Clinical Comparative Study On The Treatment Of Lumbar Hernation Between Chemonucleolysis And Percutaneous Laser Disc Decompression

Objective: To observe and compare the short-term outcome and clinical character in the patients of lumbar disc herniation treated by chemonucleolysis (C N L) and percutaneous laser disc decompression (P L D D) using DSEP and clinical outcome assessment scale.Method: 56 patients who had a diagnosis of lumbar disc herniation during Oct. 2001桪ce, 2002 were divided into (CNL)group and (PLDD) group. Utilizing the no-vascular interventional procedure under fluoroscopic guidance, patients underwent performnace of CNL and PLDD, had disc vaporized with laser and were injected collagenase. Each patient was measured with dermatomal somatosensory evoked potential (DSEP) on the time of pre-operation, 1 week post-operation and 3 months post-operation, latency and amplitude were documented. Patients were also established with outcome assessment of ZhongHua Orthopedic Association on the time of 3 months post-operation Classified in "Excellent ,Good, Fair, and Poor" four grades. All the results were collected.The statistical analysis was performed with the SPSS statistical software system ( version 10. 00, SPSS. ).Results: All patients were followed up until 3 months . Except two in CNL group and one in PLDD group, the datas of the patients who was followed up successfully were collected and analyzed statistically. 1.Success rates of CNL group and PLDD group were 69% and 79% , there was no significant difference between the success rate of PLDD group and CNL group in the time of 3 months post-operation. (P=0. 402). 2. The lantency of CNL group durig pre-and post- operation were (48.7± 1.9) ms, (49.0±2.1) ms, (45.3.±2.5) ms, The chang of amplitude of CNL grouppost- operation were (9.96±3.45) %, (37.62±11.53) %: The lantency of PLDD group during pre-and post-operation were (49.4±2.2) ms (45.3 ± 2.3) ms, (41.6±1.9) ms, the change of amplitude of PLDD group during pre-and post- operation were (28.75±8.75) %, (56.01 ±17.73) %: The latency and the change of amplitude of CNL group during pre-and post- operation were significant difference as well as CNL group, After operation, the latency was shorten and amplitude became higher in both two groups, It indicated that function of lumbar nerve has been improved. 3. In the time of 1 week post-operation and 3 months post-operation, compared with the pre-operation , the latency and the change of amplitude of PLDD group had significant difference with the CNL group in the same time. (P<0. 05).Conclusion: Both CNL and PLDD appear to be safe and effective treatment for herniated intervertebral disks. The short-term outcome of PLDD is same as CNL. The outcome and clinical character of PLDD and CNL can be evaluated objectively using the technigue of DSEP.