Application Of Percutaneous Endoscopic Combined With Interspinous Process Dynamic Reconstruction System In Youth Lumbar Disc Herniation

BackgroundLumbar disc herniation(LDH)is a common disease in department of orthopedics which can cause low back pain,and the most common segment are located in L4/5and L5/S1 segment.In recent years,the incidence of lumbar disc herniation in young people is on the rise,more and more cases of surgical treatment are needed.Surgical treatment for youth lumbar disc herniation at present stage include open window lumbar discectomy,microendoscopic discectomy,percutaneous endoscopic lumbar discectomy and so forth.The advantage of percutaneous endoscopic are small trauma,less bleeding,less postoperative pain,quick recovery and so on.However,the simple removal of nucleus pulposus can result in the decrease of intervertebral height,and the residual of nucleus pulposus in operation,and young patients still need a lot of activity,long time sedentary learning after surgery,so the recurrence rate of simple removal of nucleus pulposus is high.Park thought that the reason of high recurrence rate after operation was that the height of intervertebral space decreased after operation,which caused the instability of the segment of the lesion.Xu Ding thought that the application of Coflex dynamic internal fixation could reduce the effect ofnucleus pulposus resection on the stability of the spine,and make up for the lack of simple nucleus pulposus removal.Combination of the advantage of percutaneous endoscopic technique and Coflex interspinous dynamic fixation system in the treatment of lumbar diseases,young patients with lumbar disc herniaton were treated with percutaneous discectomy combined with spinous process Coflex.The clinical data of these patients were reviewed and the clinical effect of the operation was summarized.ObjectiveTo evaluate the effectiveness of percutaneous endoscopic combined with Coflex interspinous dynamic internal fixation system for the treatment of youth lumbar disc herniation.MethodsThe clinical data of 56 youth patients with lumbar disc herniation treated by percutaneous transforaminal endoscopic discectomy combined with planting Coflex dynamic internal fixation system in interspinous were retrospectively analyzed between February 2013 and June 2015.According to the difference of the implanted segments,all patients were divided into L4/5 group and L5/S1 group.There were 32patients(18 males,14 females)with an average age of 25.5 years(range,18-34 years)and a mean disease duration of 10.2 months(range,6-16 months)in L4/5 group.There were 24 patients(12 males,12 females)with an average age of 25.7 years(range,19-33 years)and a mean disease duration of 11.4 months(range,6-18 months)in L5/S1 group.The operation time and intraoperative blood loss were recorded.The height of ventral intervertebral space(VH),dorsal intervertebral space(DH),and intervertebral foramen(IFH)of lesion segment were measured on lateral radiographs,and the range of intervertebral motion(ROM)of lesion level and upper adjacent segment on hyper-flexion and hyper-extension radiographs were measured at preoperation and final follow-up.Oswestry Disability Index(ODI)and Japanese Orthpoaedic Association(JOA)score were used for clinical efficacy assessment.ResultsThe 56 patients were successfully completed surgery.The operation time was(89.8±16.4)min and intraoperative blood loss was(43.8±11.4)mL in L4/5 group,and were(93.6±17.1)min and(46.6±13.6)mL in L5/S1 group.All of the patients were followed up,and the follow-up time were 12-18 months(mean,16.3months)in L4/5group and 12-20 months(mean,17.2 months)in L5/S1 group.There was no serious complications occurred in the two groups after operation.Comparision of operation time and intraoperative blood loss with two groups,the difference was not statistically significant at the time of final follow-up(P>0.05).The data of ODI、JOA score of lesion segment at final follow-up were statistically difference compared with those of preoperation(P<0.05).The data of ODI 、 JOA score were no significant difference between the two groups either preoperation or final follow-up(P>0.05).The data of VH、DH、IFH、ROM at final follow-up were statistically difference compared with those of preoperation(P<0.05),and the ROM of the upper adjacent segment at final follow-up was no significant difference compared with that of preoperation(P>0.05).ConclusionsPercutaneous endoscopic combined with Coflex interspinous dynamic internal fixation system can achieve complete decompression,restore intervertebral space height,relieve low back pain and lower limb symptoms,and maintain spinal stability.It also has the advantages of shorter operation time,less trauma,less bleeding,and faster postoperative recovery.It can be considered as a minimally invasive technique with significant effect in treating youth patients with LDH,and there was no significant difference in the clinical efficacy between L4/5 with L5/S1.