Analysis Of The Failure Causes On LIDH Treatment With Collagenase Chemonucleolysis And Selection Of Retreatment

Objectives:To analyze the failure causes on LIDH treatment with collagenase chemonucleolysis, explore such patient how to select the methods of treatment again, and discuss the influence of treatment failure with collagenase chemonucleolysis.Methods:Ⅰ.The clinical data of the 42 patients with failed lumbar intervertebral disc herniation treated with collagenase chemonucleolysis from 2008 to 2010 in our hospital were analyzed retrospectively.To discuss the reason for failure by analyzing the clinical symptoms, signs, X-ray, CT and MRI etc materials before collagenase chemonucleolysis and summarizing observations under intraoperative looking.Ⅱ.The clinical data of the 33 patients with failed lumbar intervertebral disc herniation treated with collagenase chemonucleolysis from January 2008 to October 2010 in our hospital were analyzed retrospectively,and according to treatment type, they were divided intononoperative treatment group and operative treatment group. We then compared the clinical curative effect of 6 to 24 months after operation to investigate the difference of curative effect between nonoperative treatment group and operative treatment group. According to operation type, they were divided into posterior lumbar interbody fusion group and lumbar interbody nonfusion group. We then compared the clinical curative effect of 6 to 30 months after operation and evaluated two operation type as good medium and poor.Ⅲ.We compared the operative curative effect between patients with failed LIDH treated with collagenase chemonucleolysis and common LIDH operated by the same treatment group in the same time. And then,analyzed the influence for LIDH patients. Results:Ⅰ.The causes of failed collagenase chemonucleolysis included:a.28 cases of improper choice of indication for treatment, accounted for 66.7%.b.6 cases of incomplete dissolve,accounted for 14.3%.c.4 cases of operating error,accounted for 9.5%.d.4 cases of other causes, accounted for 9.5%.Ⅱ. The clinical data of the 33 patients afer 6 to 24 months follow-up illustrated:3 cases of clinical cure,5 cases of improvement,8 cases of invalid among 16 cases of nonoperative treatment; 8 cases of clinical cure,7 cases of improvement,2 cases of invalid among 17 cases of operative treatment.The clinical data of 2 group patients operated on different operation type afer average 20 months follow-up illustrated:6 cases of excellent,6 cases of good,3 cases of medium and 2 cases of poor among 17 cases of lumbar interbody nonfusion. 9 cases of postoperative X-ray with lumbar vertebra gap narrowed and instability were equal to 52.9 per.9 cases of excellent,6 cases of good,2 cases of medium and 0 cases of poor among 17 cases of posterior lumbar interbody fusion.Postoperative X-ray showed that vertebral body height return to normal and bony fusion rate between vertebral bodies was 94.1%. All patients did not appear serious complications.Ⅲ.The operated patients with failed LIDH treated with collagenase chemonucleolysis and common LIDH were all followed-up, which illustrated:24 cases of clinical cure,8 cases of improvement,2 cases of invalid among 34 cases of experimental group.32 cases of clinical cure,2 cases of improvement among 34 cases of contrast group.Conclusion:Ⅰ.Collagenase chemonucleolysis is a treatment method of LIDH.We should control the choice of patient. This method has itself shortage needed to be improved. The treatment failure will make the following treatment difficult.Ⅱ. The curative effect of nonoperative treatment on LIDH patients that were treated failured with Collagenase chemonucleolysis is poorer, however the curative effect of operative treatment is satisfied.As the patients that were treated failured with Collagenase chemonucleolysis choose surgery treatment,operator should operate PLIF except for removing nucleus pulposus and completely decompression to improve the curative effect and obtain the long-term outcome.Ⅲ.The surgery effect of patients that were treated failured with Collagenase chemonucleolysis is poorer than that of common LIDH.