The Clinical Study Treatment Of Special Types Of Lumbar Disc Herniation With Percutaneous Endoscopic Interlaminar Discectomy

BACKGROUND AND OBJECTIVE: Treatment of lumbar disc herniation has achieved good results with percutaneous endoscopic interlaminar discectomy,the advantage is that under local anesthesia surgery,under direct exposure to complete the nerve tissue to complete the decompression,no damage to the stability of the lumbar structure,infection and less bleeding,faster recovery.The technique is not clear for the treatment of special types of lumbar disc herniation,such as calcified and migrated of lumbar disc herniation.This study evaluated the efficacy of percutaneous endoscopic interlaminar discectomy and its improved techniques for the treatment of calcified and migrated lumbar disc herniation.FIRST PART: METHODS:The data of patients undergoing percutaneous endoscopic interlaminar discectomy(PEID)in Department of Second Affiliated Hospital of Nanchang University from November 2013 to March 2016 were collected.Among them,20 patients with calcified lumbar disc herniation were included in the study group(average age is 43 years,30-59 years old),and the patients with age,sex and body mass index(BMI)with non calcified lumbar disc herniation were matched as control group(n = 20)(average age is 40 years,22-58 years old).Perioperative data were collected.Preoperative and postoperative 3,6,12 months visual analogue scale(VAS),Oswestry dysfunction index(ODI),application improved Mac Nab criteria to determine efficacy.The postoperative 12 month outcome of calcified lesions was evaluated by lumbar CT.RESULTS: Two groups of 40 patients,the operation was successful and was followed up.There was no significant difference in sex,age,BMI and lesion segment(P> 0.05).The operation time of CLDH group was significantly longer than that of NCLDH group,the difference was statistically significant(P <0.05).After surgery,patients with lower back pain and lower limb pain symptoms were immediately relieved.There were significant differences in VAS and ODI scores between the twogroups preoperative and postoperative operation(P <0.01).The difference was not statistically significant(P> 0.05)with two groups of patients with VAS score in each time point.However,the VAS score and the ODI score of NCLDH group was slightly better than that of CLDH group in the early stage of the operation the difference was not statistically significant(P> 0.05).The CLDH group and the NCLDH group in the final follow-up of Mac Nab excellent results percentage were 90% and 95%,the difference between the groups was not statistically significant(P > 0.05).Patients with abnormal sensation in CLDH group preoperative and postoperative each time point were more than those in NCLDH group,the difference between the groups was not statistically significant(P > 0.05).Postoperative evaluation by lumbar CT,short-term discs did not once again found significant calcification lesions.SECOND PART: METHODS:15 patients had been included in the study according to Lee's high degree of migrated of the lumbar disc herniation(1-4 area)in November 2013 to March 2016.8 cases of male patients and 7 female patients(mean age 41 years,22-56 years old),L4 / L5 gap in 5 cases,L5 / S1 gap in 10 cases.Perioperative data were collected.Preoperative and postoperative 3,6,12 months visual analogue scale(VAS),Oswestry dysfunction index(ODI),application improved Mac Nab criteria to determine efficacy.RESULTS:15 patients successfully completed the operation,postoperative lower limb pain were immediately disappeared,no nerve root injury,postoperative bleeding and dural rupture and other complications.Surgery time is 50-72min(average 60min).The VAS score and ODI index were significantly different(P <0.01)at 3,6 and 12 months after operation,there was no significant difference between the time points(P> 0.05).According to Mac Nab evaluation criteria,excellent rate of 93.3%(14/15).CONCLUTION: Percutaneous endoscopic interlaminar discectomy and its improved technique have a good clinical effect in the treatment of special types of lumbar disc herniation,especially for the treatment of calcified and migrated of lumbar disc herniation.Safe,effective,trauma,short-term clinical efficacy is better,its long-term efficacy need further clinical research.