Microendoscopic lumbar discectomy combined with annulus suture in lumbar disc herniation

English Keywords:Lumbar disc herniation  Microendoscopic discectomy  Annulus suture

English Abstract:

  【Abstract】 Objectives: To investigate the safety, clinical efficacy and recurrence rate of microendoscopic lumbar discectomy(MED) combined with annulus suture in the treatment of lumbar disc herniation. Methods: A total of 290 patients with lumbar disc herniation, who were treated with MED in Department of Spinal Surgery from March 2012 to March 2014, were followed up and analyzed. There were 160 males and 130 females, with a mean age of 38.1±12.1 years. This study included 118 cases of MED combined with annulus suture(suture group) and 172 cases of MED(control group). The followings were recorded: height of disc space, operation time, blood loss, scores of Oswestry disability index(ODI) and visual analogue scale(VAS). Results: There was no significant difference between the two groups in the average operation time or blood loss. All cases had been followed up for an average of 28.35±5.08 months(ranging from 24 to 32 months)． In both groups, the ODI and VAS scores significantly decreased form the pre-operation to the 3 months follow-up and the last follow-up(P<0.05); but no significant difference was observed between the two groups(P>0.05). On average, the disc height reduced by 19.83%(8.29±1.43mm to 10.34±1.74mm) from the pre-operation to the last follow-up in control group. In suture group, the disc height reduced by 14.53%(8.94±1.35mm to 10.46±1.55mm), while the difference was not statistically significant between the two groups(F=1.461, P=0.230). There were 14 cases of recurrence after operation in control group and 3 cases in suture group. Among them, 6 patients in control group received surgery again and 1 patient in suture group. The recurrence rate was 8.14% in control group and 2.54% in suture group. The reoperation rate was 3.49% in control group and 0.85% in suture group. The two groups displayed significant difference in the recurrence rate(χ2=3.973, P=0.046) and reoperation rate. Conclusions: These findings indicate that MED combined with annulus suture is safe, feasible, and simple to operate. Compared with discectomy alone, additional annulus suture can obtain equivalent and remarkable clinical outcomes. The recurrent rate and reoperation rate are reduced significantly if the procedure is performed in patients with certain surgical indications.