Comparison of Automated Percutaneous Lumbar Discetomy (APLD ) and Chemonucleolysis in the Treatment of Herniated Lumbar intervertebral Discs / 대한정형외과학회잡지

Automated percutaneous lumbar discectomy (APLD) and chemonucleolysis represent two major modalities of recently popularized minimally invasive surgical procedures for the treatment of herniated lumbar discs. However, the controversies concerning the safety and efficacy of the procedures are yet to be settled. The purpose of retrospective study was to determine the efficacy of these percutanous procedures and hence to establish a rational guideline for the treatment of lumbar disc herniations. Clinical review of 615 patients treated by percutaneous procedures revealed 81% success rate following chemonucleolysis and 83% following APLD, with a mean follow-up of 38 months (range 24- 60 months) and 30 months (range 24-38 months) respectively. APLD required less time for resolution of back pain, and resulted in less disc space narrowing than chemonulceolysis. Clinical failures of the procedures were associated with extruded or calcified discs, combined spinal stenosis and discitis. Reduction of herniation size in postoperative CT had no significant correlation to the clinical results. In conclusion, both procedures were effective in contained disc without calcification or associated spinal stenosis. This study suggests some advantages of APLD over chemonucleolysis in the aspect of rapidity of symptom relief, disc space narrowing and possible complications. Reduction in herniation size was not imperative for clinical success. Both procedures appear to be good alternatives to open discectomy in well selected patients, and may be good bridges for the wide gap between conservative treatment and open surgery.

Comparative study between myelograpic and operative finding on 150 cases of lumbar H.I.V.D / 대한정형외과학회잡지

During January 1975 to December 1979, myelographic studies followed by operation was carried out on 150 cases of lumbar H.I.V.D. at Chung Nam National University Hospital. As to the myelographic findings, mode, level of indentation, and positive and negative finding were analyzed in comparison with operative findings. The followings results were obtained: 1. Plain radiography has a Iittle value In diagnosis of Iumbar H.I.V.D. about one third of 150 cases show significant sign in plain film study. 2. The major discrepancies between myelographic and operative findings were found in 11.3%, while the minor discrepancies were 4%, so giving an accuracy of 84.7%. 3. Positive myelographic finding(120 cases) consisted of smooth round defect in 83 cases (48.8%), unilateral wedge defect In 45 cases (26.4%), block defect In 18 cases (10.5%), bilateral wedge defect in 13 cases (7.6%), and hourglassdefect In 11 cases (6.4%), respectively. 4. Operative findings revealed the protruded disc: 74.5%, bulging: 11.1%, extruded: 22%, and mlgrated: 1.7%. 5. The myelographic finding of bulging type disc usually showed smooth round filling defect and those of protruded were smooth round filling defect, wedge shape and block filling defect, while the extruded type revealed smooth round filling defect In the most cases. 6. The myelography can be a valuable aid in the determination of the level and degree of H.I.V.D. and very helpful ln differential diagnosis.