The Clinical Effect Of Reformed Percutaneous Lumbar Diskectomy (RPLD) Combining With Intradiscal Electrothermal Treatment (IDET) In The Treatment Of Lumbar Disc Herniation

ObjectiveTo investigate the clinical effect of reformed percutaneous lumbar diskectomy(RPLD) combining with intradiscal electrothermal treatment(IDET) in the treatment of lumbar disc herniation.And to evaluate the effect of IDET by comparing with single RPLD.To discover whether the type of disc herniation affect the clinical effect of RPLD by comparing its effect on lumbar disc extrusion and disc protrusion.Materials and MethodsRetrospect 110 patients with lumbar disc herniation who had conducted RPLD combined with IDET or single RPLD in our department from 2006 to 2008.Among them 42 patients were treated by single RPLD and 68 patients treated by RPLD combined with IDET.There were 60 patients suffering from disc protrusion and 50 patients suffering from disc extrusion.Difference between the traditional PLD and RPLD lies in the puncture technique.IDET was performed after RPLD in the combining group.Efficiency and complications of the two groups was analyzed after the operation.The visual analogue scale(VAS) was recorded completely before and after(1week,3months,and 6months) the interventional treatment.Using MacNab criteria for evaluation in accordance with the operation efficiency,and the evaluation time was 1 year,1 to 2 years,and 2 to 3 years after the treatment.Using CT or MR/images before and after(1 month,3months,and 6months) the treatment to observe the disc retraction.A total of 46 cases of patients have complete EMG data,and the evaluation time was 1 week and 3 months postoperative.ResultsAll procedures were completed successfully under DSA guide.RPLD+IDET group compared with RPLD group:Preoperative VAS score of RPLD+IDET group was average 7.08±0.55,and RPLD group was average 7.16±0.49, and there was no difference between them(p＞0.05).In the following 1week,3months and 6months,both groups showed a persistent downward trend with VAS.After 6 months,the united group score was 1.41±0.34,and the single group was 2.95±0.28,by independent samples t test,the difference has statistical significance(P＜0.05).The efficiency of the treatment(according to MacNab criteria) was followed up for 1 to 3 years,RPLD+IDET group was 89.71%and RPLD group was 83.33%,there is no significant difference between them(P＞0.05).After 3 months,the united group and the simple group has respectively 39 cases and 25 cases of nucleus retraction to varying degrees,six months later the united group and the simple group has respectively 44 cases and 30 cases of disc retraction,but its relationship with the degree of clinical improvement is not positively correlated.Among 28 cases of the united group and 18 cases of the simple group with EMG,there were respectively 24 cases and 13 cases whose spontaneous potential decreased or vanished after the operation,accompanied by clinical symptoms and signs improved.Protrusion group compared with extrusion group:Preoperative VAS score of protrusion group was average 6.75±0.34,the extrusion group was average 7.52±0.34 and there was statistical difference between them(p＜0.05).In the following 1week,3months, 6months,both showed a persistent downward trend with VAS.After 6 months,the protrusion group score was 1.82±0.83,and the extrusion group was 2.51±0.73,by independent samples t test,the difference has statistical significance(P＜0.05).The efficiency of the treatment(according to MacNab criteria) was followed up for 1 to 3 years, protrusion group was 93.33%and extrusion group was 80.00%,there is significant difference between them(P＜0.05).After three months,protrusion group and extrusion group has respectively 35 cases and 29 cases of nucleus retraction,six months later the protrusion group and the extrusion group has respectively 41 cases and 33 cases of nucleus retraction.Among 25 cases of the protrusion group and 21 cases of the extrusion group with EMG,there were respectively 22 cases and 15 cases whose spontaneous potential decreased or vanished after the operation.ConclusionBoth RPLD +IDET and single RPLD are effective in the treatment of lumbar disc herniation.Postoperative analgesic effect of RPLD+IDET within six months is better than single RPLD technique.IDET helps to relieve low back pain.However,there is no significant difference in long-term efficacy between RPLD +IDET and single RPLD. RPLD has good effect on both disc protrusion and disc extrusion.Disc herniation type has an impact on the efficiency of RPLD,and the efficiency of extrusion type is below the protrusion type.RPLD technique has broader indications than the traditional PLD technique.