The Curative Effect Of Two Different Surgical Treatments For Lumbar Disc Herniation

Objective: To investigate the clinical effects observed after theinter-laminar space discectomy and fenestration discectomy for thetreatment of low lumbar disc herniation and choose the best surgicalapproach for the treatment of low lumbar herniation.Methods:We retrospectively analyzed a total of86cases from January2008to December2013treated for lumbar disc diseases in Bin ZhouMedical School Affiliated Hospital of Yan Tai (lumbar disc herniation LDH).Depending on different surgical procedures, we divided the cases into twogroups: group A include45cases underwent inter-laminar space discectomy,and group B include41cases underwent posterior lumbar fenestrationdiscectomy. The cases of two groups presented with unilateral lumbar discherniation, the typical clinical manifestations and signs were present, anddiagnosis was assisted by preoperative X-ray films, CT, MRI. Basicsituation of all cases were recorded on admission, operative time, intraoperative blood loss, postoperative bed time, postoperative hospitalstay were also recorded and analyzed by the same physician. JOA score forthe clinical curative effects evaluation was recorded before and aftersurgery (Japanese orthopedic association low back pain score system [1]).All the results were analyzed by SPSS19.0software (social science)statistical package for statistical results and to test the statisticalsignificance. Objective evaluation of clinical curative effects provide thebasis for surgical treatment.Results:Both groups were followed up after surgery for an averagetime of20months. There was no statistical difference between the basicclinical data of the patients in the two groups. Group A (inter-laminar spacediscectomy) has less intra-operative blood loss than group B (fenestrationdiscectomy), postoperative bed time was shorter in group A than group B,the difference was statistically significant (P <0.05). There was nostatistical difference between two groups for operation time andpostoperative hospital stay (P>0.05). One week post-operative curativeeffect evaluation and therapeutic effect evaluation to2groups was done byusing spine surgery efficacy standards promulgated by the Chineseorthopedic association1994, there was no significant difference (P>0.05).Preoperative, postoperative1month and18months follow-up and JOArating was compared using t-test, there was no significant differencebetween two groups (P>0.05), but the preoperative, postoperative1month and18months follow up was statistically significant when analyzed byvariance (P=0.000). Relief rate of low back pain in group A group was83.4%and79.3%in B group. Two groups were statistically non-significantby chi-square (P>0.05).Conclusion:For patients with unilateral low lumbar disc herniation,can obtain satisfactory effects by inter-laminar space discectomy andfenestration discectomy, inter-laminar space discectomy have less trauma,less bleeding, shorter postoperative bed-time, rapid decompression andelimination of the symptoms and also retain the greatest degree of stabilityof the spine. It also decrease Lumbar instability and reduce the incidence ofdural adhesions, thereby enhance the long-term efficacy, appropriate in theabsence of basic hospital minimally invasive devices.