The Clinical Outcome And Intervertebral Disc Rehydration Of Percutaneous Dynamic Stabilization In The Treatment Of Lumbar Disc Herniation

ObjectiveTo evaluate the early clinical outcome of percutaneous lumbar dynamic stabilization combined with percutaneous endoscopic lumbar discectomy in the treatment of patients with lumbar disc herniation,and observe the effects on the motor function and rehydration of the lesion segmental made by percutaneous lumbar dynamic stabilization.MethodsA retrospective review of 23 cases with lumbar disc herniation was performed who had undergone percutaneous lumbar dynamic stabilization and percutaneous endoscopic lumbar discectomy in spine surgery of the First Affiliated Hospital of University of South China from May 2013 to May 2015.There were 14 males and 9 females,with a mean age of(45.39±5.13)years(range,33-52).The visual analogue scale(VAS)of low back and lower extremity pain,and Oswestry disability index(ODI)preoperatively and postoperatively were compared to evaluate the early clinical outcome.The intervertebral space ratio(IVS)and range of motion(ROM)of operative segment and adjacent segmentwere measured,as well as the range of motion of global lumbar spine,on the preoperative and postoperative lumbar lateral and flexion-extension radiograph.The average calibrated disc signal(CDS)of operative segment and adjacent segment were measured and calculated on the preoperative and postoperative lumbar magnetic resonance imaging.ResultsThe 23 patients were followed up for 24.83 ± 6.29 months(range,16-37 months).In all cases,except for 1 case was reherniation,there were no other complications such as infection,nerve injury,dural injury,epidural hematoma,cerebrospinal fluid leakage,loosening or breakage of internal fixation,adjacent segment degeneration and so on.The preoperative VAS score of low back pain was(5.17 ± 1.34),and(1.74± 1.10)at the last follow-up postoperatively;the VAS score of lower extremity pain before operation was(7.57 ± 1.24),and(1.30 ± 1.02)at the last follow-up postoperatively;the preoperative Oswestry disability index was(71.52 ± 14.69)%,and(20.94 ± 7.72)% at the last follow-up postoperatively;there were statistically significant differences between preoperative and postoperative(P<0.05).The preoperative intervertebral space ratio(IVS)of operative segment was(40.88 ± 7.43)%,and(40.41 ± 5.92)% at the last follow-up postoperatively;the preoperative IVS of the cranial adjacent segment was(40.05 ± 6.90)%,and(39.66± 5.64)% at the last follow-up postoperatively;the preoperative IVS of the caudal adjacent segment was(39.69 ± 9.72)%,and(40.10 ±8.81)% at the last follow-up postoperatively;there were no statistical significance differences between preoperative and postoperative(P>0.05).At the last follow-up,the range of motion(ROM)of the operative segment was(3.09 ± 1.25)°,which was(5.62 ± 2.08)° before operation,and there was statistically significant difference(P<0.05).The ROM of the cranial adjacent segment was(5.15 ± 1.39)°,and at the last follow-up it was(5.48 ± 2.01)°,while the ROM of the caudal adjacent segment was(3.60 ± 1.77)° before operation,and at the last follow-up it was(3.78 ±1.86)°,there were no statistically significant differences(P>0.05).The ROM of the global lumbar spine was(27.16 ± 13.81)° before operation,while it was(24.91 ± 10.79)° at the last follow-up,there was no significantly differences(P > 0.05).The calibrated disc signal(CDS)of the operative segment was(61.73 ± 11.61)% before operation,while it was(68.59 ± 13.67)% at the last follow-up,and there was statistically significant difference(P < 0.05).The CDS of cranial adjacent segment before operation was(83.46 ± 11.90)%,while it was(80.24 ± 17.29)% at the last follow-up,and there was no statistically significant difference(P > 0.05).the CDS of caudal adjacent segment was(78.62 ± 10.26)%before operation,while it was(79.60 ± 9.14)% at the last follow-up,there was no statistically significant difference(P > 0.05).Conclusion1.The hybrid minimally invasive technique combined percutaneous lumbar dynamic stabilization with percutaneous endoscopic lumbardiscectomy in the treatment of lumbar disc herniation can gain a satisfied early clinical outcome,which is safe,effective,and minimally invasive.2.The lumbar disc of operative segment showed the phenomenon of rehydration,which indicates this percutaneous posterior lumbar dynamic system may play a role of promoting the self-repair of the degenerative intervertebral disc.