Clinically Comparative Study On The Treatment Of Lumbar Disc Herniation Between Microendoscopic Discectomy And Traditional Open Operation

Objective: To observe and compare short-time and long-time outcome in patients with microendoscopic discectomy or traditionally open operation, investigate how to broaden the indications of MED and make the clinical application of MED further progress by the comparison with MED and open operation.Method: In the first place, the standards of fit and rejection were formulated. We select eighty patients in hospital with lumbar disc herniation during Oct 1,2000-Dec31,2001 and divide them into group A and guoupB, each group having forty patients. The patients in groupA were performed with open operation. The open operation include that the intervertebral disc were removed by "fenestration procedure" or hemilaminectomy. If the patients suffered from single lumbar spinal canal stenosis at the same time, the nerve root canal would be enlarged. The patients in groupB were treated by posterior spinal approach microendoscopic discectomy. Intraoperatively, under the guidance of the "C" arm X-ray machine and the monitor of fluoroscope, the fibrous annulus and herniated disc were removed, the thickened and hypertrophic ligament were resected, the lateral recess was enlarged, the nerve roots were decompressed thoroughly. All cases were followed up from a week,a month , three months and six months postoperatively. After six months, all patients were followed up each six months, including rechecking, mailed, qestionnaire and so on. The data of observation were collected almost completely. After that, all data were analyzed by SPSS 10.0 in order to observe the obvious diffence between the both groups. By the above, good quality and defects between the two operations were found, then further analysis and conclusion would be drawn.Results: All the patients were followed up from 3 to 18 months. Except several patients, the data of the other were collected ( groupA 37, groupB 38). The results indicated that the patients of the two groups had obvious distinction in the length of incision, operative time, the amount of bleeding intraoperatively, the amount of drainage and time of lying in bed postoperatively. But in short-time clinical effects, the patients of both groups had no significant difference. Besides, accordiong to the Nakai standard scale, 5 as fair and 1 as poor in groupA, 3 as fair and having no poor in groupB. By the examination of X-ray and CT, in groupA, two patients were due to unthorougly discectomy of intervertebral disc or cicatricial adhesion and the two patients were due to herniation of disc of the adjacently intervertebral space. The other were unknown. In groupB, a patient was due to unthoroughly discectomy of intervertebral disc and the other one was due to unthorough decompression of nerve roots. The other is unknown.Conclusion: The MED led to small incision, less hemorrhage, little soft tissue injury and little influence on the stability of the middle and posterior structure of the lumbar vertebrae. The procedure was safe and effective in a surgical field of magnification of several folds. Posterior spinal approach microendoscopic discectomy for the treatment of lumbar disc herniation has characteristics of advanced technique, minimal invasion, fast recovery and thorough decompression to nerve roots. It has positive effect and broadly applicable future.