Small Incision Limited Lumbar Discectomy Combined With Annulus Repair In The Treatment Of Lumbar Disc Herniation

BackgroundLumbar disc herniation(LDH)is a common disease in spine surgery,the symptoms of more than 80% patients can be relieved or disappeared after strict conservative treatment.Surgical treatment is necessary if it is not effective,lumbar discectomy is a commonly used surgical method with good outcome,but the long-term existence of annulus fractures is one of the main causes of failed back surgery syndrome(FBSS),such as postoperative stubborn low back pain and recurrence.The recurrence rate after lumbar discectomy is 3 %-23%,how to reduce the re-herniation rate is an urgent problem to be solved.In recent years,our department has combined classic posterior small incision limited lumbar discectomy with annulus fibrosus repair to find a solution to this problem.ObjectiveThrough a retrospective study,compared the clinical efficacy of small incision limited lumbar discectomy combined with annulus fibrosus repair and simple nucleus discectomy for lumbar disc herniation,to investigate the impact of annular repair on re-herniation rate.MethodsCollected clinical data of patients with lumbar disc herniation who underwent small incision limited lumbar discectomy combined with annulus fibrosus repair and simple nucleus discectomy in the fourth department of orthopaedic surgery of the First Affiliated Hospital of Xinxiang Medical University from October 2016 to March 2018.Based on the inclusion and exclusion criteria,60 patients who were treated with simple nucleus discectomy were selected as control group.The male to female ratio was 34:26,age ranged from 27 to 71 years.The average age was(47.53 ± 8.69)years.L3/4: 2 cases,L4/5: 33 cases,L5/S1: 25 cases,and central type 8 cases,26 cases herniated to the left,26 cases herniated to the right,with a history of 4 to 22 months,with an average of(13.45 ± 4.71)months;49 patients with posterior small incision limited nucleus discectomy combined with annular repair were selected as suture group,the male to female ratio was 28:21,and the age ranged from 37 to 68 years.The average age was(49.24 ± 6.26)years.L3/4: 3 cases,L4/5: 27 cases,L5/S1: 19 cases,and central type 6 cases.22 cases herniated to the left and 21 cases herniated to the right.The medical history ranged from 2 to 26 months,with an average of(13.65 ± 5.84)months.Preoperative,3 months,12 months and 2 years after operation,changes of the height of the intervertebral space of the surgical segment were recorded;Visual Analogue Score(VAS),Oswestry Disability Index(ODI)and Japanese Orthopaedic Association Score(JOA)scores were used to evaluate the efficacy of the operation;the modified MacNab score was used to evaluate the excellent rate at the last follow-up,and the re-herniation cases were recorded.Results1.The two groups of patients successfully completed the operation without changing the surgical method.No serious complications acct.There was no statistical difference in sex ratio,age,operation level,herniation classification,and preoperative symptom duration between the control and suture groups(P>0.05).No significant differences were noted in incision length,operation time,intraoperative blood loss,postoperative drainage,and postoperative hospital stay(P>0.05).2.The VAS score for low back and lower extremity pain,ODI scores,and JOA scores at each time point in the two groups were significantly improved than preoperative(P<0.05),and there was no significant difference between the groups(P>0.05).3.No significant difference was found in the improvement rate of JOA score and the modified Macnab score at the last follow-up between the two groups(P>0.05).4.The re-herniation rate in the suture group was lower than that in the control group,which was statistically significant(P<0.05).The disc height in the suture group was(10.01 ± 0.74)mm and(8.37 ± 0.74)mm in the control group at the last follow-up,statistical difference was noted(P <0.05).Conclusion1.Small incision limited lumbar discectomy combined with annulus fibrosus repair for the treatment of lumbar disc herniation is simple,safe and reliable,and can achieve satisfactory clinical outcomes.2.Under the strict premise of surgical indications,annulus fibrosus repair can reduce the postoperative re-herniation rate,delay the loss of disc height,and slow down the process of disc degeneration.