Micro-endoscopic discectomy for the treatment of lumbar disc herniation in senile patients over seventy years old / 中国骨伤

ABSTRACT

<p><b>OBJECTIVE</b>To explore applicability and therapeutic effects of Micro-endoscopic discectomy (MED) for the treatment of lumbar disc herniation in senile patients over seventy years old.</p><p><b>METHODS</b>Thirty-two patients over seventy years old with lumber disc herniation were treated by MED from December 2007 to June 2010. Among them,20 patients were male and 12 patients were female,ranging in age from 70 to 86 years, with an average of 78.5 years old. The course of diseases ranged from 2 weeks to 30 years, with an average of 3.5 years. The main clinical symptoms were low back pain with radiating pain in lower extremities, especially under the keen joint. The surgical time, blood loss, complications and function recovery were evaluated retrospectively immediately after operation. X-ray at 1 week after operation was used to observe the change of physical curvature of lumbar; MRI at 1 month after operation was used to observe the radiographic change of lumbar before and after treatment; MacNab standard was applied to evaluate the therapeutic effects at 3 months after operation.</p><p><b>RESULTS</b>The mean follow up period was 12.5 months (from 3 to 30 months). The mean operative time was 60 min (from 30 to 120 min) and the mean blood loss was 45 ml (from 15 to 150 ml). Leakage of cerebrospinal fluid occurred in 1 case, the operation continued after pressing by brain cotton and without nerve root and vessels injury; 1 case aggravated after revive, but other patients were eased. X-ray at 1 week after operation showed physical curvature of lumbar of 25 patients improved; MRI at 1 month after operation showed residue intervertebral disc and calcification tissue in 8 cases. Eleven patients still had numbness of limbs,but the pain and tenderness of limbs relieved. According to MacNab standard at 3 months after operation, 25 cases got an excellent result (78.1%), 6 good (18.8%) and 1 fair (3.1%).</p><p><b>CONCLUSION</b>MED is effective for the senile patients over 70 years old with lumbar disc herniation and promotes ambulation earlier. MED has the advantage of minimal invasive, less blood loss and good clinical effects; MED is suitable for the patients with obvious radiating pain in lower extremities, especially under the keen joint and combine with mild spinal stenosis and root stenosis.</p>