without the formation of articular processes,can effectively reduce the learning curve and improve the efficiency of puncture and tube placement.The position of the working channel can be appropriately adjusted to remove the protruding nucleus pulposus,and the targeted operation can be completely realized.Second partMethods:Sixty patients with single-segment lumbar disc herniation who were operated in the Second Affiliated Hospital of Nanchang University from January2017 to December 2018 were collected,including 36 males and 24 females.Thelesion segment included 8 cases of L3/4,42 cases of L4/5 and 10 cases of L5/S1.28 cases were prominent on the left side and 32 cases were prominent on the right side.All patients included in the preoperative measurement of the three-dimensional CT L3-S1 intervertebral foramen with a width greater than 7 mm.All patients were treated by the same physician according to random enrollment using conventional targeted or modified targeted transforaminal nucleus pulposus removal.Perioperative data were collected,preoperative,immediate postoperative,postoperative 3 months,postoperative 6 months and last follow-up of straight leg elevation,VAS score,ODI index,and modified Macnab criteria.Results : All patients underwent successful operation without transfer or replacement of the surgical approach.The straight leg elevation angle and VAS scores of the two groups of immediate and postoperative 3 months,half-year and last follow-up were significantly improved compared with preoperative(P<0.01),but there was no difference between the groups.The ODI index at the last follow-up was significantly improved compared with preoperative(P<0.01),and there was no difference between the two groups.According to the improved MacNab standard,the excellent and good rate of the two groups were 93.33%(28/30).All patients had no complications such as infection,dural tear,nerve root injury and nerve root adhesion.One patient in the conventional PETD group had no postoperative pain relief and lower limb muscle strength,and no relief after symptomatic treatment.Open surgery was performed 1 week later.In the modified PETD group,2 patients had residual soreness and numbness after operation,and the symptoms were relieved after 3-6months.One case of recurrence occurred in the next month.Conclusion:Improved targeted transforaminal approach for endoscopic nucleus pulposus removal can be effectively performed with similar efficacy as targeting techniques;It has the advantages of less trauma,less bleeding,faster recovery and less complications.It is effective in short-term,It is a safe and effective minimally invasive surgery.This procedure selects the rupture of the annulus as a target for puncture and tube placement,with high success rate and less fluoroscopy,which can effectively reduce the learning curve.Third partMethods :A total of 30 patients with single-segment lumbar disc herniation/prolapse/prolapse or laminar space stenosis were enrolled in the Second Affiliated Hospital of Nanchang University from January 2017 to December 2018,including 13 males and 17 females.The segment included 3 cases of L4/5,27 cases of L5/S1;intervertebral disc herniation/prolapse 18 cases,intervertebral disc prolapse 7 cases,intervertebral disc free 5 cases;22 cases were soft and prominent,and 6 cases were combined with different degrees of Calcification,2 patients with ankle ring disconnection.All patients were treated with posterior laminar space enlargement and endoscopic nucleotomy with the same physician.Perioperative data were collected,preoperative,immediate postoperative,postoperative 3 months,postoperative 6months and last follow-up for straight leg elevation,VAS score,ODI index,and modified Macnab criteria.Results:All patients successfully completed the operation,there was no transfer opening or replacement of the surgical approach,the operation time was 50-150 min,with an average of 82±10.5min.The straight leg elevation angle and VAS scores of immediate and postoperative 3 months,half-year and last follow-up were significantly improved compared with preoperative(P<0.01).The ODI index at the last follow-up was significantly improved compared with preoperative(P<0.01).According to the modified Macnab standard,the excellent and good rate was 96.67%(29/30).One patient had a decrease in muscle strength of the quadriceps muscle after surgery,It was grade II-III at the time of discharge,after rehabilitation exercise and nutritional neurotherapy,the patient returned to grade IV after 3 months.No infection,hematoma formation,and dura mater and nerve root adhesion complications occurred.Conclusion : Posterior lumbar interlaminar space enlargement of endoscopic nucleus pulposus removal for lumbar disc herniation can be effectively performed.The curative effect is equivalent to conventional PEID technology;It has the advantages of less fluoroscopy,low puncture requirements,It is safe and effective.The operation procedure is similar to the open operation,which is in line with the lumbar posterior lumbar surgery habits,which can effectively reduce the learning curve.it caneffectively complete in the laminar space stenosis and the high degree of prolapse of the intervertebral disc,and expand the indications for endoscopic surgery.