| Objective:To explore the clinical mini-incision technique of B-Twin intervertebral cage and MED technique in the treatment of lumbar degenerative disease and to evaluate clinical effect in order to provide theoretical and technical basis in the near future in spine area.Method:We review 56 cases with lumbar degenerative disease using posterior intervertebral endoscope mini-incision and single piece B-twin in Dalian University affiliated No 1 Hospital from March 2008 to March 2009.Among them there are 31 men and 25 women, their ages ranged from 27-58 years (average36.2years).there are 56 intervertebral discs in total. Among them 33 patients got protrusion of lumbar vertebra disc in L4-L5, and 23 patients in L5-S1.All of them presented low back pain, radiating pain in legs, and numbness. The cause of disease was from 6 months to 25 years (average42.3months).Every patient took radiography on lumbar before operation and then we measured the height of intervertebral space, slippage degree and vertebra stabilization. According to JOA, VAS and OID score system to evaluate operation effect.Results:Surgical operation time was 60-100 minutes (average78.5minutes); Operation blood loss was about 20-65 ml (average42.5ml); Incision for decompression just needed one stitch and all of them were primary healing. All of them use single piece B-Twin. The length of stay after operation was from 3-6 days (average 4.3days). No complications such as infection, nerves injury and B-Twin displacement were found. One case got nerve root irritation after operation, fortunately disappeared after one week. We follow up patients 1,3,6,12 months after operation. According to X-ray, we found that the height of intervertebral space increase 20%. When the follow up finished, the average height of intervertebral space loss was 10%. No complication such as the disorder and displacement of B-Twin. Compare with preoperation, preoperative VAS score was 8.9±1.3(ranged from 5.8 to 9.2), postoperative VAS score was 3.0±1.8 (ranged from 1.2 to 6.2). The pain improved 97.7%(p<0.05). preoperative ODI score was 43.35±8.35, postoperative ODI score was 16.48±2.15. The pain improved 97.7%(p< 0.05).Excellent assessment of JOA score in 45 cases (80.36%), good in 9 cases (16.07%),2cases (3.57%) showed no difference between the assessment of cases. We did not find bad result. The satisfactory rate was 96.43%. Postoperative imaging all of the cases after intervertebral body fusion were in good position to maintain the height of intervertebral space. There was no collapse. Fusion time was 5.7-8.6 months, with an average 7.4 months. Every followed-up patient's image display fusion, without exception. No cases were found displacement and collapse.Conclusion:1) The association surgery of B-Twin and intervertebral endoscope has some advantages such as microsurgical trauma, few complications, satisfactory decompression, quick postoperative recovery, and good out-looking; 2) There are no need pedicle screw to alleviation patient's economic burden and get good effect; 3) This method change tradition method and have bright application and prospects in spine.
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