Anatomical Study Of Percutaneous Cannula Lumbar Para-spinal Approach, Imaging-based Research And Minimally Invasive Treatment Of Lumbar Disc Herniation

Object: Conduct anatomic study on lumbosacral paraspinal muscle tissue, to evaluate the feasibility of percutaneous cannula lumbar paraspinal approach and provide clinical reference for percutaneous cannula approach.Method: We selected 12 adult specimens with structural integrated lumbar spine, and dissected them by posterior approach to observe tissue morphology of paraspinal muscles gap and multifidus muscle. The distance between paraspinal muscle gap and posterior median line, both sides of the facet joints, the facet and the spinous were measured.Result: Regional anatomical measurements show that, The distance between the skin projection point of paraspinal multifidus cannula,dorsi cannula outer border and posterior median line at the level of L1 to L5 were:L1:(2.29±0.12)cm;L2:(2.44±0.10)cm;L3:(2.75±0.12)cm;L4:(3.17±0.13)cm;L5:(3.35±0.09)cm;the distance between the skin projection of paravertebral muscles,iliocostalis muscle gap edge facet were at the level of L1 to L5 were:L1:(5.52±0.12)cm;L2:(6.66±0.11)cm;L3:(7.63±0.12)cm;L4:(7.90±0.22)cm;L5:(8.58±0.11)cm;Wiltse gap was obviously segmented and partially filled by adipose tissue. No significant neurovascular distribution was found. The bottom of the gap can be progressively softened by percutaneous cannula. Multifidus muscle tissue is gradually widened from L1 to L5,and there is a gap between the bundle which can be blunt dissected. Through progressively softened by percutaneous cannula,we can finally reach lamina.Conclusion:Muscle gap approach can prevent paraspinal muscles from stripping and postoperative injury,reduce the incidence of postoperative stability decreased in spine and lumbar postoperative syndrome. Minimally invasive treatment of lumbar disc herniation by percutaneous cannula approach is feasible. The surgeon should properly choose the surgical approach and method according to the surgical aim and local structural characteristics.Object: By measuring adult lumbar spine CT images, to observe the characteristics of percutaneous cannula approach, analyze the position of percutaneous cannula in different lumbar segments, and provides imaging reference to the clinical application of percutaneous cannula lumbar paraspinal approach.Method: 42 patients with lumbar disc herniation as the main clinical symptoms on admission were involved and imaging features of percutaneous cannula in different lumbar segments was observed and measured.Result: The distance between inferior articular lateral border process and spinous process at the same segment shows gradually increasing trend from top to bottom, especialy from L3 to L5. Measurements were left: L1:(1.24±0.09)cm;L2:(1.37±0.09)cm;L3:(1.13±0.11)cm;L4:(1.46±0.10)cm;L5:(1.99±0.11)cm;right:L1:(1.23±0.09)cm;L2:(1.37±0.09)cm;L3:(1.13±0.11)cm;L4:(1.46±0.11)cm;L5:(1.98±0.13)cm. The distance between inferior articular lateral border process and spinous process at the same segment shows gradually increasing trend from top to bottom.The distance between paraspinal multifidus cannula,dorsi cannula outer border and posterior median line at the level of L1 to L5 were left:L1:(2.42±0.20)cm;L2:(2.58±0.24)cm;L3:(2.80±0.22)cm;L4:(3.11±0.22)cm;L5:(3.34±0.20)cm;right:L1:(2.35±0.19)cm;L2:(2.52±0.19)cm;L3:(2.80±0.24)cm;L4:(3.12±0.26)cm;L5:(3.37±0.22)cm. The angle between the centre line and connect of bilateral paraspinal multifidus and dorsi cannula was gradually outward deflection from L1 to L5. Measurements were left:L1:(-12.63±1.46)°;L2:(-11.47±1.49)°;L3:(-10.24±1.46)°;L4:(4.07±1.50)°;L5:(10.14±2.08)°;right:L1:(-12.54±1.38)°;L2:(-1142±1.54)°;L3:(-10.21±1.58)°;L4:(4.18±1.60)°;L5:(9.91±2.33).Conclusion: The study results suggest that minimally invasive treatment of lumbar disc herniation by percutaneous cannula approach is feasible. The surgeon should properly choose the surgical approach and method according to the surgical aim and structural features of different segments.Object: To compare the clinical efficiency of percutaneous cannula lumbar paraspinal approach and traditional posterior median approach.Method: 49 patients with lumbar disc herniation whose symptoms did not relieve after 3 to 6 months of conservative treatment were involved. They were randomly assigned to percutaneous cannula lumbar paraspinal approach group and traditional posterior median approach group. Different operative approaches were conducted, indicators before and after surgery were analyzed, to evaluate the clinical efficiency of percutaneous cannula lumbar paraspinal approach in the treatment of lumbar disc herniation.Result: The operation time, bleeding, time in bed, hospital stay and incision pain duration in percutaneous cannula lumbar paraspinal approach group are significantly better than the traditional posterior midline approach group. Mean creatine phosphate kinase(CPK-MM) at 1d, 3d, 5d postoperative is significantly lower in percutaneous cannula lumbar paraspinal approach group. JOA score is significantly higher than traditional posterior median approach group(P <0.05). VAS score in percutaneous cannula lumbar paraspinal approach group is lower at 1d,7d postoperative.Conclusion: Microscopic percutaneous lumbar para-spinal approach can reduce muscle and nerve injury,completely decompress spinal canal and nerve root, its clinical curative effect is satisfying.