The Multi-center Clinical Efficacy Analysis Of Percutaneous Endoscopic Lumbar Discectomy In The Treatment Of Lumbar Degenerative Disease

Lumbar degenerative disease refers to the general term for a group of diseases caused by an irreversible degenerative change in the structure of the lumbar spine as human's age.The degenerative changes of the lumbar vertebrae include: lumbar zygapophyseal joints,ligamentum flavum,posterior longitudinal ligament,intervertebral disc,cartilage endplate,posterior vertebral body and so on.The symptoms caused by degenerative lumbar spine include: lumbar and leg pain,abnormal lower limbs,difficulty walking,severe paresthesias and abnormalities in the stool.Lumbar degenerative diseases include: 1,lumbar degenerative disc disease;2,lumbar degeneration instability;3,lumbar degenerative spinal stenosis;4,lumbar degeneration vertebral spondylolisthesis;5,degenerative scoliosis.Among them,lumbar disc herniation,lumbar spinal stenosis,and degenerative lumbar spondylolisthesis are the most common.Lumbar degenerative diseases currently include conservative treatment and surgical treatment.Most patients can receive short-term symptom relief through conservative treatment,but the long-term symptoms are more likely to repeat,and tend to increase gradually.At present,there are many surgical methods for degenerative diseases of the lumbar spine,which mainly consist of lumbar fusion and minimally invasive techniques.Fusion technology is still the "gold standard" for surgical treatment at home and abroad.However,minimally invasive techniques,especially percutaneous endoscopic lumbar discectomy(PELD),its advantages and curative effects have been recognized by the majority of patients and doctors,and have become one of the means to treat lumbar degenerative diseases,and have gradually become the preferred treatment plan for some patients.Objective:To analyze and compare the efficacy of lumbar spine lateral intervertebral for endoscopic lumbar disc herniation,lumbar spinal stenosis,degenerative lumbar spondylolisthesis,and to explore the multi-center clinical treatment of lumbar degenerative disease with lumbar intervertebral foramen Efficacy,summarizing the advantages of transforaminal endoscopic techniques and their clinical application value.Methods:Retrospective follow-up From April 2016 to March 2017,210 patients were treated with multi-central lumbar decompression under local anesthesia and underwent transforaminal endoscopic surgery.198 patients were followed up through the Internet or telephone for one year complete follow-up data.Among the 198 patients,there were 83 patients with lumbar disc herniation,52 male patients,31 female patients,and an average age of(38.8±11.8)years;113 patients with lumbar spinal stenosis,63 male patients,50 female patients,mean age(60.9±10.6)years old;2 cases of degenerative lumbar spondylolisthesis were male,aged 68 and 59 respectively.Visual analog scale(VAS),Japanese Orthopaedic Association Scores(JOA),preoperative,postoperative week,one month,three months,six months,and one year were recorded.Oswestry disability index(ODI)and MacNab criteria.83 cases of lumbar disc herniation,113 cases of lumbar spinal stenosis,and 2 cases of degenerative lumbar spondylolisthesis were analyzed by VAS,JOA,and ODI.We can get the Multi-center clinical efficacy of transforaminal endoscopic discectomy in the treatment of lumbar degenerative disease.Results:All the 198 patients were successfully performed by the author's tutor.All the patients were followed up.The follow-up was followed by Internet or telephone follow-up.The VAS score of 83 patients with lumbar disc herniation was 8.19±1.16 before operation and 0.82±0.89 in one year after operation.The difference was statistically significant(P<0.05).The preoperative JOA score was 9.82±2.24.And the postoperative score of one year was 27.25 ± 1.34.The difference was statistically significant(P <0.05);ODI index before surgery(84.65 ± 5.10)%,one year after surgery(10.00 ± 5.98)%,the difference was statistically significant(P <0.05).The improved Macnab score was excellent in 60 cases,good in 16 cases,fair in 7 cases,and the excellent and good rate was 91.6%.The VAS score in 113 patients with lumbar spinal stenosis was 7.91±1.08 before operation,and 1.89±0.83 in one year after surgery.The difference was statistically significant(P<0.05).The preoperative JOA score was 11.87±2.07.And the postoperative score of one year was 24.20 ± 1.98.The difference was statistically significant(P <0.05);ODI index before surgery(78.37 ± 5.70)%,one year after surgery(17.75 ± 6.26)%,the difference was statistically significant(P <0.05).The improved Macnab score was excellent in 68 cases,good in 34 cases,and fair in 11 cases,and the excellent and good rate was 90.2%.In 2 patients with degenerative lumbar spondylolisthesis,VAS scores were 6 and 8 before surgery,and 3 and 3 years after surgery respectively.The JOA scores were 10 and 11 before surgery and 22 and 24 after one year.The index was 68% and 72% before surgery and 46% and 34% after surgery.The improved Macnab score was good in 1 case and excellent in 1 case.Only 2 patients with degenerative lumbar spondylolisthesis have fewer cases and no statistical analysis was performed.However,the postoperative scores of both patients were improved compared with preoperative ones,and the postoperative patients' symptoms were relieved to achieve patient satisfaction effect.No infection occurred in all patients after surgery.Both patients suffered from slight damage to the dura due to the location of the spiral drill,resulting in cerebrospinal fluid leakage because the drainage tube was routinely placed during the operation and symptomatic treatment was given after rehydration.Therefore,2 patients were routinely treated.No discomfort after unplugging the drainage tube and the wound healed well.In 1 patient with painful arthritis,back pain and hip pain lasted for one year,and pain disappeared after bed rest and medication.Conclusion:Through the statistical analysis and comparison of the large-sample and multi-center follow-up cases in this study,it can be concluded that the efficacy of the lateral intervertebral foramen in the treatment of lumbar disc herniation is clear and the excellent rate is high;and the cause of lumbar spinal stenosis There are many pathogenic factors,and the patients are older,so the curative effect and good rate of lumbar disc herniation are decreased.However,there is no statistical difference in postoperative curative effect between the two patients,and both can achieve satisfactory results;degenerative lumbar spondylolisthesis Patients' scores after surgery were improved compared with preoperative scores,and the patient's symptoms were reduced.Therefore,the clinical efficacy of lateral lumbar interfacial microscopy in the treatment of lumbar degenerative disease is reliable,and the value of clinical promotion is relatively large.