Clinical Observation Of Degenerative Lumbar Spinal Stenosis Treated By Single End Incision Under Microendoscopic Discectomy

RESEARCH BACKGROUND:For middle aged and elderly, degenerative lumbar spinal stenosis is a common disease in spinal surgery. With the growth of the age, Lumbar intervertebral disc nucleus pulposus also gradually produces degenerative changes, which highlight degeneration of the intervertebral disc. Moreover, the elderly facet process or ligament occurs to hyperplasia and hypertrophy, which resulting in reduction of the effective volume of the spinal canal, and then formed the degenerative lumbar spinal stenosis disease ultimately. After conservative treatment by traditional Chinese medicine, western medicine or traditional Chinese and Western medicine, most of the patients have a good result, but there are still small parts of patients need surgical treatment. There are a variety of surgical treatments of degenerative lumbar canal stenosis in modern medicine. As minimally invasive surgery, the unilateral approach of spinal expand operation which assisted by the micro endoscope had small damage, rapid recovery and clear effect. Therefore, it clinically concerned and recognized by the majority of patients.RESEARCH OBJECTIVES:To observe the clinical effects of microscope-assisted bilateral decompression via unilateral approach for the treatment of degenerative lumbar spinal stenosis.In order-to help the degenerative lumbar stenosis patients to find a more effective method.RESEARCHMETHODS:Methods Retrospective analysis were conducted 34 cases of the clinical data of patients with degenerative lumbar spinal stenosis, and the surgical approach are used in micro endoscope assisted surgery via unilateral approach or bilateral vertebral canal decompression. Also, the operation segment, the length of operation, the amount of bleeding during operation, the number of postoperative use of anti-inflammatory analgesic drugs, hospital days, postoperative complications and postoperative imaging changes were recorded. The evaluation of clinical efficacy were made by the Japanese Orthopaedic Association of lumbar disease 29 points scoring method (JOA score), which evaluated the effect of the case the daybefore and after the first day of surgery and the final follow-up (3 to 24 months, an average of 10.6 months). Finally, analyzed the relevant data through statistical analysis and comprehensively evaluated of the clinical efficacy of the procedure.RESEARCH RESULTS:1 Japan Orthopaedic Association lumbar spine disease 29 score method (JOA score)Before and after the first day of operation, the last follow-up of the Japanese Orthopaedic Surgery Association lumbar disease 29 points scoring method (JOA score) were 16.45+1.76, 24.79+1.63,25.03+1.54. The difference was statistically significant (P＜0.05) between the first day and the final follow-up (24 to 3 months, with an average of 10.6 months). There was no significant difference (P> 0.05) between the first day and the last follow-up. Average improvement rate:68.67%.2.perioperative index analysisThe operation time is 70min～225min, the average time is 116min. The average amount of bleeding was 62.4ml, the average postoperative use of anti-inflammatory drugs 0.38 times, complications of 1 cases of dural tear, no neurological complications. The hospital stay was 7 days to 22 days, and the average length of stay was 10.8 days.3.postoperative imaging changesPostoperative lumbar lateral X-ray films showed unilateral approach laminectomy laminectomy decompression and postoperative lumbar CT showed unilateral approach spinal bilateral decompression, most of intervertebral joint were retained, the postoperative lumbar MRI showed spinal canal enlargement and adequate decompression.RESEARCH CONCLUSIONS:For elderly patients, micro endoscope mirror via unilateral approach for spinal expand surgery for the treatment of degenerative lumbar spinal stenosis, the operation can make operation visual field very clear so that to precise deal with the lesion; also to ensure the operation avoid to damage the nerve roots and dural sac which can not see with the naked eye because of the open surgery; to make the minimally invasiveworking channel which near the spinous process can adjust the direction, and to make the line on the side of the lateral recess and the nerve root canal extensive, in order to achieve the purpose of decompression and lateral, thus reducing the spinal facet structure re-injury. In a word, according to the study of this topic, it is proved that the clinical application of micro endoscope mirror via unilateral approach for spinal expand surgery for the treatment of degenerative lumbar stenosis has less damage, good effect, and it is worth to expend in minimally invasive surgery.However, the follow-up time is short, and the number of samples is small, so more long-term efficacycomparison should be observe and study. Meanwhile it needs prospective studies in order to obtain more credible evidence to confirm the long-term efficacy of surgery.