| Objective: Low back pain(LBP) is a clinical syndrome with lumboscaralarea pain or uncomfortable feel, with or without lower limps pain. LBP is notuncommon clinical diseases, about80%of people suffered at least one lowback pain in their lives. The common cause of LBP are degenerative disc,inflammation of muscles and ligaments, irritating never root, hyperosteogeny,sacroiliitis, and the discogenic low back pain include39%of the commonreasons. DLBP is a not never root pain syndrome, without spinal abnormalityand unstability, which is caused by disc pathological changes. Disc is thelargest without blood supply tissue of the body, it is hard repaired by itself,conservative treatment is usually ineffective. As the development of minimallyinvasive spinal surgery, there are have appeared some minimally invasivetechnical for DLBP, and obtained a satisfactory clinical result. It includeintradiscal electrothermal therapy, percutaneous laser disc decompression,posterolateral transforaminal endoscopic discectomy radiofrequency ablationand annuloplasty, extreme lumbar interbody fusion or direct lateral interbodyfusion. The3in1technique of Disc-FX system, namely: discectomy,radiofrequency ablation and annuloplasty, which were invented by Anthony TYeung in2007on the basis of the work experience in its15years of spinalendoscopic minimally invasive spinal surgery channel system, has beenwidely applied in clinical.Methods: From February2010to March2011, we treated44DLBPpatients with Disc-FX system, using local anesthesia, patients stayclear-headed through the surgical procedure and could response the feelingtimely, it's could make the operation more safety. Discography is used at first.First determined the needle point under C X-ray machine based on Yeung'smethod, needle point distance the midline about10~12cm, and it should make a appropriate adjustments according to patient body, if the patient is more fatthe needle point should be more outside. Carry out percutaneous puncture with18G spinal needle, it should parallel to endplate, and25°to30°to coronal,go to the disc through Kambin's triangle. When the point of the needle reachedof the1/3of the disc, inject of iohexol and methylene blue9:1mixed solutionof about2ml. We can determine the responsibility of the disc for low backpain when the disc degeneration change tear were found under C X-raymachine and copied usual pian. Then the Disc-FX system technical werecarried out. Take out of the needle stylet, placing the guide wire, removing theneedle, then placed expansion and working channel along with the guide wire.Take out of the degenerative nucleus tissue through working channel withspecial rongeur. Take the radiofrequency ablation and annuloplasty with thebipolar RF electrode. The nucleus fragment and inflammatory factors will bewashed out by lavage. Removing of the working channel and sticking thewound at last.There were23males and21females, with an average age of39.2years(ranged,31-58years). The visual analogue scale (VAS) scoring was applied toevaluate the back and low limb pain.The MacNab score was also evaluated atlast follow up.Results: All the44patients were followed up for12months to25months, with an average18.7months. The operative time was20min to40min, average26min. Amount of lost blood was lower than10ml. There wasno surgical complication was found during the follow up. The VAS ofpreoperative low back pain was (6.32±1.16), VAS score of low back pain1week,3month,6month,12month, and final follow-up after operation were(1.59±1.19),(1.68±1.29),(1.57±1.19),(1.59±1.13) and (1.61±1.22)respectively. The postoperative VAS of low back pain1week,3month,6month,12month and final follow-up decreased significantly compared with thatpreoperative; The VAS of preoperative limb pain was(2.75±1.62), VAS scoreof limb pain1week,3month,6month,12month and final follow-up afteroperation were (1.18±0.82),(1.16±0.75),(1.11±0.81),(1.18±0.72) and (1.16±0.83) respectively. The postoperative VAS of limb pain1week,3month,6month,12month and final follow-up decreased significantly compared withthat preoperative; The evaluation of MacNab score was excellent in21patients, good in17, fair in5, and poor in1, suggesting an effective rate of86.4%(38/44). There were no complication were found include disc spaceinfection, dural tear, nerve or vascular injuries and feeling unusual. Onepatient recurrence after one month of the treatment, and reappear the low backpain and appear one side sciatic never pain. No significant improvement afterused of the anti-inflammatory medication, and underwent lumbar posteriordiscectomy when in hospital again, the symptoms release, no sign of relapseduring6months follow-up.Conclusion: Disc-FX System, which combined three surgical techniquein one procedure, provides a new choice for orthopedics to treat discogeniclow back pain. It can get satisfactory clinical outcomes during a short-termfollow up, but indications for this procedure should also been controlled andthe long term clinical outcomes still remains unknown. |
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