Relationship Between The Operative Effect Of Lumbar Disc Herniation And TESSYS Typing Method

Objective:The traditional method of classification of lumbar disc herniation is based on direct observation and imaging findings,which have some guiding value in the treatment of lumbar disc herniation.In recent years,the treatment of lumbar disc herniation has minimally invasive trend,especially after the introduction of percutaneous transforaminal endoscopic technology,this technology has been widely used in clinical treatment of various types of lumbar disc herniation and lumbar spinal stenosis patients.In the treatment of lumbar disc herniation with percutaneous endoscopic discectomy,the traditional classification methods are of limited value.Observation of the morphology of intervertebral disc in patients with lumbar disc herniation and its relationship with nerve root.According to the classification criteria of TESSYS tying method,which was put forward by Lu Honghui[1],the patients were divided into 4 types.The clinical symptoms,the degree of dysfunction and the postoperative curative effect of patients with different types of patients were evaluated before surgery and after one year.To guide and improve the operation of percutaneous endoscopic discectomy in the treatment of lumbar disc herniation。Methods:200 cases of lumbar disc herniation with the main symptoms of nerve root symptoms,all met the selection criteria.Percutaneous endoscopic TESSYS technique was used for surgical treatment.After implantation of endoscope,the morphology of lumbar intervertebral disc herniation and its relationship with nerve root were observed and recorded under endoscope,According to the standard of TESSYS tying method,it was divided into 4types: oppress,scar,calcification and lateral recess stenosis.The operativetime,intraoperative blood loss,length of hospital stay were recorded.The pain visual analogue scale(VAS)was used to assess the degree of pain in waist and lower extremities of 12 patients before and after operation.Oswestry dysfunction index(ODI)was used to evaluate each patient’s functional limitations,and the modified MacNab score was used to evaluate the clinical efficacy of each patient.The rate of pain relief and functional improvement were calculated for each patient.The general situation of the patients,the degree of relief of pain in waist and lower limbs,the recovery of functional disorder and the effect after operation were compared and analyzed statistically.Results:Among the 4 types of lumbar intervertebral disc herniation,there were 95 cases of oppress type,calcification type in 34 cases,scar type in 38 cases,and lateral recess stenosis in 33 cases.There was no significant difference between the 4 groups in the operation time,blood loss and length of hospital stay between the 4 groups(p>0.05).12 months after operation,The degree of relief of low back pain between the four groups was compared,The improvement rate of VAS score of low back pain in the oppress and calcification group was higher than that of scar type and lateral recess stenosis group(p<0.05),There was no significant difference in the improvement rate of VAS score between oppress and calcification(p>0.05),There was no significant difference in the improvement rate of VAS score between the scar and lateral recess stenosis(p>0.05).The degree of pain relief in the lower limbs between the four groups was compared,The improvement rate of VAS score of low limb pain in the oppress,calcification and scar group was higher than that of lateral recess stenosis group(p<0.05),There was no significant difference in the improvement rate of VAS score between oppress,calcification and scar types(p>0.05).The improvement rate of ODI score between the 4 types was compared,The improvement rate of ODI score in the oppress,calcification and scar group was higher than that of lateral recess stenosis group(p>0.05),There was no significant difference in the improvement rate of ODI scorebetween oppress,calcification and scar types(p>0.05).Excellent rate of 4types of modified Macnab criteria respectively: oppress type:91.58%,calcification type: 91.18%,scar type: 81.58%,lateral recess stenosis in69.70%,there was significant difference between the excellent rate of each type(p<0.05),a linear decrease.The effective rate was 98.95% of the oppress type,calcification type of 100%,scar type: 92.11%,lateral recess stenosis:75.76%.There was significant difference between the groups(p<0.05),a linear decrease.Conclusion:The short term efficacy of percutaneous endoscopic discectomy for lumbar disc herniation is closely related to the classification of lumbar disc herniation.The degree of pain relief,function improvement and postoperative effect of low back pain were different according to TESSYS types.For the oppress type and calcification type,the lower lumbar and lower limb pain relieved obviously,the function recovery and the curative effect is best.For the scar type,The lower limb pain and function recovered well,Postoperative curative effect is better,But the relief of low back pain is relatively low.During the operation,the broken fibrous ring should be repaired more carefully,to prevent the nucleus pulposus from re-organization,to stimulate the nerve root repeatedly and to produce a large number of inflammatory hyperplasia.For the lateral recess stenosis type,the postoperative efficacy,pain relief and functional recovery were lower than those of the other three types.Before the operation,the difficulty of the operation should be evaluated comprehensively,and the sufficient exploration and decompression of the lateral recess of the operation should be carried out,At the same time,we should avoid leaving behind residual nucleus pulposus,so as not to cause nerve root oppression and make the clinical effect poor.