Clinical And Puncture Study On Percutaneous Endoscopic Lumbar Discectomy

PART1Regional location study on Percutaneous endoscopic lumbardiscectomyObjective: In comparison with traditional open surgery percutaneousendoscopic lumbar discectomy(PELD) has many unique advantages. PELD isless traumatizing, the operative time is shorter, scarring can be avoided.and theintact intra-epidural structures, such as epidural fat and yellow ligaments, canbe conserved. Retain the lumbar ligament and bone and jointstructure.endoscopic discectomy do not need general anesthesia，Particularlysuitable for elderly patients who can not tolerate open surgery. However,clinical application of PELD is limited, due to the steep learning curve andblocking of the anatomical structure. Steep learning curve mainly due to thedifficulty in puncture.In this study, Divide the zone, depending on the type oflumbar disc herniation.To abserve the different regions of the puncture,whichcan give guidance for percutaneous.Methods: Design the lumbar spine model, According to the type oflumbar disc herniation and the anatomic landmarks line, divide the zone.Positioning needle in different zone, get the anterioposterior and lateralradiographs.Results: Getting24anterioposterior and lateral radiographs.Taking theradiographs of the modle to analye the correlation of needle’s location withanatomical markline.propose a classification of lumbar disc herniationaccording to MRI、CT and anterioposterior and lateral x-ray.Set up an usefulldate for PELD.Conclusion: Combination of zoning and anatomic landmarks line can bequickly and accurately positioning, to improve the success rate of puncture. PART2The clinical studyand of Percutaneous endoscopic lumbardiscectomy for migrated disc herniationObjective: non-contained lumbar discherniations pose a great challengeeven for experienced surgeons.These herniations are hidden from theendoscopic view by anatomic barriers like hypertrophied facet, inferiorpedicle and foraminal ligaments.The purposes of this study were to propose aanatomical classification of disc migration and surgical pproaches of PELDaccording to the classification.Methods: A retrospective analysis of28patiens operated for migratedintracanal lumbar disc herniatioms by percutaneous endoscopic lumbardiscectomy from March2011to September2011.16were male and12werefemale with an average age of43.3years (range,21–69years). Meanfollow-up was9months (range,6–12months). Patients were evaluated bypostoperative Visual Analog Scale for leg pain and Oswestry Disability Indexscores. Outcomes were graded according to modified MacNab criteria.Results: The average preoperative VAS score for radicular pain and ODIwere8.2±1.7and53.6±18, Mean follow-up was9months (range,6–12months). The patients had an average VAS of2.4±1.6for radicular pain andan average ODI of20.6±9at the final follow-up. The improvements in VASand ODI were statistically significant(p＜0.01).Conclusion: In a Percutaneous endoscopic lumbar discectomy, thedifficult, non-contained disc is considered to be the most important factorimpeding the success of surgery. By applying anatomical classification of discmigration and surgical pproaches of PELD according to the classification, good surgical results can be obtained, even in high grade, non-contained discherniations.