Strategies Of Mr-Guided Minimal Invasive Surgery For Treatment Of Lumbar Disk Herniation In Subdivision

ObjectiveTo explore the effect and safety of individually choosing the strategies for MR-guided percutaneous minimally invasive treatment of lumbar disk herniation(LDH) in subdivision.MethodsUnder the real-time guidance and monitoring of optical instrument mounted to the0.23T open MR scanner,115patients which were diagnosed as lumbar disk herniation of different types by CT or MRI were treated with diskectomy therapy and ozone-oxygen injection by different puncture approaches. And there were a total number of115lumbar intervertebral disks which located at the levels of L3-4in13cases, L4-5in65cases, L5-S1in37cases.28cases of expended type were punctured into disk center by posterolateral approach, then injected8ml ozone-oxygen mixture of60μg/ml into disk center combined with diskectomy therapy, retreat the needle to the paravertebral space and inject15-20ml ozone-oxygen mixture of40μg/ml and4ml pain-block liquid of corticosteroid, vitamin and anesthetic mixture.23cases of posterolateral protrusion type were punctured into disk center by posterolateral approach, then underwent diskectomy and ozone-oxygen therapy and nerve block. Meanwhile, a needle was punctured to the posterior border of protrusion via medial posterior approach to carry out ozone-oxygen injection and nerve block.38cases of posterolateral extrusion type were punctured into the local prominence and then underwent diskectomy and ozone-oxygen therapy and extra-discal nerve block.14cases of forminal type and12cases of extreme lateral type were treated with diskectomy and ozone-oxygen therapy and extra-discal nerve block via posterolateral approach. Patients were in hospital for3days, short term outcome were assessed according to symptoms improvement and complications. Postoperative clinical symptoms improvement were analyzed with JOA score. Mid-long term outcome was assessed after a mean follow up period of between8and10months by using a modified MacNab method.ResultsAll punctures of115cases were performed successfully under the real-time guidance, and the puncture success rate was100%.The clinical effective rate of expended type was96.4%(27/28),85.7%(24/28),89.2%(25/28),92.9%(26/28) respectively3days,1month,3months and6months after procedures. The clinical effective rate of posterolateral protrusion type was91.3%(21/23),78.3%(18/23),82.6%(19/23),86.9%(20/23) respectively3days,1month,3months and6months after procedures. The clinical effective rate of posterolateral extrusion type was94.7%(36/38),84.2%(32/38),90.4%(34/38),92.1%(35/38) respectively3days,1month,3months and6months after procedures. The clinical effective rate of forminal type was92.8%(13/14),71.4%(10/14),78.6%(11/14),85.7%(12/14) respectively3days,1month,3months and6months after procedures; The clinical effective rate of extreme lateral type was91.6%(11/12),66.6%(8/12),75.0%(9/12),83.3%(10/12) respectively at3days,1month,3months and6months after procedures. Postoperative infection of intervertebral space occurred in lcase of posterolateral extrusion type, and no dural and nerve root injury occurred in both groups.ConclusionLumbar disk herniation subdivision has important clinical value for selecting appropriate invasive treatment methods, meanwhile MR-guided percutaneous treatment acting as individual typing of lumbar disk herniation is safe, feasible and reliable.