Posterolateral Approach The Clinical Curative Effect Of Lumbar Disc Herniation By Percutaneous Transforaminal Endoscopic Treatment

Obiective:Lumbar disc herniation(1umber disc herniation)is the most common cause of low back and leg pain caused by,refers to the lumbar intervertebral disc degeneration,fibrous ring rupture after nucleus pulposus to highlight the rear or outstanding to lamina resulting in surrounding tissue by irritation or compression and appear a series of clinical symptoms.According to the pathological changes,morphological changes and clinical symptoms have a variety of classification methods.Lumbar disc herniation could be divided into three kinds,they are extralateral disc hemiation,foraminal lumbar disc herniation,and central lumbar disc herniation.Lumbar disc herniation often according to the condition of patients with partial laminectomy,for combined with spinal stenosis patients must be total laminectomy,but traditional open surgical trauma,bleeding,postoperative need long time recovery with hair lumbar instability risk.Many new minimally invasive techniques have begun to be used in the treatment of lumbar disc herniation.percutaneous transforaminal endoscopic discectomy is the traditional lateral approach of lumbar intervertebral disc treatment technology and spine peep mirror technology combined with,it appeared for the surgeon to solve of lumbar intervertebral disc protrusion a disease provides a new treatment options.This study was to explore the clinical efficacy of lumbar disc herniation in the treatment of lumbar intervertebral disc herniation by comparing the improvement of symptoms after surgery.Methods:From January 2014 to February 2015,49 cases of posterior lateral lumbar disc herniation were treated with posterior lumbar interbody surgery in our hospital.A patient in the prone position,the conventional disinfection shop single operation area.C arm fluoroscopy positioning the intervertebral space,marking.Select the intervertebral level,the center opened near the 10-14 cm point of puncture,0.5% lidocaine local anesthesia injection 20 ml.Under the perspective of percutaneous puncture position after satisfactory placement of guide needle.Intradiscal injection of methylene blue contrast agent is about3 ml,under fluoroscopy visible intervertebral lumbar disc herniation.Take after the skin incision about 8mm,bidirectional needle placement step by step expansion casing,perspective position satisfaction,use of the three drill facet forming.To establish a working channel and endoscopic operation and exploration see blue stained nucleus pulposus intruding into the spinal canal,pith nucleus clamp removal of the herniated disc tissue.After decompression see relaxation of the dural sac and nerve root.The radiofrequency,disc tissue shrinkage forming,again repeated exploration of neural tissue relaxation without compression.All the patients in this study in 26 cases of female patients and 23 malepatients;age ranged from 17 to 78 years old,the average age of 37.52 years.Evaluation of therapeutic effect using visual analogue scale(VAS),JOA and Mac Nab score.Results:The group of 49 patients,46 patients were operated successfully follow-up,followed up 3,6 months average 4.2 months,preoperative leg VAS score(7.10± 0.71),postoperative VAS score 3 months of lower limb for(240 ± 0.58),the difference is statistically significant(P < 0.05),after six months of lower extremity VAS score(2.28±0.75),the difference is statistical significance(P < 0.05).Preoperative JOA score(13.7±0.88),3 months after the JOA score(21.6±1.17),the difference was statistically significant(P<O.05),6 months after the JOA score(22 ± 0.77),the difference was statistically significant(P<O.05).No complications were observed in this group of patients,1 cases of postoperative symptom is preoperative no apparent ease,and communicate with patients undergoing lumbar discectomy graft bone fusion and internal fixation in the treatment,2cases of postoperative recurrence,after a full account and patients,patient selection undergoing lumbar discectomy graft bone fusion and internal fixation surgery.The overall excellent and good rate was 91.3%.Conclusion:The safety and effectiveness of the lumbar intervertebral disc herniation treated by the application of the intervertebral foramen,and the key to the success of the operation and the guarantee of the curative effect were strictly grasped.