Application Of Single-segment Percutaneous Endoscopic Lumbar Discectomyin The Treatment Of Multi-segment Lumbar Disc Herniation

Objective Multi-segment lumbar disc herniation,a common clinical disease,usually has complicated clinical symptoms.In the past,open surgery was more widely used to treat this disease.In recent years,with the development of minimally invasive techniques and concepts,spinal endoscopy is also widely used in the treatment of multi-segment lumbar disc herniation.However,at present,multi-segment decompression is mostly used for treatment.It is traumatic and may affect spinal stability.A numberof studies have shown that good surgical results can also be achieved if the responsible intervertebral disc in multi-segment herniation can be accurately found and "selective decompression" is conducted.In this subject,the purpose is to study the effectiveness of single-segment nucleus pulposus enucleation under intervertebral foramen endoscope for patients with multi-segment lumbar disc herniation.Methods From September 2015 to March 2018,seventy-five patients with multi-segment lumbar disc herniation hospitalized in our department were analyzed retrospectively.According to the induced pain caused by lumbar discography,seventy-five patients were divided into three groups.One group was double-segment induced pain group(group D),one group was single-segment induced pain group(group S)and the other group was non-induced pain group(group N).According to the condition of intervertebral disc radiography and nerve localization signs,the responsible intervertebral disc of each group of patients was comprehensively judged.Moreover,the patient was subjected to single-segment(responsible intervertebral disc)nucleus pulposus enucleation under intervertebral foramen endoscope.The VAS score and Oswestry dysfunction index(ODI)were compared and observed before the operation and six months after the operation and the surgical efficacy was evaluated by Mac Nab standard.Results All patients underwent single-segment nucleus pulposus enucleation under intervertebral foramen endoscope.The operation went smoothly and there were no complications such as infection,hematoma,nerve injury,etc.After the operation,the patients were followed up for at least six months.At six months after the operation,the VAS score and ODI index of the three groups of patients were significantly improved compared with those before the operation.And the difference was statistically significant(P(27)0.05).There was no statistically significant difference in VAS score and ODI at six months after the operation between the three groups of patients(P(29)0.05).Evaluation of the curative effect of modified Mac Nab after the operation: group S(excellent in 17 cases,good in 5 cases,normal in 3 cases,poor in 0 cases,excellent and good rate was 88%),group D(excellent 11 cases,good 10 cases,fair 3 cases,poor 1case,excellent and good rate 84.0%),group N(excellent 15 cases,good 7 cases,fair 1case,poor 2 cases,excellent and good rate 88.0%),there was no statistical difference in the excellent and good rate among the three groups(P(29)0.05).Conclusion For most patients with multi-level lumbar disc herniation,under the premise of accurately identifying the responsible disc,single-level percutaneous endoscopic lumbar discectomy can achieve good long-term results.