Safe Anatomic Study And Clinical Application Of Lumbar Discectomy Via Percutaneous Endoscopic Approach On Lumber Disk Herniation

Objective:(1) To investigate the security of the application of lumbar discectomy via percutaneous endoscopic approach on lumber disk herniation by our countrymen. (2) To determine minimal invasion through contrastive study of clinical application between this surgery and general fenestration operation. Methods:(1) 4 adult dead body undergone endoscope-assisted surgery, dura mater and damaged nerve root were found in approach after resection of intervertebral disc tissue. Structure characteristics of L3-S1.intervertebrale foramen and its position relation between spinal nerve roots were observed. Anteroposterior, transverse and axial diameters of intervertebrale foramen and safe region for puncture were measured out. (2) Patients who choose orthopaedics department of Chengdu 363 hospital to treat Lumbar disk herniation included 33 cases by lumbar discectomy via percutaneous endoscopic approach and 37 cases by general fenestration. The indexes of these two surgical methods such as peroperative bleeding, operation time, length of incision, postoperative activity out of bed days, postoperative hospital stay, complications were evaluated by using visual analogue score, Lehmann lumbar functional rating score, Macnab score. Leukocyte count, neutrophil counts, erythrocyte sedimentation rate, plasma C-reactive protein, plasma aldosterone, angiotensinâ…¡, plasma renin activity were measured out for comparison and statistic analysis.Results:(1) The width of the intervertebral foramen in lower part of lumbar (L3-S1)reduced gradually, the height was obviously greater than the width. The anteroposterior, transverse and axial diameters of intervertebrale foramen were significangtly greater than microendoscopic discectomy. (2) Damaged nerve root or dural sacs were not found in 4 cases after the simulation operation. The triangular safe region of L3-S1 has enough space to implant coaxial appliances. (3) In clinical operation, compared with control group, experiment group has small incision, less blood loss, short hospitalization time, short operative time and off-bed early. The results of the two group were different significantly. (4) The two groups in 1 month postoperative and latest follow-up, the lumbar functional rating score, VAS score different significantly compared with pre-operation. But the score had no significant differences between experiment group and control group in pre-operation,1 month post-operation and latest follow-up respectively. (5) In experiment group, the excellent rate was 90.9% in 1 month post-operation and 94% in latest follow-up. In control group, the excellent rate was 91.9% in 1 month post-operation and 94.6% in latest follow-up. (6) In the 1st and 5th day after the operations, blood sedimentation rate, plasma C-reactive protein, plasma aldosterone, angiotensin II and plasma renin activity increased markedly in control group compared with experiment group, the results were different significantly while Leukocyte count and neutrophil counts have no statistical difference.Conclusions:(1) There is enough space for implanting 6.5mm endoscope in triangle safe workplace of L3-S1. (2) Damaged nerve root or dural sac were not found in simulated operation on dead body. The above results showed that lumbar discectomy via percutaneous endoscopic approach is relatively safe. (3) Compared with control group, experiment group has small incision, less blood loss, short hospitalization time, short operative time and off-bed early. The results of the two groups were different significantly. (4) Experiment group and control group showed significantly improvement in results of lumbar function scores and VAS scores after treatment. (5) Stress indexes of control group, such as blood sedimentation rate, plasma C-reactive protein, angiotensinâ…¡, plasma renin activity increased markedly than experiment group.