The Clinical Effect Of The Treatment Of Lumbar Disc Herniation With Invasive From Multifidus Muscle Gap

Objective:By comparing the clinical of the treatment of lumbar disc herniation bymultifidus muscle gap approach with traditional posterior lumbar middle of thesurgical treatment, we aim to investigate the actual efficacy of the surgery ofmultifidus muscle gap invasive approach.Methods:In the period from January2011to September2012, we selected82patients inthe First People’s Hospital of Chenzhou City, who were admitted and diagnosed withlumbar disc herniation or lumbar disc and spinal stenosis. And the40cases of lumbardisc herniation surgery patients with traditional posterior lumbar midline incision intothe surgical treatment were set for group A as a control. In this group, the simplediscectomy18cases after the traditional lumbar posterior middle of the incision into asingle segment were set as group A1, while the other22cases with the traditionalposterior lumbar middle of the incision in the single segment laminectomydiscectomy and interbody fusion bilateral pedicle screw fixation were set as group A2.On the other hands,42cases of lumbar disc herniation surgery with minimallyinvasive multifidus gap approach to the treatment were set for group B as a minimallyinvasive group. In this group,12cases with including minimally invasive multifidusgap into single segment unilateral discectomy were set as group B1, and the14caseswith minimally invasive gap into single segment unilateral pedicle screws andinterbody fusion and internal fixation were set for group B2,16cases with minimallyinvasive multifidus muscle space into a single segment bilateral multifidusthe pediclescrew interbody fusion and internal fixation were set for group B3. The following dataof two groups of surgical patients were recorded and analyzed: the operative time,blood loss, postoperative drainage, postoperative hospital stay and the ODI of12 month after preoperative, the VAS of pain of back and leg, pain incidence of backand leg, the rate of fusion.. The databases were established and analyzed usingSPSS13.0statistical software. All measurement data were counted as mean±standarddeviation（x±s）; Data between the groups were compared using a completelyrandomized design t-test for two sample (P＜0.05was considered for significantstatistically difference), while the paired design two sample t-test was used tocompare the data within groups (P＜0.05was considered for significant statisticallydifference). X~2test was used for comparing the counting data between the two groupswhile the level data were compared with rank sum test; significance level a=0.05.Result:1. Group B1of minimally invasive and the control group A1has significantstatistically differences (P＜0.05) in the operative time, blood loss, postoperativedrainage and postoperative hospital-stay.2. Group B2and B3of minimally invasive and the control group A2havesignificant statistically differences (P＜0.05) in the operative time, blood loss,postoperative drainage and postoperative hospital-stay.3. Comparing with preoperative, Bothe group B1of minimally invasive and thecontrol group A1were significantly improved in ODI and VAS scores and otherparameters (P＜0.05), and leg pain VAS score showed no statistical significance (P＞0.05), but the two group have significant statistically difference in ODI and lowback pain VAS score (P＜0.01).4. Comparing with preoperative, group B2, B3of minimally invasive and thecontrol group A2were significantly improved in ODI and VAS scores and otherparameters (P＜0.05), and leg pain VAS score showed no statistical significance (P＞0.05), but the two group have significant statistically difference in ODI and lowback pain VAS score (P＜0.01).5. After12months of follow-up study, there were no patients in this researchwith dural tear, cauda equine or nerve root injury in the intraoperative, and the skinnecrosis, incision or intervertebral infection did not appear postoperative, there was no one case of fracture fixation,prolapse and failure of fusion cage collapse.Conclusion：Minimally invasive multifidus gap approach decompression and interbody fusionand internal fixation for the treatment of lumbar disc herniation is a safe and effectivesurgical method. Comparing with the traditional lumbar posterior middle of theincision technique, this surgery has advantages of smaller surgical trauma, less bloodloss, quicker postoperative recovery, which is according with the concept ofminimally invasive surgery.