Clinical Research On Safety Range Of Head Tilt Angle:TESSYS Via Intervertebral Foramen Has Been Used To Treat Lumbar Intervertebral Disc Herniation With Prolapsed In Spinal Canal

Background Percutaneous endoscopic lumbar discectomy(PELD)is a minimally invasive method for the treatment of lumbar disc herniation(LDH),Mainly through the Thomas Hoogland endoscopy spine system(TESSYS)developed by Dr.Thomas Hoogland.Compared with traditional surgery,this technique has the advantages of short operation time,low complication rate,short hospitalization time,quick recovery and high satisfaction,and is popular with spine surgeon and patient.It has become a routine treatment methods for LDH.But because of its learning curve "steep",has been plaguing the spine surgeon,especially the application of TESSYS technology in the treatment of spinal canal prolapse LDH.Objective 1.Puncture head inclination Bone sign(upper joint height,intervertebral space height)was measured in the lumbar DR using image post-processing software(Vue PACS)on the application of intervertebral foramen approach TESSYS technique puncture,For the clinical application of intervertebral foramen approach TESSYS technology to provide anatomical basis for puncture positioning.2.Combined use of lumbar vertebrae DR,CT,MRI,preoperative measurement by Vue PACS by intervertebral foramen approach TESSYS technology targeting puncture with spinal canal prolapse LDH puncture head tilt safety range for TESSYS technology to provide security Precise reference data.And through the preoperative determination of the puncture tip inclination safety range verify the safety of TESSYS technology in the treatment of spinal canal prolapse LDH in clinical practice.3.The visual analogue scale(VAS),Ochestry disability index(ODI)and improved Mac Nab score were measured before and after surgery,1 day,3 months postoperatively,Follow-up to evaluate the efficacy of TESSYS in the treatment of LDH.Method 1.From May 2013 to December 2016,120 patients were checked with lumbar DR in our hospital.Outpatients(n = 80)and hospitalized patients with "single-segment LDH"(n = 40).The height of L4 ~ S1 lumbar left and right upper articular height,L3 ~ 4,L4 ~ 5,L5 ~ S1 intervertebral space height were measured on the lumbar vertebrae in each patient by Vue PACS.And compared with the "single-segment LDH" patients in the intervertebral disc height,intervertebral space height for statistical analysis,to study the anatomical landmarks of TESSYS technology for targeted puncture localization.2.A total of 59 patients with spinal canal prolapse LDH were treated with intervertebral foramen approach TESSYS technology from May 2013 to December 2016 in our hospital.The following indexes were measured on the Vue PACS before operation: the depth of the nucleus pulposus(MRI,CT),L3 ~ 4,L4 ~ 5,L5 ~ S1 disc light and severe prolapse of the head tilt angle safety range(DR).According to the measured head tilt range to determine whether the desired puncture target and surgical efficiency and safety can be achieved.3.The patients who were treated with TESSYS were used "VAS","ODI" and improved Mac Nab score to evaluate the efficacy of TESSYS in the treatment of LDH at Before surgery,1 day after surgery,3 months after surgery,after surgery in June.Result 1.In our hospital 120 cases of outpatient and inpatients lumbar L3 ~ 5 vertebral body using Vue PACS measurement statistics show that: There was no significant difference in the height of upper articular between the normal and single-segment LDH patients(P> 0.05).There was significant difference in the intervertebral space height between the normal and single-segment LDH patients(P <0.05).2.According to the range of head tilt angle measured before the operation,all the patients reached the preset position.L3~4,L4~5,L5~S1 intervertebral head tilt angle of central light prolapse can be unified for the 15 °~30 ° and severe prolapse was40 °~45 °;Head tilt angle of Non-central light prolapse was 35 °~45 ° and severe prolapse was 25 °~30 °.There were statistically significant differences(P<0.05)in the head inclination angle between different prolapse degree and spinal positionin the same segment.3.The curative effect of the patients was evaluated by "VAS" and "ODI" before operation,1 day after operation,3 months after operation and 6 months after operation.Statistical analysis showed that there was no significant difference in the efficacy of TESSYS in the treatment of light and severe thoracic prolapse LDH(P <0.05);According to improved Mac Nab evaluation criteria excellent rate was 93.2%.Conclusion 1.Normal and "single-segment LDH" patients with lumbar L4 ~ S1 on the upper articular height of the no significant difference,indicating that the upper articular height can be used for intraoperative targeted puncture positioning bone markers in the application of TESSYS technology.There was significant difference between the two groups(P <0.05),and the intervertebral space height decreased with the prolonged duration of single-segment LDH patients;Indicating that lumbar disc herniation and intervertebral space height have a certain relevance,can be based on the height of the intervertebral space on the extent of the degree of shedding.2.The degree and location of nucleus pulposus prolapse can be judged by DR,CT and MRI before operation,and the safety angle of the incision angle of the puncture needle can be measured according to the degree of prolapse,in the surgical targeting of the target position to determine,improve the success rate of TESSYS technology puncture and surgical safety;That is based on the degree of different prolapse to develop personalized surgical approach,to achieve more safe and effective operation purposes.3.TESSYS technology is a more effective treatment of spinal canal prolapse LDH minimally invasive method.