The Applicational Study Of Target-injection Of Collagenase Chemolysis Directed By X-ray For The Treatment Of Recurrent Postoperative Lumbar Disc Herniation

Objective : To study the applicational value and the security of collagenase chemolysis for the treatment of recurrent postoperative lumbar disc herniation .Methods:The target-injection of collagenase chemolysis through the lateral crypt or intervertebral foramina under the guidance of X-ray was processed in 18 cases who suffered of recurrent postoperative lumbar disc herniation from january 2004 to january 2009,and 10 cases of male,8 cases of female were included in the group with a mean age of 38 years(22-65).All the caese suffered with simple lumbar disc herniation, and experienced low back pain and radiating pain of extremitas inferior in different degree.The clinical symptom,objective sign and the manifestation of imageology were completely conformity.Among the 18 cases,15 cases have received incisional operation(13 cases received operation only once, 2 cases received operation twice). Here is the recent operation: fenestration laminotomy(10 cases), hemilaminectomy(3 cases), total laminectomy(2 cases). The other three cases received recurrent postoperative lumbar disc herniation after micro-trauma operation, among whom 2 cases received percutem discoidectomy; 1 cases received medical grade oxone therapy through percutaneous puncture. All the cases were scored through subjective symptoms, objective sign, the condition of daily activities and the function of micturition, according to the marking criterion of operation about lumbodorsal pain instituted by Japanese Orthopaedic Association(JOA), and the JOA score averaged 15, with a range of -2 to 19. The time from prior disectomy to that for recurrence ranged from 8 months to 12 years, with a average 3.5 years. All the patients had follow-up evaluation 18-24 months, the JOA score, the index of vertebral disc herniation(IDH) and the CT figure in the CT image were recorded during the post-operation follow-up.Results:(1) The operation time of the cases averaged 65 minutes (40-90 minutes), and no patient was failured in the course of puncturation. One case had tardive chemical-cephalomeningitis in the next day after operation, and the symptom was reliefed after the next treatment: the replacement of cerebrospinal fluid; the stosstherapy of flushing dose urbason; dehydration therapy and the neurotrophy therapy, the function of urinate become normalizatioin after 3 weeks. One cases had urinary retention and the retention catheterization was administered, the case normalized after 1 week. Five cases had transitory aggravated low back pain, and the other cases had no complications.(2) All the patients got a relieve of low back pain and melosalgia in different degree in the next day after operation and the Lasegue sign improved average 20 degree, the Lasegue sign impreved average 30 degree as a week late. All the cases accepted a follow-up visit for 18-24 months, the JOA score, the index of vertebral disc herniation(IDH) and the CT figure in the CT image were recorded. After 1 month , the prominence of hernited lumbar disc deflated,the IDH diminished and the CT figure degraded obviously,The JOA score elevated gradually as the time extended. After 1 year these index kept stationary. In the recent follow-up visit, the JOA score averaged 26(18-29), the prominence of hernited lumbar disc lysed completely in 13 cases, and in the other 5 cases ,the prominence of hernited lumbar disc deflated obvious, the IDH diminished 50% above.Conclusion:The collagenase chemolysis improved the clinical outcome of recurrent postoperative lumbar disc herniation. In order to achieve good result, the precise target-injection is necessary, and that a proper injection routine , the efficacious monitoring through imageology, a rigorous anaesthesia experiment can safeguard the operation.