The Diagnosis And Treatment Of Free Lumbar Disc Herniation

Objective:Based on the classification and zoning of free nucleus pulposus position.To explore the clinical diagnosis and surgical treatment of free lumbar disc herniation,and observe the clinical treatment effect.Methods:Retrospective analysis was performed on 15 patients with completely free lumbar disc herniation who underwent undergraduate treatment from August 2013 to March March 1818.After conservative treatment or with acute cauda equina syndrome,the posterior approach was reduced.Surgical methods of compression,bite removal of part of the pedicle,removal of completely free lumbar disc nucleus tissue,contact with nerve root compression.Statistical operation time and intraoperative blood loss.According to Lu et al [3] classification of free intervertebral discs,the samples were divided into 3 types(Fig.1).There were 3 cases in group Ia,4 cases in group Ib,and 8 cases in group IIa.Table(VAS)scores,modified Macnab grading criteria,and Oswestry Disability Index(ODI)assessed surgical outcomes.Through the surgical treatment of 15 patients with free lumbar disc herniation,the significance of imaging diagnosis was evaluated.The preoperative,intraoperative and postoperative clinical data were systematically analyzed.The follow-up evaluation of the treatment effect was performed.Results:All patients were successfully operated and the average operation time was 200.53±37.81 minutes.No complications such as neurovascular injury,dural injury,or dural tear occurred during the operation.Preoperative(VAS)8.13±0.74 points,postoperative(VAS)1.47±0.52 points.There was significant difference compared with preoperative(p<0.05),ODI score decreased from 89.73±5.17% before operation to 13.87±2.45%,which was significantly different from preoperative(P<0.05).According to the modified Macnab grading criteria,0 cases were excellent preoperatively,0 cases were good,10 cases were fair,and 5 cases were poor.The results were excellent in 10 cases,good in 4 cases,fair in 1 case,and poor in 0 cases.The excellent rate after operation was 93.33%.Both groups were completely followed up for a period of 12 to 48 months with an average of 32.13±12.81 months.Conclusion:There is a certain incidence of free lumbar disc herniation.Due to rupture of the annulus fibrosus and prolapse of the nucleus pulposus in the extradural space of the dural sac of the spinal canal,the nerve root and dural sac are often severely compressed,causing the patient's lumbar and leg.The symptoms are very obvious and seriously affect the daily life of the patients.For free lumbar disc herniation,surgical treatment is performed to evaluate the significance of imaging diagnosis.The effect of treatment is evaluated through follow-up.After the diagnosis is made,the open window nucleus removal should be performed early.For the preoperative lumbar instability,recurrence after lumbar disc operation,and total laminectomy,simultaneous fixation of the segment can be considered.