| Objective: A study of the clinical efficacy of different spinal endoscopic facetectomy grades in the treatment of lumbar disc herniation and their effects on lumbar spine stability and parameters related to facet joints.Methods: A total of 120 patients were included in this study,all of whom were diagnosed with single-segment lumbar disc herniation and treated with spinal endoscopic surgery at the Department of Spine Surgery,Affiliated Hospital of Qingdao University from May 2020 to January 2021,and the study population was divided into three groups according to the intraoperative facetectomy method: grade I,grade II,and grade Ⅲ.The general data and relevant surgical indicators,including age,sex,BMI,duration of symptoms,operative time,and intraoperative bleeding,were recorded separately.The clinical surgical outcomes were evaluated using the Visual Analog Scale(VAS),the Oswestry Disability Index(ODI),and the Japanese Orthopaedic Association Score(JOA)for assessment of treatment at 1 month,3 months,6 months,12 months,1 year,and 2years preoperatively and postoperatively,respectively.Then,the stability of their operated segments and the postoperative changes in the contralateral facet joint parameters were assessed by reviewing their lumbar dynamic position X-ray and CT at about 2 years after surgery.Finally,we established a three-dimensional finite element model of the lumbar spine and observed the mechanical changes at different endoscopic facetectomy grades.Results: There were no statistically significant differences in age,gender,BMI and duration of symptoms among the three groups of patients in terms of basic data and surgery-related indicators(P>0.05).The corresponding operative times were 81.11±9.32,83.45±8.57,and 107.36±11.41 minutes,respectively,with statistically significant differences(P<0.05),with the longest operative times for patients in the grade Ⅲ shaped group and the same statistically significant differences in the comparison between each two groups.The corresponding intraoperative bleeding in the three groups was15.01±1.98,18.33±2.35,and 25.64±4.42 m L,and the difference in operative time between the three groups was statistically significant(P<0.05),and there was no statistical difference between the groups of patients with grade I and II plication,but there was a statistical difference in the comparison between the groups of grade I and Ⅲ and between grade II and Ⅲ,and Intraoperative bleeding was significantly higher in patients with grade Ⅲ plication compared to the other two groups.In the three groups,there was no statistically significant difference in the preoperative low back pain VAS scores among the three groups(P>0.05).During the same postoperative follow-up period,the VAS scores of low back pain in the three groups continued to decrease,and there were statistically significant differences between the group comparisons between grade I and grade Ⅲ and between grade II and grade Ⅲ,suggesting that the postoperative recovery of low back pain was slower in patients with grade Ⅲ molding than in the other two groups,and that the VAS scores of low back pain in patients with grade Ⅲ molding at the two-year postoperative follow-up period increased slightly compared with the previous follow-up period.The postoperative leg pain VAS scores of the three groups gradually decreased,and there was no statistical difference between the three groups in the overall comparison of leg pain VAS scores within the three groups and between the groups at the two-year postoperative follow-up period(P>0.05).There was no statistically significant difference in the preoperative leg pain ODI indices of the three groups(P>0.05).The ODI indices of all three groups decreased gradually after surgery,but there was a statistical difference between the three groups in the follow-up period from one month to two years after surgery between grade I and grade Ⅲ and between grade II and grade Ⅲ,but there was no statistical difference between grade I and grade II.This suggests that all three groups improved in terms of low back pain and quality of life during the postoperative follow-up period,but that patients with grade Ⅲ formations recovered more slowly than patients with grades I and II when compared between groups.Similarly,the JOA scores of the three groups showed similar trends,and although the differences in the preoperative JOA scores were not statistically significant(P>0.05),the overall comparisons were statistically different(P<0.05)at the postoperative follow-ups,and the intergroup comparisons between grades I and Ⅲ and between grades II and Ⅲ were Statistical differences were found between the group comparisons between levels I and Ⅲ and between levels II and Ⅲ,but no statistical differences were found between levels I and II.In terms of lumbar mobility indexes,there was no statistically significant difference in the preoperative hyperflexion intervertebral angle,preoperative hyperextension intervertebral angle and preoperative s ROM among the three groups(P>0.05),but there was a statistically significant difference in the postoperative indexes among the three groups.The number of lumbar instability at 2 years postoperatively was 1/54,2/49,and2/19 for the grade I,grade II,and grade Ⅲ patients,respectively,and the difference was not statistically significant(P > 0.05).With regard to the articular eminence parameters,there was no statistically significant difference in the comparison of the contralateral articular eminence angles of the three groups of patients before surgery(P>0.05),but the postoperative contralateral articular eminence angles and the values of angular changes were statistically significant,and the intergroup comparison of the three groups of patients was also statistically significant(P<0.05).The number of patients with grade I,grade II and grade Ⅲ arthroplasty who had contralateral arthroplasty degeneration at 2 years after surgery was6/54,12/49 and 7/19,respectively,and the chi-square test showed a statistical significance(P < 0.05),suggesting that the increase in the grade of arthroplasty aggravated the contralateral facet degeneration.The results of the chi-square test showed a statistical significance,suggesting that the increase in the grade of the molding aggravated the degeneration of the contralateral joint.In the finite element model,the L4/5 segmental mobility in the six activity conditions of anterior flexion,posterior extension,left flexion,right flexion,left rotation,and right rotation was greater in grade Ⅲ than in grade I and grade II arthroplasty patients,with increases of 8.1%,25.0%,12.8%,5.0%,37.5%,and 29.1%,respectively,compared with the normal model.Conclusion: The different levels of arthroplasty had definite efficacy in the treatment of lumbar disc herniation,especially in the relief of lower extremity symptoms,but grade Ⅲ arthroplasty was longer and more bleeding than grade I and grade II facetectomy,which resulted in slower relief of low back pain and increased mobility of the lumbar spine,but no significant increase in the probability of lumbar instability during the two-year observation period.As the grade of facetectomy increased,it decreased the contralateral facet joint angle and aggravated the degenerative grade of the contralateral facet joint.The finite element model results suggest that the effect of grade I and grade II forming on the mobility of L4/5 segment is significantly smaller than that of grade Ⅲ forming,and the effect of grade Ⅲ forming group on the mobility of L4/5segment is mainly concentrated in the four motion states of posterior extension,left flexion,left rotation and right rotation. |
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