Unilateral Vertebral Lamina Windowing Nucleus Pulposus Excision In The Treatment Of Lumbar Intervertebral Disc Protrusion Curative Effect Analysis

Objects: Protrusion of the lumbar intervertebral disc is the most commoncauses of waist and leg pain, is a common disease and frequently-occurringdisease in orthopedics. Although there are a variety of surgical treatmentmethods, but at present domestic and foreign commonly used surgical methodis still of posterior resection highlighted lamina windowing removal ofnucleus pulposus, the operation method in the near future curative effect iscertain, but long-term followed-up is still controversial. Therefore this studythrough the followed-up study to evaluate posterior unilateral vertebral platewindowing nucleus pulposus excision to treat different degree, different ageparagraph the clinical curative effect of patients with lumbar intervertebraldisc, discusses the advantages and disadvantages of its operation.Methods: About2006to2008, a total of54patients underwent posteriorunilateral vertebral plate windowing nucleus pulposus enucleation followed-up23cases of male and female31cases; during the operation of the age from22to72years old, average46.09years old; shortest duration2weeks, thelongest for14years, average1.89years;5~7years followed-up time, average5.83years. In accordance with the age at surgery the patients can be dividedinto age40,40~60years old, more than60curative effect evaluation on the3groups respectively;54patients of31cases collected preoperative CT scanresults, according to the severity of CT measurement of intervertebral discherniation31patients were divided intoⅠ, Ⅱ, Ⅲ degree, curative effectevaluation on the3groups. The last followed-up for all patients in2013, withreference to the Japanese orthopaedic society (JOA) of1984lumbocrural paincurative effect of standard method (29), mainly includes the subjectivesymptoms (9), the clinical signs (6), the daily life (14points) and the function of the urinary bladder (-6～0)4parts. For patients with preoperatie andfollowed-up score at the end of the time. Using SPSS13.0statistical softwarefor analysis of the data to mean±standard deviation. Using paired t test andvariance analysis to compare the preoperative JOA score and at the time of thelast followed-up, evaluating the effect of the overall operation effect and eachgroup with or without differences, with P<0.05for the difference was sta-tistically significant. Using Nakai standard to judge the effect of patients.Results:154patients with preoperative JOA score was13.02±2.85, the lastfollowed-up was22.94±1.64, recovery from the previous obviously improved.Although most of the patients had a history of low back pain, but there are fewcontinuous history of low back pain. According to the Nakai standard fine ratewas85.2%(46/54), the recurrence rate was5.6%(3/54),2cases of men andwomen in1case, after conservative treatment, basically returned to normallife.54patients were no intervertebral disc, vertebral canal infection and nervedamage.2Analysis of variance among different age groups of the JOA score at thetime of the last followed-up. Results show that more than60years old groupcompared with other age groups of postoperative JOA score difference wasstatistically significant, the rest of the JOA score differences between the twogroups have no statistical significance. Under the age of40about44.4%(8/18)of patients plagued by low back pain, and over40two groups decreasedsignificantly.354patients of31cases were collected preoperative CT examinationresults,17cases of men, women14cases. According to the differentprominence compared preoperative and JOA score the last followed-up,results show that intervertebral disc herniation Ⅲ degrees of patientscompared with the two groups of postoperative JOA score difference wasstatistically significant, the rest of the JOA score differences between the twogroups have no statistical significance. Patients with preoperative degree ofintervertebral disc herniation Ⅲ degrees at the time of the last followed-up JOA score lower than the other two groups, patients with lumbar disc veryserious (CT of intervertebral disc highlights on the section more thantwo-thirds of vertebral canal volume) line of lamina windowingdecompression alone is often poor effects in patients with relatively mildprominent.Conclusions: Lamina windowing excision of nucleus pulposus is a wayof limited trauma surgery, the advantages of the surgical methods includingthe following:（1）for patients with simple type lumbar intervertebral discprotrusion, done enough decompression;（2）reduce vertebral side stripping,lamina and the destruction of the small joints, avoided due to excessivedestruction of vertebral plate and small joints caused by spinal instability;（3）the operating time is short, for patients with trauma small and low cost, lessintraoperative and postoperative bleeding, postoperative function recoveryfaster, patients can get out of bed early activities;（4）there are still most oflamina and postoperative yellow ligament covers the dural sac, largelyretained after lumbar spinal column structure integrity, reduce thepostoperative epidural adhesion, and scar tissue adhesion complications suchas cervical stenosis. However, its shortcoming is intraoperative exposure rangeis small. Long-term followed-up of this study confirmed that the singlesegment lamina windowing decompression with excision of nucleus pulposusof long-term treatment of lumbar intervertebral disc protrusion curative effectis good, the recurrence rate is low, is the first choice for most patients with thedisease surgery method; Degree of intervertebral disc herniation in patientswith severe poor long curative effect in simple lamina windowingdecompression in patients with relatively mild prominent, for patients withdisc herniation clinical very serious (CT of intervertebral disc highlights onthe section more than two-thirds of vertebral canal volume) line of laminawindowing decompression alone often poor effects in patients with relativelymild to highlight, such patients may be more suitable for fusion surgery. Withthe development of science and technology, the improvement of technicallevel, the deepening of the concept of minimally invasive, less damage of minimally invasive surgery might replace the excision of nucleus pulposus,become a main mode of operation.