Preliminary Clinic Application Of Lumbar Artificial Disc Replacement By Laparoscope

Objective To observe and measure the displacement distance of gaster-blood vessel of lumbar spine in human body with anatomy methods.It could provide informations for the clinic anterior operations of lumbar spine to avoid blood vessel damages,especially for the anterior operations by laparoscope.Based on this,investigate the experiences and primary clinic outcome of the lumbar artificial disc replacement (ADR) by laparoscope.Methods The first part of this study is to measure the displacement distance of blood vessel (DDBV) of gaster-lumbar spine and its meanings.We measured displacement distance of blood vessel of gaster-lumbar spine in 40 cases on operation,identified the anatomy parameter of the operation space of the corresponding lumbar interspace, statisticed and analyzed the datas.The second part of this study is to do preliminary assessment in clinical curative effect of the operation of the lumbar artificial disc replacement by laparoscope. And acquired some experiences.Results①The breadth of L4/5 intervertebral disk is 5.8±0.5cm;②The breadth of L5/S1 intervertebral disk is 5.8±0.6cm;③The perpendicular distance between inferior vena cava or left-sidedness of left common iliac vein and left-sidedness of corresponding level is 3.1±1.5cm at raw state in L4/5 level,5.2±1.2cm at brisement and drag state;④The distance between left common iliac vein and right common iliac artery is 3.7±1.4cm at raw state in L5/S1 level,5.7±0.5cm at brisement and drag state.The operation time of the group was 136min(range 90-180min). In operation,the blood loss was 120ml(range80-360ml). Rechecked the lumbar actinogram in 3 days,4 weeks,6 weeks postoperative and the outcome showed that there were no mobilize, displacement or subsidence except one with prosthesis cacothesis. The low back pain was relieved obviously in 2-60 weeks follow-up. The Japanese Orthopedic Association(JOA) score was 13.5 preoperation and 24.6 postoperation.The mean improvement rate of JOA score was 71.6%. There were no complications at short term following up.Conclusion The formative operation space by the displacement distance of blood vessel of gaster-lumbar spine under laparoscope could meet the need of the ADRThe minimally invasive and non-fusion techniques are improving in spinal surgery.The lumbar artificial disc replacement by laparoscope will support a new way in treating severe lumbar discogenic pain.