The Clinical Study Of PTED Combined With Acupuncture In Treating Lumbar Disc Herniation With Modic Changes

ObjectiveFirstly,to investigate the effect of Modic changes on the postoperative efficacy and prognosis of percutaneous transforaminal endoscopic discectomy(PTED)in patients with lumbar disc herniation(LDH)through a clinical retrospective comparative study,so as to provide a reference for the selection of PTED cases.Secondly,to observe the clinical efficacy of PTED combined with acupuncture in treating LDH with Modic changes,the safety,effectiveness and feasibility of acupuncture in relieving postoperative symptoms and accelerating rehabilitation were analyzed,which provided a reference for the application of acupuncture in the perioperative period of PTED.MethodsPart One: From January 2015 to December 2017,293 patients with LDH were treated at our institution.All of the patients were underwent the PTED procedure,and were divided into two groups according to whether with Modic changes in operative segment.Of them,166 patients without Modic changes(Normal Group),127 patients with Modic changes(Modic Group),and patients with Modic?,?,?-type accounted 39,83,5,respectively.The occurrence of surgical complications andpostoperative recurrence were recorded,and the clinical outcomes were evaluated according to the visual analogue scale(VAS)for pain,Oswestry disability index(ODI)and modified MacNab criteria.Part Two: According to the diagnostic,inclusion and exclusion criteria,a total of 60 cases of LDH with Modic changes treated with PTED were screened from October 2018 to July 2019 in our institution.The patients were randomly divided into the routine group and acupuncture group,with 30 patients in each group.Their clinical outcomes were evaluated according to the VAS for pain,ODI and modified MacNab criteria.ResultsPart One: As compared with operation before,the VAS of back/leg pains and ODI at each time point after surgery were significantly improved in both groups(P < 0.05).There was no significant difference between two groups for the VAS of leg pain at any matching time point after surgery(P>0.05).However,the VAS of back pain and ODI in the Modic group were significantly higher than that in the Normal group at any matching time point after surgery(P<0.05).In the Modic group,there was no significant difference between the patients with Modic type?and ? for the VAS of leg pain at any matching time point after surgery(P > 0.05).The VAS of back pain and ODI in the patients with Modic type?were significantly higher than that in the Modic type? at 1 month follow-up(P<0.05),however,there was no significant difference at the last follow-up.Based on modified MacNab criteria,the clinical consequences were graded as excellent and good in 93.98% of the Normal group,whereas 84.25% of the Modic group,which showed statistical significance(P<0.05).The complication rates of the Normal group and the Modic group were 6.02% and 7.87%,respectively,with no significant difference(P > 0.05).The recurrence rates of the Normal group and the Modic group were 3.61%and 10.24%,respectively,with significant differences(P<0.05).Part Two: A total of 60 patients were included in this study,57 patients completed the study,28 in the acupuncture group and 29 in the routine group.As compared with operation before,the VAS of back/leg pains and ODI at each time point after surgery were significantly improved in both routine group and acupuncture group(P<0.05).The VAS of back/leg pains and ODI in the acupuncture group were significantly lower than that in the routine group at1 week and 1 month follow-ups(P<0.05).However,there was no significant difference between two groups at the 3 and 6 months follow-ups(P > 0.05).Based on modified MacNab criteria,the clinical consequences were graded as excellent and good in 89.29% of the acupuncture group,whereas 86.21% of the routine group,which showed no statistical significance(P>0.05).ConclusionFor LHD patients,whether with or without Modic changes,the PTED is safe and effective minimally invasive surgery;Modic changes will affect the mitigation of lower back pain and the restoration of function after PTED,especially in patients with Modic type?in the early postoperative period;The postoperative recurrence rate of LHD patients with Modic changes were significantly higher than that of patients without Modic changes;PTED combined with acupuncture can improve the clinical efficacy of patients within 1 month after surgery and accelerate recovery.