ABSTRACT
Objective To evaluate the effect of double tractors swing microendoscopic discectomy technique in multi-segmental lumbar disc herniation. Methods From December 2006 to November 2009,153 patients with multi-segmental lumbar disc herniation were treated with double tractors swing microendoscopic discectomy. They included 85 cases of multi-segmental disc herniation, 53 cases of degenerative canal stenosis and 15 cases of lumbar instability. Among them, 2, 3, 4 and 5 fenestrations were performed in 105,33, 13 and 2 cases respectively and interbody fusion was done with "quanhe" inflation cage and screws in 15 cases. The results were evaluated with Macnab scale. Results All the 153 patients were followed from 3to 36 months, with an average of 16 months. The mean operative time was 45, 61, 83 and 110 min for 2,3,4 and 5 fenestrations respectively, with a mean blood loss of 150 ml. And it took extra 92 min to finish interbody fusion. Complications included dural sac tears in 1 case,canda equina slight lesion in 1, superficial incision infection in 1, the formation of deep venous thrombosis in 1, and revision for"quanhe"inflation cage in 1. The mean hospital stay was 10 days. Excellent results were obtained in 117 cases, good in 32 and fair in 4. One hundred and thirty-two patients returned to their work or normal activities in 3 weeks. One hundred and forty-nine cases were satisfied with the therapeutic effect. Conclusion This technique not only can reach adjacent intervertebral space easily but also disperse pressure on the nerve root effectively. This technique can provide thorough decompression and good results.
ABSTRACT
ObjectiveTo evaluate the clinical outcome of endoscope-assisted combined anterior and posterior procedures for grade-Ⅲ and Ⅳspondylolisthesis.MethodsFrom December 2007 to May 2010,13 patients with grade-Ⅲ and Ⅳ spondylolisthesis were treated with two bilateral decompression,percutaneous pedicle screw restoration,intervertebral bone grafting and plate fixation using microendoscopic discectomy and laparoscopy,including 6 males and 7 females with an average age of 39.8 years(range,18-58 years).Eleven cases were in grade Ⅲ spondylolisthesis and two in Ⅳ.The lesion location was as follows:2 cases were at L4,5 and 11 at L5S1.The clinical outcomes were evaluated according to Oswestry disability questionnaire,and the change of radiographic data including slipping degree,slipping angle and posterior height of intervertebral disc.ResultsThe mean follow-up time was 21 months (range,12-36 months).The mean operative time was 125 min,with a mean blood loss of 415 ml.Slipping degree decreased 56.9％ in average (from preoperative 73.3％±6.1％ to postoperative 16.4％±9.5％),slipping angle decreased 19.6°(from preoperative 27.7°±5.6° to postoperative 8.1°±8.8°),posterior height of intervertebral disc increased 7.1 mm (from preoperative 2.6 ±0.8 mm to postoperative 9.7 ±3.7 mm).The clinical outcomes of the Oswestry disability questionnaire decreased 19.5 (from preoperative 35.8±5.7 to postoperative 16.3±5.2).CT scans demonstrated that solid bony fusion could be obtained in one year after operation.Complications included dural sac tears in 1 case,and superficial incision infection in 1.The results were excellent in 4 cases,good in 8 and fair in 1.ConclusionEndoscope-assisted anterior and posterior procedures for grade-Ⅲ and Ⅳ spondylolisthesis is a reliable method,which can lead to rigid fixation and fusion,and also can achieve thorough decompression and restoration as much as possible.