| Objective:In recent years,with the development of MRI,CT and other imaging technologies,the diagnosis rate of thoracolumbar intervertebral disc herniation continues to improve.Symptomatic TLDH patients account for approximately 0.15%~4% of all spinal disc herniations reported.The thoracolumbar segment is the junction of the thoracic and lumbar vertebrae,where stress is relatively concentrated.Overload labor or frequent and excessive torsion are easy to cause damage.The intraspinal nerve structures in this region include spinal cord lumbar enlargement,conus,a large number of cauda equina nerves,and nerve roots.Once symptomatic TLDH is diagnosed,surgical treatment should be performed as soon as possible,and delayed treatment will lead to serious consequences.The compression of the spinal cord by TLDH comes from the front.However,it is rarely reported that whether the nerve injury symptoms of patients with posterior ossification of ligamentum flavum are more severe than those of patients without ossification of ligamentum flavum,and whether there are differences in the postoperative clinical efficacy between the two.In this study,preoperative symptoms,intraoperative conditions and postoperative neurological function recovery status of TLDH patients with or without ossification of ligamentum flavum were compared,to explore the difference in clinical efficacy between patients with or without ossification of ligamentum flavum after surgery.Methods: Retrospective analysis was performed on the clinical data of 20 patients with TLHD who received surgical treatment from January 2016 to January 2018 and met the inclusion criteria of this study.According to with or without ossification of ligamentum flavum,there were 7 cases with ossification of ligamentum flavum in the ossification group,and 13 cases without ossification of ligamentum flavum in the non-ossification group.Patient inclusion criteria:(1)The age is 18 to 68;(2)Imaging showed a single segment of disc herniation with T10~L2;(3)Symptoms include back pain,lower limb weakness and numbness.Exclusion criteria:(1)Previous lumbar spine surgery history;(2)New lumbar fractures;(3)Spinal tuberculosis and other infectious diseases;(4)Intraspinal tumors;(5)Patients with severe cardiovascular and cerebrovascular diseases,respiratory diseases who cannot tolerate surgery.The operative time,intraoperative blood loss,postoperative drainage volume,indwelling time of tube,postoperative complications and hospitalization time of the two groups were compared and analyzed.VAS scores of patients in the two groups were recorded preoperatively,3 days postoperatively,3 months postoperatively and 6 months postoperatively.ODI scores of patients in the two groups were recorded preoperatively,3months postoperatively and 6 months postoperatively.Preoperative and postoperative neurological function recovery of the two groups was assessed using the ASIA scale.Results: There was no significant difference in age,gender and prominent segment between ossification group and non-ossification group(P>0.05).In the ossification group,the operative time was 2.14±0.51 h,the intraoperative blood loss was 628.57 ±471.57 ml,the catheterization time was 2.14 ±0.38 d,and the hospitalization time was 16.00 ±2.16 d.The operation time of the non-ossified group was 2.46±0.64 h,the intraoperative blood loss was 461.54± 236.43 ml,the catheterization time was 2.08 ± 0.28 d,and the hospitalization time was 14.62 ±4.07 d.There were no significant differences between the two groups in operation time,intraoperative blood loss,catheterization time and hospitalization time(P>0.05).VAS score of the ossification group was 6.14 ±0.69 before surgery,3 days after surgery was 3.14 ±0.69,3 months after surgery was 1.43 ±0.53,and 6 months after surgery was 0.43 ±0.53.The VAS score of the non-ossified group was 4.62 ±0.77 before surgery,3 days after surgery was 2.23±0.60,3 months after surgery was 0.62±0.65,and 6 months after surgery was 0.23±0.44.ODI score of ossification group was 48.57±3.21 before surgery,3 months after surgery was 26.29±2.14,and 6 months after surgery was 16.57± 4.58.ODI score of the non-ossified group was 41.85±4.43 before surgery,3 months after surgery was 23.85±3.95,and 6 months after surgery was 14.92±3.62.There was no significant difference between the two groups in VAS score at 6 months after surgery,ODI score at 3 months and 6 months after surgery(P>0.05).There were statistically significant differences in preoperative,postoperative,and postoperative VAS scores and preoperative ODI scores(P<0.05),and the ossification group was higher than the non-ossification group.There was no significant difference in postoperative complications between the two groups(P>0.05).Conclusion: Surgical treatment is necessary for TLDH patients with or without ossification of ligamentum flavum,and surgical treatment is an effective treatment for TLDH.The clinical manifestations of TLDH patients with ossification of ligamentum flavum are more severe than those without ossification of ligamentum flavum,but the short-term postoperative efficacy is similar,and whether there is a significant difference in long-term efficacy remains to be observed. |
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