A Study Of The Treatment For Far Lateral Lumbar Disc Herniation Using The Full-endoscopic Extraforaminal Technique

Objective To evaluate the safety and efficacy of Full-endoscopic extraforaminal tcehnique in the treatment of Far Lateral Lumbar Intervertbral Disc Herniation;we will study the expression and significance of MMP28 in the process of disc degeneration by investigating the different degenerated stages of intervertebral disc.We try to find the The role of MMP-28 in intervertebral disc degeneration.Methods Between June 2014 and March 2015,23 low-back pain patients with radicular far lateral lumbar intervertbral disc herniation underwent full-endoscopic extraforaminal targeted fragmentectomy.The clinical follow-ups were performed at pre-operation,1 month,3 months,6 months and 12 months post-opration with an extensive questionnaire,including pain visual analog scale(VAS) Japanese Orthopaedic Association(JOA) and Oswestry disability index(ODI),evaluate the efficacy with modified MacNab criteria;The tissues of the intervertebral disc were obtained from 53 Lumbar disc herniation(LDH) patients surgeried in the Orthopaedics of JS Provincial hospital of intergrated traditional and western medicine from June 2015 to February 2016.including 28 in damage-herniation type,14 in degeneration-protrusion type and 11 in posterior vertebral osteochondrosis with disc protrusion type. The expression of MMP-28 was quantified by immunohistochemical staining method in order to find the role of MMP-28 in intervertebral disc degeneration.Results Mini-invasive operation was completed successfully in all patients,The mean operative duration was 35(25-60) min,the mean amount of bleeding was 5(3-10)ml and the average postoperative hospitalization time 5(3-8)days.The postoperative medianVAS,JOA and ODI scores significant decreased at all timepoints. evaluation of modified Mac Nab effects were as follows:19 cases were rated as excellent,3 cases were good,1 case was fair. There were 48 cases found MMP28 in the disc.the rank was:(grade 1) 12 cases,(grade 2) 8 cases (grade 3) 3 cases,(grade 4) 2 cases, (grade 5) 0 cases in damage-herniation type. (grade 1)0 cases,(grade 2) 1 cases, (grade 3) 4 cases,(grade 4) 5 cases, (grade 5) 2 cases in degeneration-protrusion type. (grade 1) 1 cases,(grade 2) 4 cases (grade 3) 2 cases,(grade 4) 2 cases, (grade 5) 1 cases in posterior vertebral osteochondrosis with disc protrusion type. the expression of MMP-28 in the three groups were in a gradient manner, with the highest in the degeneration-protrusion type and the lowest in the degeneration-protrusion type,with a statistically significant difference(P<0.01).Conclusion 1.Full-endoscopic extraforaminal targeted fragmentectomy in the treatment of Far Lateral Lumbar Intervertbral Disc Herniation is safe and effective,it offers significant advantages of facilitating rehabilitation minimizing trauma and lowering expengditure.2.patients with damage-herniation type are more than the other two types,all of the discs obtainded were degenerative.MMP-28 is a accelerating factor in intervertebral disc degeneration.