Discectomy and Isobar placement for single-level lumbar disc herniation complicated with segmental instability, a three-year follow-up study

English Keywords:【Key words】 Lumbar disc herniation  Lumbar instability  Isobar  Dynamic fixation system

English Abstract:

  【Abstract】 Objectives: To explore the clinical results of a semi-rigid dynamic fixation system(Isobar) plus discectomy for single-level lumbar disc herniation(LDH) complicated with segmental instability. Methods: Thirty-two patients between January 2009 and December 2010 suffering from back and leg pain for 2-4 years and diagnosed as single-level LDH complicated with segmental instability were included in this retrospective study, all cases presented with leg pain, numbness and weakness and showed irresponsible to conservational treatment of 3-6 months. The diseased level located at L3/4 in 2 cases, L4/5 in 16 cases and L5/S1 in 14 cases. All cases underwent discectomy and decompression and fixation with Isobar. VAS and ODI scores were used to evaluate the results. X-ray and CT scan were performed at 3 months, 6 months, 1 year, 3 years to evaluate the status of implants and ROM of surgical level. Results: All patients finished 3-year follow-up. The average operation time was 70±16min, and the average blood loss was 150±42ml. The preoperative VAS score was 7.3±2.2, and the 3-month postoperative VAS was 2.2±1.0 and remained at this level until the final follow-up(1.8±0.9, P<0.05). The ODI of preoperation was (59.7±13.2)%, that of 3-month follow-up was (32.6±11.4)% and was (30.8±10.6)% of 3 years(P<0.05). The preoperative ROM was 14°±2.5°, that of 3-month follow-up was 2.8°±1.5° and the 3-year follow-up ROM was 2.6°±1.3°(P<0.05). No screw breakage or disc recurrence was noticed. Conclusions: For single-level LDH complicated with segmental instability, discectomy and Isobar placement is effective in relieving the symptoms and maintaining the segmental motion.