Use of myelography in microendoscopic discectomy / 中国微创外科杂志

ABSTRACT

Objective To investigate the significance of myelography for selecting operation methods in microendoscopic discectomy(MED).Methods A total of 196 patients with lumbar disc herniation diagnosed by CT/MRI received a myelography before MED.According to their clinical manifestations,signs,and outcomes of myelography,the patients were given three different operation methods.①Simple discectomy was performed in 105 patients with patent spinal canal,lateral impression at intervertebral level,and shift of the nerve root sleeve;②Discectomy with spinal decompression was performed in 70 patients with patent spinal canal and compression of the nerve root sleeve;③Discectomy with semilaminectomy was performed in 21 patients with patent spinal canal,semispherical compression of the nerve root sleeve,and 7-shaped nerve root.Results The operation time was 30~90 min(mean,50 min) and the intraoperative blood loss was 30~120 ml(mean,50 ml).No intraoperative complications occurred.Conversions to open surgery were required in 21 patients,including partial spinal stenosis in 16 patients and thickened vertebral plate in 5 patients.Follow-ups were carried out in 196 patients for 3~58 months(mean,34 months).According to the Japanese Orthopedic Association(JOA) scoring system,the final scores significantly increased postoperatively(25.86?2.96) than preoperatively(13.21?4.96)((t=)38.24,P=0.00).According to the Macnab and Watts standard,the rate of excellent or good results was 93.7%(164/175).Conclusions Myelography has an important reference value for selecting operation methods of microendoscopic discectomy in patients with lumbar disc herniation.