Percutaneous Endoscopic Of The Annulus Fibrosus Surface Angioplasty In Treatment For Discogenic Low Back Pain Clinical Observation

Objective To evaluate the percutaneous endoscopic of the annulusfibrosus surface angioplasty in treatment for discogenic low back painfeasibility and effectiveness.Methods From November2011to November2012,80cases ofpatients with discogenic low back pain in our hospital, male34and female46patients by conventional lateral lumbar spine hyperextension flexionX-ray film and spine MRIThe imaging studies showed no spine side of theconflict and kyphosis, without spondylolisthesis and instability signs ofsignificant lumbar hyperplasia and lumbar spinal stenosis performance.80patients were lumbar intervertebral disc angiography positive patients,within2hours after completion of angiography corresponding segments ofthe lumbar intervertebral disc MCT level scan and three-dimensionalreconstruction are visible contrast agent like lateral leakage trajectory, is theannulus break at the, but no nerve root canal stenosis signs.The case by arandom number table method divided equally into two groups of A, B, A group of18males and22females, average age37.4±7.3years of age,preoperative low back pain VAS score of6.45±0.55points, preoperativeODI score41.63±4.69;16males and24females, average age36.8±7.1years of age, preoperative low back pain VAS score of6.25±1.82points,preoperative ODI score of42.50±4.87points in group B; Treatment ofdifferent surgical methods were used, A group of prominent percutaneoustransforaminal endoscopic discectomy+annulus fibrosus breakradiofrequency ablation angioplasty group B separately fibrous ring breakpercutaneous transforaminal endoscopic radiofrequencyablationangioplasty.Surgical approach taken posterolateral approach. Thepatient’s age, weight physical assessment and pain sensitivity of theoperative and postoperative results were not statistically significant.Statistical analysis before and after treatment VAS score and ODI scores ofthe two groups of patients, and the efficacy and complications of all patientsafter surgery to assess comparison.Results All operations in accordance with the plans to be successful,completion of postoperative follow-up tracking of the two groups of patients3-12months, group A corresponding segments nerve root damage,performance of nerve root distribution numbness, muscle weakness, is alocal nerve root retractorpull due to be improved circulation, dehydration,nutrition, nerve and local physiotherapy treatment, recovered completelyafter two months, and another six patients with varying degrees of low back pain,1case back paresthesia, soft tissue contusion consider surgery area,postoperative protective muscle strength weakened, due to factors such asskin nerve endings damaged surgery area, treated with other drugs to helpforest and local physical therapy after remission.B group1casescorresponding segments of the nerve root damage, the performance for thecorresponding nerve root distribution hypersensitivity, is a local nerve rootintraoperative electrical stimulation in treatment to improve circulation,dehydration, nutrition, nerve and local treatments, Januaryrecoveredcompletely after five patients with varying degrees of back pain and pain,two cases back paresthesia, consider intraoperative soft tissue contusion,postoperative protective weakened muscle strength, skin damage to thenerve endings of the operation area and other factors.To, forest and otherdrugs and local therapy coated help remission after treatment; being no otherserious complications. A group of low back pain VAS scores and ODI score,after1month1.48±0.44points,16.50±5.90points, after3months1.68±0.66points,14.38±9.27points, after the last follow-up (after3months to12month)1.40±0.43points,14.13±7.45points; group B low back pain VASscores and ODI score after1month1.25±0.49points,14.88±7.16points,after3months1.26±0.40points,14.25±8.10points, after the lastfollow-up (after3months to12month)1.53±0.60points,1,113±7.04points, two groups of patients VAS, ODI score was significantly decreased(P <0.05), difference between the groups was not statistically significant (P> 0.05); accordance with the the improved Mac Nab rating standard, A groupof excellent in19cases, good in17cases, and poor in4cases, the totaleffective rate of90%, B group were excellent in17cases, good in18casesand poor in five cases, the total effective rate was87.5%, the differencebetween the groups was not statistically significant (P>0.05); no seriouspostoperative complications.Conclusion Two surgical methods can effectively treat discogeniclow back pain. Percutaneous endoscopic of the annulus fibrosus surfaceangioplasty in treatment for discogenic low back pain is feasibility andeffectiveness.