| Objective:To retrospectively analyze the mid-long term efficacy of Microendoscopic Discectomy(MED)in the treatment of lumbar disc herniation and to analyze the factors that influence the efficacy.Methods:Seventy-two patients with Microendoscopic Discectomy were followed up for an average of 56.0 months(36 to 77 months).VAS pain scores,JOA lower back pain scores,and Chinese ODI values were assessed before MED and during the follow-up.Meanwhile,the Macnab standard assessment were improved,the imaging assessment and satisfaction survey were conducted,and the factors affecting the efficacy were studied.Results:The preoperative VAS scores of the lower back and lower limbs pain were(5.83±1.58)points and(7.51±1.56)points respectively;the follow-up VAS scores were(2.61±1.00)points and(1.71±1.15)points(P<0.05)respectively.The JOA lower back pain score increased from(11.62±2.04)points before operations to(24.88±2.02)points during the follow-up(P<0.05)with the average improvement index of(13.16±2.60),and the average improvement rate of(76.19%±11.32%).The average ODI before the operation was(65.79%±9.21%)and the average ODI at follow-up was(14.47%±7.70%)(P<0.05).Among all the cases,2 cases suffered from dural rupture and 3 cases suffered from recurrence and re-operation.The re-operation rate was 4.16%,the overall excellent rate was 90.3%,and the overall satisfaction rate was 88.9%.Eighteen patients underwent reexamination of lumbar X-ray films;the preoperative ratio of intervertebral height was(0.405±0.042)and the average height of intervertebral space at follow-up was(0.265±0.063)(P<0.05).Eight patients underwent MRI reexamination of the lumbar spine;the preoperative diameter of the epidural indentation was(7.21 ±2.84)mm,the longitudinal axis(11.37±2.46)mm,the posterior diameter(3.18± 1.75)mm,and the vertical axis(9.12± 1.83 mm).(P<0.05);The effect of the treatment lasting less than 6 months was better than that of the treatment lasting more than 6 months(P<0.05).Conclusion:1.The mid-long term clinical efficacy of Microendoscopic Discectomy for the treatment of lumbar disc herniation is definite and the excellent rate is good.2.In this research,the preoperative course is the factor that affects the mid-term and long-term efficacy and the efficacy has nothing to do with gender,age,smoking,drinking,labor intensity,surgical segment,hospitalization time,anesthesia,back muscle exercise,and follow-up time. |
