| Background Lumbar intervertebral disc herniation is one of the common spinal diseases in orthopedics clinic.The surgical treatment for this disease has been gradually mature in clinic.However,in the postoperative follow-up,it was found that some patients still have symptoms such as lumbago and lumbar dysfunction for a long time after surgery.The reason is largely due to other lumbar diseases other than discogenic lumbago,among which the lumbar sacralization is one of the reasons leading to poor postoperative results in patients with disc herniation.According to relevant reports at home and abroad,the incidence of lumbar sacralization in normal population is about 15.8%,and in patients with lumbar disc herniation,the incidence of lumbar sacralization is about 30%.Therefore,the surgical treatment of patients with lumbar disc herniation combined with lumbar sacralization is a big challenge for clinicians.Traditional window discectomy and pedicle screw fixation combined with vertebral fusion are commonly used in clinical treatment of lumbar disc herniation.Although there are a variety of clinical methods for the treatment of disc herniation,most of them are derived from these two surgical methods.Each surgical method has its advantages and disadvantages.We still don’t know what the postoperative effect of the different surgical methods will be.This study compared the postoperative efficacy of two surgical methods in the treatment of lumbar 5-sacral 1 segment disc herniation combined with lumbar sacralization,providing reference for clinicians to choose surgical methods.Purpose To compare the difference between traditional window discectomy and pedicle screw fixation combined with vertebral fusion in the treatment of lumbar 5-sacral 1 segment disc herniation with lumbar sacralization,and to explore the best surgical method.Method A total of 75 patients with complete follow-up data who received L5/S1 segmental surgery for disc herniation combined with lumbar sacralization in our Hospital from June 2021 to December 2022 were collected and analyzed.They underwent traditional window discectomy(control group)and unilateral pedicle screw fixation combined with vertebral fusion(observation group),respectively.Inclusion criteria:1.L5/S1 lumbar disc herniation combined with lumbar sacralization was confirmed by lumbar CT or MRI in all patients.2.Strictly standardized conservative treatment for more than 3 months showed no improvement.3.The name,gender,age,hospitalization number,perioperative observation indicators and postoperative complications of the two groups of patients were recorded,and the postoperative follow-up was at least 6 months.Perioperative blood loss,operation time,hospital stay,postoperative vertebral space height and other indicators were compared between the two groups.The VAS scores,ODI index and JOA scores of the waist and legs of the two groups were compared before surgery,1 week,3 months and 6months after surgery.To evaluate the efficacy of the two operation methods comprehensively.Results This study included 35 cases in the control group and 40 cases in the observation group.All patients completed more than 6 months of follow-up through outpatient visits,telephone calls,etc.There were no statistically significant differences in preoperative age,sex ratio,BMI,L5/S1 intervertebral height, proportion of underlying diseases and lumbar sacral classification between the two groups.During the operation,compared with the observation group,the operation time,intraoperative blood loss,incision length and fluoroscopy times in the control group were all less than those in the observation group,with statistical significance(P operation time <0.05,P blood loss <0.05,P incision length <0.05,P fluoroscopy times <0.05).After surgery,there was no statistical difference in the incidence of postoperative complications between the two groups(P=0.64),the length of hospital stay in the observation group was longer than that in the control group(P<0.05),the height of the L5/S1 intervertebral space in the control group decreased after surgery(P<0.05),but the height of the intervertebral space in the observation group increased after surgery(P<0.05).The L5/S1 intervertebral space in the observation group was higher than that in the control group,and the difference was statistically significant(P<0.05).In the repeated measure analysis of variance,it was found that the lumbar VAS scores of the observation group and the control group decreased gradually before surgery,1 week after surgery,3 months after surgery and 6 months after surgery,and the pair comparison between the four time points in the group had statistical differences(P<0.05),and the overall difference between the two groups was statistically significant(P<0.05).There was an interaction between the two groups(P<0.05).Pairwise comparison between the two groups showed no significant difference before surgery and 3 months after surgery(P before surgery=0.572,P after 3 months =0.197).There were statistically significant differences 1 week and 6 months after surgery(P 1 week after surgery =0.04,P 6 months aftersurgery <0.05).In the comparison of leg VAS scores between the two groups,the difference of total time effect was statistically significant(P<0.05),and the scores at four time points in the group gradually decreased,and the difference at each time point in pairwise comparison was statistically significant(P<0.05).There was no statistical significance in the overall difference between the two groups(P=0.295),and there was interaction between the two groups with time(P<0.05).In pairwise comparison between the two groups,there was no statistical difference before surgery,1 week after surgery and 6 months after surgery(P before surgery=0.295,P 1 week after surgery =0.107,P 6 months after surgery = 0.226).However,at 3 months after surgery,the VAS score of the observation group was better than that of the control group,and the difference was statistically significant(P<0.05).In the comparison of JOA scores between the two groups,the difference in total time effect was statistically significant(P<0.05),and the scores at four time points in the group gradually increased,and the difference at each time point in pairwise comparison was statistically significant(P<0.05).The overall difference between the two groups was statistically significant(P<0.05),and there was an interaction between the two groups(P<0.05).In pair comparison between groups,there was no statistical difference before surgery and 1 week after surgery(P before surgery =0.467,P 1 week after surgery =0.792),and there was statistical significance in 3 months and 6 months after surgery(P3 months after surgery<0.05,P6 months after surgery<0.05).In the comparison of ODI scores between the two groups,the difference of total time effect was statistically significant(P<0.05),and the score of four time points in the group gradually decreased,and the difference of each time point in pairwise comparison was statistically significant(P<0.05),while the overall difference between the two groups was not statistically significant(P=0.056).There was an interaction between the two groups(P<0.05).There were no statistically significant differences before surgery and 1 week after surgery(P before surgery =0.532,P 1 week after surgery =0.139),but there were statistically significant differences after 3 months and 6 months after surgery(P 3 months after surgery <0.05,P 6 months after surgery<0.05).Conclusion In the surgical treatment of L5/S1 disc herniation with lumbar sacralization,unilateral pedicle screw fixation combined with interbody fusion is superior to traditional window discectomy in terms of postoperative long-term efficacy. |
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