| Background and ObjectiveLumbar disc herniation(LDH)is a common disease in spine surgery.Patients usually check on short term or chronic low back pain and lower limbs pain.Due to the more weight and activity of the lower lumbar spine,the occurrence of LDH is more usual in the L4/5 and L5/S1 segment.With the development of society,the increase of people's work and life pressure,bad living habits and sitting posture,sports style,etc.,the incidence of LDH is getting higher than before,and there is a tendency for young people.Low back pain and lower limbs pain,which are difficult to relieve,often have a huge impact on the quality of life of patients.In cases which conservative treatment can not alleviate the condition,such diseases often require surgery treatment.For the surgical treatment of LDH,there are many surgical procedures that can be selected,including the most classic simple lumbar discectomy(LD),and lumbar fusion surgery,which are widely used.However,there are often some new clinical problems after surgery,such as adjacent segment degeneration(ASD)after fusion surgery,which often affects the prognosis and long-term efficacy of patients.These problems always troubles the spinal surgeon and patients.Therefore,non-fusion surgery has always been one of the hot surgical choice for spinal surgeon and patients when considering surgical procedures.The Coflex interspinous fixation system(Coflex system)is a non-fusion surgery treatment that has been widely used in clinical practice.At present,the clinical reports on its therapeutic effects pay more attention to its short-term efficacy,and most of them are clinically compared with fusion surgery.There are few clinical comparison reports on the long-term efficacy of Coflex with classic simple lumbar discectomy.To compare the long-term clinical efficacy between classic simple lumbar discectomy and lumbar discectomy with Coflex system,we retrospectively studied patients diagnosed as lumbar disc herniatio in our hospital with long-term follow-up.MethodsWe retrospectively studied the patients data from the same treatment group in the Orthopedics department of the First Affiliated Hospital of Zhengzhou University.Patients who were diagnosed with lumbar disc herniation,and underwent simple lumbar discectomy and lumbar discectomy with Coflex system surgery from January 2009 to December 2010 were followed up.Patients were divided into two groups according to different surgical methods.Group A patients underwent simple lumbar discectomy with total of 37 patients,including 23 males and 14 females,the average age was(41.2±14.1)years old,the average time of follow-up was(95.7±10.4)months.Group B patients received lumbar discectomy with Coflex system surgery,total of 30 cases,including 17 males and 13 females,the average age was(40.8±10.3)years old,the average time of follow-up was(93.4±9.8)months.The Japanese Orthopaedic Association(JOA)score,Oswestry Disability Index(ODI),visual analogue scale(VAS)and height of intervertebral space and foramen were calculated and analyzed for each patient at preoperation,1 years after surgery,and at the last follow-up.SPSS21.0 software was used to analysis the measurement data,and the data was expressed as mean±standard deviation(?x±s).The comparison between the two groups of data was performed by the independent sample t-test.The paired sample t-test was used to compare the data within the group.The difference was statistically significant at P < 0.05.ResultsAt the last follow-up,the JOA score,ODI index and VAS scores of the two groups were significantly different from those at preoperation and at postoperation of one years(P < 0.05),and the clinical symptoms of the all patients were significantly improved.There were no significant differences in JOA score,ODI index and VAS score between the two groups at 1 year and at the last follow-up(P>0.05).In the height of the intervertebral space and foramen,at the last follow up patients in group A had significantly lower heights than those at preoperation and at the 1 year follow-up,the difference was statistically significant(P<0.05).Group B had a significantly higher height of intervertebral space and foramen at 1 year follow-up(P<0.05);at the last follow-up,the height values were all lower than those at 1 year follow-up,but the difference was no statistically significant(P>0.05),but it was still significantly higher than those at preoperation(P<0.05).Conclusion1.At the long-term follow-up,both simple lumbar discectomy and lumbar discectomy with Coflex system have good long-term clinical outcomes of the treatment for patients diagnosed as lumbar disc herniation?2.At the long-term follow-up,compared with the simple lumbar discectomy,using Coflex system combined with lumbar discectomy has a better clinical effect in maintaining the height of intervertebral space and foramen for the surgical segment. |
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