Clinical Observation Of Percutaneous Transforaminal Endoscopic Surgery In The Treatment Of Lumbar Disc Herniation

Research Background and Objective: Lumbar disc herniation is a degenerative change in the lumbar intervertebral disc.Based on the loss of water and the external force,the annulus fibrosus ruptures,and the internal nucleus pulposus protrudes through the rupture of the annulus fibrosus.Roots,dural sacs and cauda equina cause mechanical compression or chemical stimulation,causing a clinical syndrome characterized by low back pain,lower extremity emanating pain,and changes in symptoms of urination.It is one of the main causes of low back pain and leg pain.Although conservative treatment of 85% to 90% of patients can improve leg pain,about10% of patients still need surgical intervention to relieve pain.The current surgical methods for relieving the pain caused by the lumbar disc herniation are numerous and mainly divide into two major categories: traditional open surgery and minimally invasive surgery.In 1954 Mixter and Barr first proposed that LDH is the main cause of low back pain.The treatment of LDH has undergone rapid and diversified development.With the rapid development of science and technology,spine surgery has also achieved remarkable results in the field of minimally invasive surgery.Since the first use of papaya chymotrypsin in the treatment of lumbar disc herniation in 1964,after a half century of development,minimally invasive spine surgery has been well received by medical staff due to its advantages of small trauma,quick recovery,good effect and few complications.Percutaneous transforaminal endoscopic discectomy(PTED)is one ofthe most minimally invasive surgical procedures in the treatment of LDH at home and abroad.In this study,the clinical symptoms of PTED patients were observed to improve the clinical symptoms of lumbar disc herniation after 1-year period.Methods: From January 2016 to December 2016,98 patients(51 males and 47females)underwent percutaneous transforaminal endoscopic discectomy in our hospital.Surgical procedures include transforaminal(TF)and interlaminar(IL)..Selected inclusion and exclusion criteria,all patients underwent preoperative X-ray(posterior and dynamic position),CT(with lesion segment as the center,including at least a disc and the next intervertebral space)and MRI examination,.The operative methods is the intervertebral foramen approach or interlaminar approach in prone position,and the operative segment is located by C-arm,and the calibration of the puncture point on the skin,preoperative measurement of needle angle by CT.The VAS,ODI,VAS,ODI score of patients before operation were calculated,including VAS,ODI,intraoperative blood loss,operation time,average postoperative hospital stay,postoperative 1 week,3months and 1 year.Results: The preoperative and postoperative 1 week,3 months and 1 year VAS score were 7.15 ± 1.21 points,1.82 ± 0.95 points,1.45 ± 1.10 points and 1.02 ± 0.7points respectively.The ODI score of one week,three months and one year after operation were 42.53 ± 3.57,22.58 ± 5.90,18.52 ± 7.45 and 14.15 ± 5.6,respectively.Postoperative and preoperative VAS and ODI scores decreased significantly.The differences were statistically significant.The efficiency of Macnab is 93.88%.Conclusion: Percutaneous transforaminal endoscopic microsurgery is one of the most effective surgical methods in the treatment of lumbar disc herniation.The effect of percutaneous transforaminal endoscopic surgery is no significant difference compared with traditional open incision.However,due to less bleeding and shorter operation time and recovery time and other characteristics,very competitive.At thecurrent,PTED technology of minimally invasive spine surgery,it is worth to study and apply.But we should grasp the indications and contraindications,according to the different circumstances of different patients with different surgical options.