A Comparative Study On The Clinical Efficacy Of PELD In The Treatment Of Lumbar Disc Herniation With Different Modic Types

Objective: To compare the postoperative efficacy of percutaneous intervertebral foramen endoscopic discectomy in the treatment of lumbar disc herniation with different Modic types,in order to evaluate the effectiveness of this method and the difference between different Modic types,and to provide some reference for clinical treatment in the future.Methods: A total of 90 patients with lumbar disc herniation who were hospitalized in the Department of Spinal surgery of the first affiliated Hospital of Guangxi University of traditional Chinese Medicine from January 2019 to August 2020 were retrospectively analyzed.According to their lumbar Modic changes and Modic changes,90 patients with lumbar intervertebral disc herniation were divided into group A(no Modic changes),group B(with Modic changes type Ⅰ)and group C(with Modic changes type Ⅱ).The pain degree and lumbar function were evaluated by VAS score and ODI score of waist and leg before operation,1 day,3 months and 6 months after operation in the three groups.The excellent and good rate of treatment was evaluated by modified Mac Nab method in the last follow-up.SPSS26.0 statistical software was used to analyze the results.Results : In this study,the information of 90 patients were included and collected completely,including group A(n = 30),group B(n = 30)and group C(n = 30).All patients completed the operation successfully.The main results were as follows:(1)there was no significant difference in sex,age,BMI,drinking history,diabetes history,course of disease,lesion segment,operation time and postoperative activity among the three groups(P > 0.05).(2)the VAS score and ODI score of waist and leg in the three groups were significantly lower than those before operation(P < 0.05).The modified Mac Nab evaluation results of the last follow-up showed that the total excellent and good rate was 87.78%,and the excellent and good rates of the three groups were 93.33%,83.33% and 86.67%,respectively.there was no significant difference in the excellent and good rate among the three groups(P > 0.05).(3)there was no significant difference in leg VAS score at each time point among the three groups,and there was no significant difference in waist VAS score and ODI score between the three groups before operation and 1 day after operation.There were significant differences in lumbar VAS score and ODI score among the three groups at 3 months after operation.The results of multiple comparison showed that there were significant differences in the above two indexes between the three groups(P < 0 05).The results of multiple comparison showed that the differences of the above two indexes among the three groups were statistically significant(P < 0 05).There were significant differences in lumbar VAS score and ODI score among the three groups at 6 months after operation.The results of multiple comparison showed that when the above two indexes were compared between the three groups,there were significant differences between group A and group B,group A and group C,but there was no significant difference between group B and group C(P > 0.05).Conclusion:(1)PELD is effective in the treatment of lumbar disc herniation with or without Modic changes,and the operation is safe and reliable.(2)the change of Modic is a factor affecting the improvement of low back pain and the recovery of lumbar function in the short term after PELD of lumbar disc herniation,and the influence of Modic change type I is relatively more obvious.(3)when strictly selecting the indication of PELD operation,we should pay more attention to the patients with type Ⅱ lumbar disc herniation without Modic change or Modic change.