The Practical Research Of Trans-abdominal Lumbar Diskectomy For L2-5 Intervertebral Discs Under CT Monitoring

Objective: to study and explore a safe and effective interventionaltherapy for L2 - 5 disk protrusion and herniated nucleus pulposus in order to enlarge the indication scope to the treatment. Methods: From the March of 2004 to the March of 2005, we applied the digestive tract contrast and the abdominal major blood vessel contrast examinations, three-dimensional spiral CT graphic reconstruction and other relevant anatomical data to establish puncturing access to the L2 -5 discs. The trans-abdominal lumbar diskectomy was performed in cases with protrusion of intervertebral disks. The enlisted group included 18 cases of 16 of L4/5, lof L3/4 and 1 of L2/3. The key steps of the procedure are: to exert pressure on the abdomen, shift the intestinal position for the puncturing site and dodge the abdominal major blood vessels under the direction of CT, and then to adopt a hollow needle with a certain negative pressure to puncture the target disk, take the stepwise way of puncture trocar to establish the operative pathway and repeatedly cut off the nucleus puposus tissue with a protractor for the purpose of directly reducing of the local pressure. Results: the total effective rate was 96% and there were no major case in those patients. Conclusion: the trans-abdominal lumbar puncturing diskectomy is regarded as a kind of practical therapy. But the key point should be remembered: Ll/2 disk closes anatomically to the pancreas, stomach, duodenum and the others, therefore, the trans-abdominal puncturing diskectomy should be not adopted for it Otherwise, owing to the L2/3 adjoining to the major blood vessels in the renal pedicle, the operation has a certain risk so that the contrast examination must be performed before the surgery and required the detail data and the analysis of the indications. Puncturing to L3/4 and L4/5 disks, the intestinal position should be shifted completely enough. The removal of nucleus pulposus tissue be required under the CT monitoring to make, and only acted as a sort of saving method for the operation through the lateral-posterior direction in the special situation.