The Diagnosis Of Sequestered Lumbar Disc Herniation And Comparison Of The Effect Between Percutaneous Endoscopic Lumbar Discectomy And Fenestration Discectomy

Objective To be familiar with the special imaging findings of sequestered lumbar disc herniation(SLDH),and reduce the misdiagnosis.On the basis of the types and partitions of sequestered nucleus,to discusse the surgical approach of removing sequestered disc and evaluate the clinical efficacy of percutaneous endoscopic lumbar discectomy(PELD)and fenestration discectomy(FD)for sequestered lumbar disc herniation.Methods Between August 2015 and December 2016,45 patients of SLDH with surgical treatment were analyzed retrospectively by our department.The imaging data of such special and emergency patients were analyzed and summarized.According to the difference of surgical treatment,patients were divided into group FD and PELD.Among them,21 patients of FD group received fenestration discectomy and 24 cases in PELD group received percutaneous endoscopic lumbar discectomy.The results were evaluated by visual analogue scale(VAS)according pre-and post-operative low limp pain at three days,1 months,6 months and 12 months.The surgical effects were evaluated by Oswestry disability index(ODI)and modified MacNab grading criteria 12 months after surgical operation.The two groups of patients' operation time,blood loss volume,post-operative hospital stay were recorded and analyzed respectively.Results All patients were followed up for 12-14 months and the mean follow-up time was 13.6 months.The sequestered disc tissues of 45 patients showed a low signal in preoperative T1 weighted MRI.32 cases showed a slightly high signal and 13 cases showed a low signal in T2 weighted MRI.28 cases(62%)with the course of over two weeks presented peripheral rim enhancement in enhancement MRI.After the operation,on low limb pain VAS score and ODI score compared to that of preoperation,the difference was statistically significant(p<0.05).But no significant difference was found between the two groups(p>0.05).According to the final follow-up modified MacNab criteria score,the excellent and good rate of PELD group was 91.7%and the FD group was 85.7%.There was no significant difference(P>0.05)between the two groups on MacNab criteria score.The operative time of PELD group was longer than FD group,and the difference was statistically significant(p<0.05).On blood loss volume and postoperative hospital stay,PELD group was superior to the FD group,and the difference between the two groups were statistically significant(P<0.05).Conclusions Patients with SLDH had special imaging findings.Before operation,it was necessary to be fully familiar with them and conduct a comprehensive diagnostic evaluation based on the clinical data.On the basis of the types and partitions of epidural sequestered lumbar disc herniation,we can remove the epidural sequestered disc tissue by different approaches of PELD.Compared with FD,they showed the same clinical efficacy.Besides,they can achieve complete decompression of the nerve root in a more secure and less invasive way under local anesthesia and broaden indications of PELD for the treatment of lumbar disc herniation.