ABSTRACT
<p><b>OBJECTIVE</b>To evaluate the clinical effects of unilateral lamina osteotomy replantation versus fenestration in the treatment of unilateral lumbar disc herniation.</p><p><b>METHODS</b>The clinical date of 119 patients with unilateral lumbar disc herniation underwent surgical treatment from May 2012 to August 2014 were retrospective analyzed. There were 64 males and 54 females, aged from 40 to 59 years old with an average of 49.6 years. Among them, 58 patients were treated with lamina fenestration and decompression and nucleus pulposus resection(fenestration group);61 patients were treated with unilateral lamina osteotomy and replantation after nucleus pulposus resection (replantation group). The incidence rate of nerve and dural injury during operation, lamina healing rate, the recurrent rates of postoperative low back and leg pain were observed. According to the standard of JOA score, the clinical effects was compared between two groups.</p><p><b>RESULTS</b>A hundred and seventeen patients were followed up more than 1 year, each group 1 case was lost to follow up. The injury rate of nerve and dural was 3.33%, 5.00% respectively in replantation group, while 7.02%, 8.77% respectively in fenestration group, there was no significant differences between two groups(>0.05). One year after operation, there was significant difference in the recurrent rate of low back pain and JOA, VAS scores between two groups, replantation group was better than that of fenestration group(<0.05). CT showed the osteotomy of 2 cases had not obtained bone healing in replantation group with lamina healing rate of 96.7%, no loosening or breakage of titanium plates and screws were found.</p><p><b>CONCLUSIONS</b>The design of unilateral lamina osteotomy replantation is more reasonable. Widen surgical vision not only guarantee the spinal stability, but also prevent epidural adhesion, which reduce the lower back and leg pain recurrence. It is a safe and effective new approach to treat lumbar disc herniation.</p>
ABSTRACT
@#Objective To report the surgical technique and preliminary clinical results of bilateral decompression under microscope via unilateral approach for the treatment of lumbar stenosis. Methods Sixteen eases of lumbar stenosis were treated in our institute. For the surgical treatment, only one side paraspinous muscle was dissected. The upper and lower margins of the adjacent laminae were drilled, and the underlying ligament flavum was exposed. By changing the direction of the microscopy, the base of the spinous process and the internal side of the contralateral laminae were also drilled off till the lateral recess. Finally, decompression of the spinal canal was achieved by removing the ligament llavum. Results Follow-up ranged from 6 to 47 months. Intermittent claudication was totally relieved in 14 out of 16 cases, and markedly relieved in 2 cases. Back pain was relieved totally in 6 cases, marked improved in 8 cases, not change in 2 cases. Pain was significantly relieved in all 5 cases with sciatica, among them, diseetomy had to be performed in 3 cases. During follow-up, there was no symptom recurrence, and dynamic X ray did not show lumbar in-stability. Conclusion Bilateral decompression under microscope via unilateral approach for the treatment of lumbar stenosis is minimally invasive surgery, the effect of the operation is good. The technique has little in-fluence on spinal stability.