The Clinical Study Of Percutaneous Transforaminal Endoscopic Discectomy Through Grinding Upper Medial Notch Of The Pedicle In The Treatment Of Lumbar Vertebral Lateral Recess Stenosis And Highly Migra

Object:A prospective study was conducted to evaluate the clinical efficacy of the treatment for lumbar vertebral lateral recess stenosis and highly migrated disc herniation by percutaneous transforaminal endoscopic discectomy through grinding upper medial notch of the pedicle.Method:A total of 27 patients were selected from January 2017 to September 2018 who received modified TESSYS technique in our hospital.There were 17 males and 10 females with an average age of 65 ±26 years,including 12 patients with bony lateral recess stenosis and 15 patients with highly migrated lumbar disc herniation.We modified the traditional TESSYS technology,changing the forming part from small joint to upper medial notch of the pedicle,and increasing head inclination angle of work cylinder Channel and directly opening the bony lateral recess.Visual analogue scales(VAS)of low back pain and leg pain,Oswestry disability index(ODI),modified Macnab scores of preoperation,3 months,6 months and 12 months postoperative was recorded and analysis to assess the effectiveness of the procedure.At the same time,we have collected three groups of data using TESSYS technology,including age,sex,surgical segment,preoperative ODI score and preoperative and postoperative leg pain VAS score as the matched group to compare the clinical efficacy.Results: All operations were successfully completed without any changes in the procedure.The average operative time of the s bony lateral recess stenosis group was 60±20 min,and the average operative time of the highly migrated lumbar disc herniation group was 80±30 min.The intraoperative observation of the lesion was consistent with preoperative.The average follow-up time was 10.2 ±1.2 months.Postoperative review of lumbar CT showed complete decompression of osseous lateral recess and complete removal of free disc tissue.The hospital stay was 4-7 days,with an average of 5 days.Low back pain and leg pain relief of symptoms in all patients significant relief.After surgical treatment,the VAS and ODI scores of the two groups were significantly improved.The VAS score of preoperative low back pain was 7.58±0.62 in the bony lateral recess stenosis group,and the VAS score of postoperative low back pain was 1.8±0.8.The difference was statistically significant because of P<0.05.The preoperative leg pain VAS score was 8.05±1.48,and the postoperative leg pain VAS score was 1.25±0.87.The difference was statistically significant because of P<0.05.The preoperative ODI score was 55.34±7.17,and the postoperative ODI score was 15.82±3.83.The difference was statistically significant because of P<0.05.Postoperative Macnab scores were excellent in 9 cases and good in 3 cases.The VAS score of preoperative low back pain was 6.35±1.20 in the migrated disc herniation group,and the VAS score of postoperative low back pain was 2.10±0.43.The difference was statistically significant because of P<0.05.The preoperative leg pain VAS score was 8.60±1.08,and the postoperative leg pain VAS score was 1.67±0.30.The difference was statistically significant because of P<0.05.The preoperative ODI score was 50.55±10.17,and the postoperative ODI score was 18.80±5.61.The difference was statistically significant because of P<0.05.Postoperative Macnab scores were excellent in 10 cases and good in 5 cases.At the same time,compared with the traditional groups,the P value of VAS score of leg pain in the improved group was greater than 0.05,and there was no statistical difference.Meanwhile,we compared the age,sex,operative segment and preoperative ODI scores of the patients between the improved group and the traditional group,and there was no statistical difference because of P>0.05.The VAS score of leg pain in the improved group was not significantly different from that in the traditional group because of P>0.05.There were no complications such as nerve root injury and dural rupture during surgery.No other serious complications occurred after the operation.Conclusion:The technique of grinding upper medial of the pedicle notch approach is a safe and effective surgical method.It is a supplement to the traditional TESSYS technology.It broadens the indications for percutaneous endoscopic surgery.It is effective in the treatment of bony lateral recess stenosis and migrated disc herniation.