The Intact Or Not Of The Annulus Fibrosus And The Selection Of Interventional Therapeutic Methods In Lumbar Disc Herniation

ObjectiveTo study the effect of the annulus fibrosus rupture or intact on the selection ofinterventional therapeutic methods and the relationship of the serum immunoglobinIgG, IgM with annulus fibrosus intact or not in lumbar disc herniation (LDH).MethodsUnder the X-ray guidance,the discography was carried out with 5ml low concentrationO2-O3 mixture injection in lumbar intradisc before the interventional therapy. On thebasis of the discography,400 patients were classified into two types:rapture(n=149) andintact(n=251) disc herniations.Then different therapeutic methods were chosen in intact disc herniations,85 cases withPLD,87 cases with O₃, 79 cases with collagenase;in rupture disc herniations,30 caseswith PLD,29 cases with O₃,43 cases with collagenase,47 cases with O3 combinedCollagenase.Seventy one cases with intact discs and 35 cases with rupture discs were invovled in thestudy of immune status, the levels of IgG and IgM in serum were examined beforeinterventional therapy by rate nephetometry,at the same time,which were compared withnormal control of 30 cases each other.After the treatment of 3-6 months,the follow-up results were assessed according to theimproved Macnab criteria.Results1. In intact disc herniations group,there is no significant difference about therapeuticeffect among the three methods of PLD, O3, collagenase, but the complications with significant difference.2. In rupture disc herniations group,there is significant difference about therapeuticeffect between the treatment O₃ combined Collagenase and simple O₃, PLD,but nodifference was found between treatment of O₃ combined Collagenase and simpleCollagenase. The complications of Collagenase were significant higher than those withO₃,O₃ combined Collagenase.3.Great difference existed between intact and rupture disc herniations with treatment ofPLD and O₃ (P<0.05),but there were no difference for collagenase(P>0.05).4.The levels of serum IgG and IgM in rupture disc herniations were higher than intactdisc herniations before interventional therapy with significant difference(P<0.05),but nosignificant difference was found between intact disc herniations and normalcontrol(P>0.05).Conclusions1.Simple PLD,O₃ or Collagenase injection are all effective interventional methods forintact disc herniations,but the complications of O3 are the lowest among them.2.O₃ combined Collagenase injection is the most effective and safe interventionalmethod for rupture disc herniations and should be the first choice.3.The levels of serum IgG and IgM have correlation with the pathologic types ofLDH ,which is useful for predicting rupture or not of disc herniations.