| Object:Make the study of L5/Slintervertebral disc and the structures around it on cadaver, get the microstructure data for MED, then draw a conclusion of L5/S1 intervertebral disc and the structures around it. Treated the L5/S1 intervertebral disc herniation under the guidance of the conclusion with MED.Method:20 cadavers lied down on the operating-table facing to the ground after the operation on the lumbar, anatomize the L5/S1 vertebral plate space carefully, get the data with the vernier caliper, the protractor and the ruler like these: 1 , The distance between the lower margin of L5 spinous process and the inferior margin of S1 vertebral plate.2, The distance between the L5/S1 intervertebral disc and the L5 vertebral plate lower margin.3, The angle of L5/S1 intervertebral disc in the vertical plane.4, The distance between the farthest point of the L5/S1 vertebral plate space and the middle line of the spine.5, The abduction angle of the two sides. Draw a conclusion from them. Chosed 55patients of L5/S1 intervertebral disc herniation who would be treated with MED and were followed-up for 6 and 12 months, estimated with JOA criterion (15points). Result:1 , Three relations between the lower margin of L5 spinous process and the inferior margin of S1 vertebral were observed:65% of the cases, the former was above the latter with the average distance of 0.76±0.39cm. 22.5% were opposite to that with 0.80±0.40cm, the others were on the same level.2, There were three relations between the L5/S1 intervertebral disc and the lowermargin of L5 vertebral lamian: 17.5% were above with the averge distance of 0.37±0.18cm, 62.5% were below with the average distance of 0.67±0.40 cm, the others were on the same level.3> The angle of L5/S1 intervertebral disc on the sagittal plane was 27.9°±7.0°, and the abduction angle of two sides were 28.6°±6.1 "without significant difference.4-. 55cases were treated with MED , the operation time was 50min with 35 ml blood , followed with 1 sclerosing liipogranuloma trauma, 1 infection of the incision.The pain of three patients' got worse because of the excessive counter traction.of the never roots. Treated with dehydrating agent for 3 days and the symptoms disappeared.5% 51 cases could stand for 30min without any pain at the day after the operation, and 4 cases could do that after 1 week.6> All the cases were followed up with 6 and 12 months after the operation, 51 and 52 cases were evaluated as excellent for each time. The rate of excellent and good was 96.36%. The rate of the recovery was no significant difference between the two times. Among them 1 case was evaluated as bad for the second time because of the secondary hurt. Conclusions: 1 % The applied anatomical results were very important for the MED operation:a) The lower margin of L5 spinous process could be used as the incision when treat the L5/S1 intervertebral disc herniation with the MED;b) Put the tube along the margin of L5 spinous process was safety and was on the right location.c) During the operation, we should think carefully about the angle in the sagittal plane and the abduction angle. Also we could modulate the tube according to the situation.d) It was not necessary to recect the lower margin of L5 vertebral plate during the operation for most of the cases, but some of them needed it. This was fitted to the biological requirement of the spine.2% The operation of MED could be successful with smaller incision, less blood and more rapid recovery, the recent results were satisfactory. But the criteria of the operation were sterner than laminotomy. Also this operation had many shortcomings and need to be improved in the future.3 ^ The long-term results were not sure because of the limited time for the start of this operation and this clinical study. It need a follow-up for a longer time.
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