Clinical Analysis Of Surgical Treatment Of Lumbar Disc Herniation In 1020 Patients

Objective: The purpose of this study was to retrospectively investigate the change characteristics of surgical outcome of lumbar disc herniation (LDH) and the related influence factors, compare surgical efficacy between Microendoscopic discectomy (MED) and traditional open operation. Methods: A questionnaire following-up investigation by telephone, letter and outpatient interview was carried out in 1020 patients who underwent lumbar discectomy for lumbar disc herniation at our hospital during 1983～2003. The following-up cases were divided into four groups according to postoperative time (1～2 years, 2～4 years, 4～8 years and ﹥8 years). Multiple regression analysis was used to analyze correlation factors of surgical outcome in each of the four groups respectively and Group comparison was undertaken to analyze the change features of treatment effect. For the sake of finding the differences of surgical outcome of different operation methods, a comparison was performed between MED and traditional open operation(total laminectomy, hemi-laminectomy, interlaminar fenestration). Results: Seven hundred and thirty-six replied questionnaire letters were retrieved. The following-up rate was 71.88% and 204 cases had integrity following-up data. The average follow-up period was 5.2 years (1.1～20.5 years). MED had an advantage over the traditional open operation in that it reduced intraoperative bleeding volume, shortened operation time and the duration of hospitalization (p<0.05). The complication rate of total laminectomy such as dura tear and nerve roots injury was higher than that of MED (p<0.05). There were no statistical significantly differences between MED and traditional open operation with respect to reoperation rate, subjective satisfaction rate and Prolo curative effect score (p>0.05). The effect of lumbar discectomy had nothing to do with years of age, sex, occupation, culture degree, history of trauma, change of tendon reflex, preoperative muscle strength, angle of straight-leg raising test (SLR), operation methods (the extent of articular process resection was confined within 1/3 as far as possible) and numbers of affected segments of lumbar vertebrae. However, the duration of preoperative symptom had a significant association with surgical outcome. According to Prolo score, no statistical significant differences of surgical outcome were found among the four groups (1～2 years, 2～4 years, 4～8 years and ﹥8 years). Conclusion: The clinical efficacy of lumbar discectomy was correlated with the symptom duration of backleg pain and presents a relatively stable characteristics after 2 years postoperation. Compared with traditional open operation, MED provided an equivalent clinical result and furthermore showed a significantly superiority for its less hemorrhage, less trauma, shorter operation time, shorter duration of hospitalization and less influence on the stability of posterior structure of lumbar vertebrae. Because of clear and stable imaging quality as well as magnifying surgical field, the operation procedure of MED had become more accurate and the complications such as dura tears and nerve roots injury decreased maximatily. For these reasons mentioned above, MED was a safe and effective method for lumbar disc herniation (LDH) and had a widely applicable perspective.