Comparison Of The Therapeutic Effect Of Endoscopic Spinal Surgery And Fenestration Discectomy In The Lumbar Disc Herniation Mimicking Tumour

objective:Tumor like lumbar disc herniation refers to a special type of free disc herniation in the spinal canal.Because of the formation of inflammatory vascularization around the free nucleus pulposus,MRI shows the ring sign of enhanced aperture around the nucleus pulposus,which is easy to be misdiagnosed as neurogenic tumor,hematoma and other diseases.The traditional treatment is open surgery with fenestration and interbody fusion,which is traumatic and has many complications.Spinal endoscopy has become a mature minimally invasive surgery for free lumbar disc herniation,but there are few reports and clinical studies on the treatment of tumor like disc herniation by spinal endoscopy.With the development of imaging technology and the understanding of tumor like disc herniation,our team adopts spinal endoscopy on the basis of accurate preoperative diagnosis The treatment of tumor like lumbar disc herniation has achieved an ideal effect.However,there is no systematic comparative study on the short-term and long-term effects of the treatment of tumor like lumbar disc herniation by spinal endoscopy and traditional fenestration.The purpose of this study is to compare the clinical effect of endoscopic surgery and traditional fenestration in the treatment of tumor like lumbar disc herniation,so as to provide a basis for more minimally invasive and effective treatment of tumor like lumbar disc herniation.Methods:TFrom July 2016 to December 2018,the data of 24 cases of tumor like lumbar disc herniation in orthopedics department of the Second Affiliated Hospital of Nanchang University were analyzed retrospectively.12 cases were treated with endoscopic lumbar discectomy(minimally invasive group),12 cases were treated with posterior laminectomy(open group).After one-year follow-up,the efficacy of the two methods was evaluated by operation time,intraoperative bleeding volume,length of stay,incidence of complications,VAS pain score,ODI score and modified macnab score Result:The average operation time,intraoperative hemorrhage and hospitalization time in the minimally invasive group were significantly shorter than those in the open group(P < 0.05).The incidence of postoperative complications in the minimally invasive group was higher than that in the open group(P < 0.05).The postoperative VAS pain score and ODI score of the two groups were significantly better than those of the preoperative group(P < 0.05).There was no significant difference in VAS pain score and ODI score between the minimally invasive group and the open group(P > 0.05).There were 4 excellent,6 good,2 fair,and 0 poor in the minimally invasive group,with an excellent and good rate of 83.3%;there were 4 excellent,4 good,3 fair,and 1 poor,with an excellent and good rate of 66.7% in the open group,with no significant difference(P > 0.05).Conclusion:Spinal endoscopy is a good choice for the treatment of tumor like lumbar disc herniation.There was no significant difference in the short-term effect between the endoscopic technique and posterior laminectomy in the treatment of tumor like lumbar disc herniation.