The Effect Of Percutaneous Endoscopic Lumbar Discectomy On Lumbar Spine Dynamic And Its Prognostic Analysis

ObjectiveLumbar disc herniation(LDH)is a common and frequently-occurring disease characterized by low back pain as a typical symptom.Chinese medicine has long had a deep understanding of this type of disease,and it is based on traditional Chinese medicine theory in terms of treatment and rehabilitation.After LDH occurs,most patients can obtain curative effect through conservative treatment based on traditional Chinese medicine characteristics.For example,acupuncture,moxibustion,massage,orthopedics,traction,suspension,exercise,internal medicine,Chinese herbal medicine,fumigation,and injections containing Chinese herbal medicines,etc.However,in patients with poor conservative treatment,surgical intervention is often required.Surgical treatment is increasingly becoming minimally invasive.Percutaneous endoscopic lumbar discectomy(PELD)is one of the most minimal invasive ways to treat lumbar disc herniation(LDH).Many literatures at home and abroad have reported the clinical safety and effectiveness.However,there are still too few studies on the effect-factors of lumbar spine such as the height of lumbar intervertebral space,range of lumbar motion,lumbar curvature,lumbar stability,The purpose of this study was to investigate the dynamic effects of PELD surgery on lumbar spine and prognosis.MethodsA retrospective study was performed on 72 patients with single-segment LDH undergoing PELD surgery in Our department from 2015.10 to 2016.3.All patients took preoperative and postoperative radiographs of the lumbar positive and side position,extending and bending position.Patients were assessed for subjective sensation of waist and leg pain by VAS.All patients were regularly followed up by phone,SMS,WeChat and outpatient appointments.The patients were followed up preoperatively,discharged from hospital,1 month after surgery,3 months after surgery,Postoperative 6 months,postoperative 12 months,postoperative 18 months,the last follow-up and were measured by CAD drawing software to measure the change of physiological curvature of the entire lumbar spine(the Cobb angle of the lumbar spine),Cobb angle of the lesion segment(lumbar mobility),Intervertebral space height,VAS score of back and legs pain before and after operation.And postoperative complications were assessed.ResultsAll the 72 patients underwent successful operation under local anesthesia and monitoring.There was no change in the surgical procedure,no change of anesthesia,no serious complications occurred such as nerve root injury and interspinous infection after operation.One case of patients with recurrence 3 months after surgery in the same segment,then accepted MED surgery,1 patient with the same segment after 14 months underwent recurrence by lumbar instability,at last accepted posterior minimally invasive surgery-Transforaminal lumbar interbody fusion(MIS-TLIF).Another 19 patients were lost to follow-up(the rate of lost follow-up was 27.14%).A total of 51 patients were followed up in our study.The follow-up time of 51 patients was(21.31 ± 2.45)months.The imaging data of all patients were taken in our hospital.The VAS scores of postoperative waist and leg pain were significantly different from those before operation(P <0.05)The scores of lumbar and leg pain in each time point had no significant difference(P> 0.05).The lumbar curvature after operation was improved compared with that before operation,but there was no significant difference in lumbar curvature between before and after operation(P> 0.05).There was significant difference in DHI and SROM values between preoperative and postoperative 12 months and postoperatively(P <0.05).There was no significant difference in DHI and SROM values at 6 months and before it after operation(P> 0.05).ConclusionsPELD is effective in treating LDH and has good patient satisfaction.It can be used as the first choice for the treatment of lumbar disc herniation.PELD can restore the lumbar curvature to some extent(P> 0.05),but PELD accelerates lumbar degeneration,and having no effect on lumbar dynamic changes early,but there is the potential risk of long-term instability,the possibility of lumbar instability,low back pain.