The effective of percutaneous endoscopic lumbar discectomy for L5/S1 disc herniation via an interlaminar approach versus a transforaminal approach / 中国医师杂志

Objective To compare the clinical results of percutaneous endoscopic interlaminar discectomy (PEID) and percutaneous endoscopic transforaminal discectomy (PETD) in L5/S1 disc herniation.Methods A total of 102 patients with L5/S1 disc herniation in our hospital from September 2014 to June 2016 were enrolled in this study.Fifty-two patients underwent percutaneous endoscopic interlaminar discectomy (PEID group) and 50 patients underwent percutaneous endoscopic transforaminal discectomy (PETD group).The surgical effectiveness was assessed according to Visual Analog Scale (VAS),Oswestry Disability Index (ODI),and modified MacNab criteria.The frequencies of intraoperative radiation exposure,operation time and complication rates were compared between the groups.Results All the patients completed follow up with a mean of 15.0 months (range,10-20 months).In the PEID group,the mean operation time was 44-72 (58.3 ± 12.0)minutes and the intraoperative frequencies of radiation exposure were 3-6(3.8 ±2.1)seconds.For the PETD group,the mean operation time was 52-96(82.4 ± 16.0) minutes and the intraoperative radiation time was 13-34 (24.1 ± 10.1) seconds.There were significant differences in operation time and radiation frequency between the two groups (P ＜ 0.05).The postoperative VAS and ODI were obviously improved in both groups when compared with preoperation (P ＜ 0.05),but there were no significant differences between the two groups (P ＞ 0.05).There was no statistically significant difference considering the satisfactory rates according to the MacNab criteria between PEID group (96.1％) and PETD group (96.0％).Conclusions The treatment of L5/S1 disc herniation through lamina or intervertebral foramen approach is both effective.PEID can significantly reduce the frequencies of intraoperative radiation exposure and operation time.

Application progress of percutaneous transforaminal endoscopic discectomy in the treatment of lumbar intervertebral disc herniation / 中国医师杂志

Lumbar intervertebral disc herniation (LDH) is a syndrome caused by various reasons such as nucleus pulposus protrusion,compression of nerve root and herniation of nucleus pulposus,and stimulation of nerve root and cauda equina nerve.It is one of the most common diseases in orthopedics.There are a variety of surgical treatments for this disease,including traditional open surgery and minimally invasive techniques.At present,the minimally invasive technique represented by percutaneous transforaminal endoscopy has gradually replaced the traditional open surgery as the mainstream because of its advantages of less trauma,faster recovery and fewer complications.This article will systematically expound the application and progress of percutaneous lumbar intervertebral foraminoscopy in the treatment of lumbar disc herniation from the development course,indications,operation skills,matters needing attention,curative effect analysis,complications and so on.

Effect of low-temperature plasma radiofrequency ablation and ozone injection on the quality of life of patients with lumbar disc herniation / 中国医师杂志

Objective To investigate the curative effect of low temperature plasma radiofrequency ablation and ozone injection in the treatment of lumbar disc herniation (LDH) and its effect on the quality of life of patients.Methods 240 patients with LDH who were treated in Xining First People's Hospital from December 2015 to February 2017 were enrolled in the study.The patients were divided into low temperature plasma group (low temperature plasma radiofrequency ablation therapy) and ozone injection group (ozone injection therapy) by random number table method,with 120 cases in each group.The operative indexes,complications,and visual analogue scale (VAS) score at different time points,numbness and muscle strength indexes and WHO quality of life scale (WHOQOL-BREF) score were compared between the two groups.The clinical efficacy was compared between patients with different image credit type in two groups.Results The operation time,hospitalization time and the cost of treatment in the ozone injection group were less than that of the low temperature plasma group (P ＜ 0.05).There was no significant difference in VAS score and numbness score between the two groups at different time points (P ＞ 0.05).The abdominal time and the supine crouch time in the low temperature plasma group in 3 months after operation were longer than those in the ozone injection group (P ＜ 0.05).The excellent rate of the lateral type in low temperature plasma group in 3 months and 6 months after operation was higher than that in the ozone injection group (P ＜0.05).The physiological field score,psychological field score and total score in WHOQOL-BREF of low temperature plasma group in 1 month,3 months and 6 months after operation were significantly higher than those of ozone injection group (P ＜ 0.05).There was no significant difference in the incidence of complications between the two groups (P ＞ 0.05).Conclusions Low temperature plasma radiofrequency ablation has better effect in the treatment of lateral LDH,and it can improve lumbar and dorsal muscle strength and lumbar abdominal muscle strength more obviously,improve the quality of life of the patients,but the operation time and hospitalization time are longer,and the cost of treatment is higher.

The early clinical effects of lumbar discectomy associated with annulus repair in the treatment of lumbar disc herniation / 中国医师杂志

Objective To explore the early clinical effects of lumbar discectomy associated with annulus repair in the treatment of lumbar disc herniation.Methods A prospective study was conducted to review 56 patients with lumbar disc herniation who accepted discectomy surgery in Subei People's Hospital of Jiangsu Province from January 2014 to September 2015,including 28 cases of discectomy associated with annulus repair (repair group) and 28 cases of discectomy (control group).Oswestry disability index and visual analog scale scores were recorded.Simultaneously,incision length,operative time,blood loss,hospitalization time,surgical complications,and postoperative recurrence of lumbar disc herniation were recorded.Results All patients completed the follow-up for 12 to 18 months (14.5 ± 1.3).There was no difference between the repair and control groups in the incision length,blood loss and hospitalization time (P ＞ 0.05).The operative time of the repair group was longer than that of the control group,but the difference was not statistically significant (P ＞ 0.05).The Oswestry disability index and visual analog scale scores for lumbar and lower limb pain significantly decreased in both groups after surgery (P ＜ 0.05).The visual analog scale scores at 24 hours and 3 days after surgery in the repair group were less than that in the control group (P ＜ 0.05).The satisfactory rate of treatment in the repair group was slightly higher than that in the control group,but the difference was not statistically significant (P ＞ 0.05).There was no recurrence in the repair group,but 2 recurrence cases in the control group (P ＞ 0.05).Conclusions These findings indicate that discectomy associated with annulus repair is a safe and reliable method to obtain remarkable early clinical results and can reduce the recurrent rate in the treatment of lumbar disc herniation.

The correlative factors affected the early clinical efficiency of surgical management of lumbar disc degeneration / 中国医师杂志

Objective To explore the correlative factors that affected the early clinical efficacy of surgical management of lumbar disc herniation.Method 208 cases of lumbar disc herniation were recruited since December 2007.The details of their therapy in different periods were compared and analyzed.Result The aggressive discectomy was the most powerful factor related to the better early clinical outcome.The patients with preoperative JOA score ＞ 17 were associated to the poor clinical outcome.The patients with postoperative JOA score ≥ 25 on 3 month and ≥ 24 on 1 year after operations were associated to better early clinlcal outcome.Conclusion The pre- and post-operative JOA score and aggressive discectomy were the factors affected the clinical outcome.