ABSTRACT
Intraoperative neurophysiologic monitoring was performed in a patient by somatosensory evoked potential, motor evoked potential and free-running electromyography with intraoperative stimulation. It was verified that after decompression, there was an increase in the amplitude of motor evoked potential responses, showing an immediate improvement of the treated levels. Intraoperative neurophysiologic monitoring for surgical lumbar disc herniation in an athlete allowed a dynamic neurophysiological diagnosis, differentiation of the involvement of compression at the central or foraminal levels, and clinical awareness of the iatrogenic damage, thereby increasing safety.
Foi realizada em um paciente a monitorização intraoperatória neurofisológica com potencial somatossensitivo, motor e eletroneuromiografia contínua com estimulação intraoperatória. Depois da descompressão, ocorreu aumento da amplitude de resposta do potencial evocado motor, mostrando imediata melhora dos níveis tratados. A monitorização neurofisiológica intraoperatória para hérnia de disco lombar em um atleta permitiu um diagnóstico neurofisiológico dinâmico, diferenciação da compressão central ou foraminal e diagnosticar qualquer alteração iatrogênica aumentando a segurança.
Subject(s)
Humans , Male , Decompression, Surgical , Intervertebral Disc Displacement/surgery , Monitoring, IntraoperativeABSTRACT
【Objective】To assess the indications and therapeutic effect of surgical treatment for lumbar disc herniation(LDH) associated with lumbar degenerative instability(LDI).【Methods】Fifty-eight LDH associated with LDI patients,which were ineffective after strictly conservative treatment or simple decompression with disc excision,received lumbar vertebral plate resection and disc excision from posterior approach,and transpedicular screw fixation combined with posterior lumbar interbody fusion.【Results】A averaged 13-month follow-up was carried out in 54 patients.The therapeutic effect assessed by Japanese Orthopaedics Association(JOA) was as follows: excellent in 37 patients,good in 13,ordinary in 4,and the excellent +good rate was 92.59%.The results of X radiography 3 months after the operation showed that lumbar interbody fusion was successful in 52 patients,the infusion rating being 96.30%.【Conclusion】Lumbar vertebral plate resection and disc excision from posterior approach,and transpedicular screw fixation combined with posterior lumbar interbody fusion are effective for the treatment of LDH associated with LDI.
ABSTRACT
Objective To explore the clinical outcomes of the removal of nucleus pulposus with vertebral lamia fenestration in the treatment of lumbar disc herniation.Methods A total of 5482 patients with lumbar disc herniation were performed to remove nucleus pulposus with vertebral lamia fenestration.The follow-up study was conducted in 4329 cases for the duration varying from 6 months to 20 years,averaging 6.7 years,and the therapeutic effect of the operation was evaluated.Results After operation,the patients could walk in(3?2) days,resumed their daily activities in (15?6) days and went back to work in(28?9) days.According to the Nakai scale,excellent results were achieved in 3374 cases(77.9%),good in 652 cases(15.2%),improved in 249 cases(5.8%) and poor in 54 cases(1.1%).The rate of excellent and good results was 93.1%.Conclusion The advantages of the removal of nucleus pulposus with vertebral lamia fenestration are the removal of the annulus fibrosus,the calcified ligamentum flavum and osteophyte under direct vision.The operation may preserve the utmost integrity of the posterior lumbar structures,and the operative treatment has shown its good results.