Clinical and laboratory study of early nerve foot lesion after collagenase chemonacleolysis / 中国矫形外科杂志

ABSTRACT

[Objective]To investigate the etioloty of the early nerve root lesion(RNRL) after collagenase chemonucleolyoio(CC) and its prevention and treatment.[Method]Twelve-hundred and eighty case of lumbar disc herniation undergoint cc were reviewed and analyzed.From January,2000 to December,2004 with follow-up time of 4~30 months,in which 12 cases(0.94%)had obvious ENRL after CC.Eighteen rabbits were randomly divided into three groups of six eachGroup A,posterior longitudinal ligament intepated+intradisca injection;group B,parterior longitudinal ligamen+booteen+intradiscal injection,and group C,extradiscae injection.The disc and the nerve roots at the inject side were removed,fixed and examined by microscope,and the changes of the discs end nerve roots were analyzed in different inject side and different time after CC.[Result]As the collagenase dose was large in groups of intradiscal+intradiscal injections case of ENRL in this group were more than that in other groups.In the 12 ENRL cases,ten cases of ENRL appeared in about 7 days after CC,8 cases without nerve root compression and all cases were improved in different degree,but no one reeovered completely at follow-up with excellent and good rate of efficiency in the cases operated in 3 days than that in cases operated after 8 days.In the experiment rabbits,there lowed obvious lyeis of nucleus.Pulpus in group A and group B,with severe damage of nerve roots in group B,while in group C,there was no obvious lipis of nucleuss pulpus and damage of nerve roots[Conclusion](1)As the larger collagenas dose in the cases with intradiscal and extradiscal injections can raise.The incidence of ENRL,it is suggested that CC used in cases with broken posterior longitudenal ligament of and brous anmulus and,with nucleus pulpuses herniated into spinal canal,CC should be prudent to apply.(2)The prognoseo of the ENRL after CC is poor and is related to operation time.(3)The incidence of ENRL after CC can be lowered with absolute bed rest and changing body position after CC.