Evaluation The Surgical Techniques And Curative Effect On Percutaneous Transforamial Endoscopic Discectomy In Treatment Of Central Lumbar Disc Herniation

Objective: Only the general description related on percutaneous transforamial endoscopic discectomy cure various types of lumbar disc herniation in the literature and report of the past. They didn’t specific classify the types of lumbar disc herniation in the process of operation they failed to reflect the difference even have a clear classification. central lumbar disc herniation has been regarded as contraindication of surgery of percutaneous transforamial endoscopic discectomy in the past clinical, but with the continuous improvement of surgical technique and equipment in rencent years, we can solve patients pain though the surgery treatment. This study objective to evaluation the surgical techniques and clinical curative effect on percutaneous transforamial endoscopic discectomy in treatment of central lumbar disc herniation.Methods: A total of 41 cases of CLDH with average age of 38.3 years(ranged from 18 to 66 years)during November 2012 to March 2014 underwent percutaneous transforaminal endoscopic surgery in this hospital were included in this retrospective study. Surgical indication: ①Patients cured after the formal conservative treatment for three months is invalid and whose clinical symptoms recurrent again and again; ②Lumbar X-ray, CT, MRI confirmed for central lumbar disc herniation meanwhile it is not associated with lumbar instability; ③Don’t have lumbar spine surgery in the previous time; ④Protrusions is not seen obvious calcification.In these 41 cases, 20 were males and 22 were females, their course of disease with average age of 3.6 years(ranged 3 months from to 10 years), L3~4 3 cases, L4~5 25 cases, L5~S1 14 cases, all of them are diagnosed central lumbar disc herniation. The patient’s clinical symptoms present diversity, their main show: back pain associated unilateral or bilateral or alternation pain or swelling of lower limb. We successfully follow all patients with average months of 16.7(ranged 12 from to 22 months). We use following indicator to evaluate the curative effect of operation: ①A comparison of VAS(visual analogue scal)of preoperative and postoperative immediately, 3 months, 12 months; ② Preoperative and postoperative 1-year assessment of treatment using JOA(Japanese orthopaedic association); ③last follow-up function and pain scores using Mac Nab index score(Oswestry, 2.0 version).Results: One patient L5~S1 patient, the higher the position of the iliac crest, we can not fully decompression surgery diverted after laminectomy and fusion combined with internal fixation.The 41 patients with preoperative VAS score(7.32±1.49), immediate postoperative VAS score(4.27±1.39), after three months VAS score(3.27±1.43), after one year VAS score(2.63±1.44), compared with the preoperative difference was statistically significant(P <0.05). Preoperative JOA score(12.92±2.7)after one year of JOA score(23.17±2.48), the difference was statistically significant(P<0.05). Mac Nab excellent ratings last follow-up rate can reach 85.36%.Conclusion: Percutaneous transforaminal endoscopic surgery as a new minimally invasive spine techniques applied for curing central lumbar disc herniation small trauma, whose surgical complications was significantly less than that of open surgery and the short-term effect is worthwhile.