Curative effect observation of unilateral dynamic fixation under a Quadrant system combined with lumbar discectomy in the treatment of lumbar intervertebral disc herniation

English Keywords:Lumbar disc herniation  Quadrant system technique  Dynamic non-fusion fixation system

English Abstract:

  【Abstract】 Objectives: To investigate the clinical effect of Quadrant system-assisted unilateral dynamic fixation combined with lumbar discectomy in the treatment of lumbar intervertebral disc herniation. Methods: 23 patients (13 males and 10 females) with lumbar disc herniation who underwent unilateral dynamic fixation combined with lumbar discectomy assisted with Quadrant system in our hospital from January 2013 to November 2018 were retrospectively analyzed. The patients averaged 31.0±6.9(20-40) years old and were followed up for 42.0±6.6 months(28-68 months). The operative time, intraoperative blood loss, and postoperative hospital stay were recorded. The visual analogue scale(VAS), Oswestry disability index(ODI), and Japanese Orthopaedic Association(JOA) score were compared between preoperation, 2d after operation, and final follow-up to assess the clinical outcomes. Anteroposterior lateral and dynamic lumbar X-rays examinations were performed on postoperative 2d and at final follow-up to measure the intervertebral space height and intervertebral motion range. Lumbar MRI examination was performed before and at final follow-up, and Pfirrmann scale was applied to evaluate the height and signal changes of the operative segments and adjacent segments, and Pfirrmann grading improvement was claculated. Results: All patients completed the operation successfully. The operation time was 82.5±11.6min, the intraoperative blood loss was 58.8±9.5ml, and postoperative hospital stay was 3.1±0.4d. The postoperative 2d and final follow-up ODI, JOA score, and VAS were significantly improved than before operation(P<0.05). The height of the intervertebral space of operative segments and upper adjacent segments and the range of motion of upper adjacent segments on postoperative 2d and at final follow-up were not statistically different from those before operation(P>0.05), while the range of motion of operative segments on postoperative 2d improved significantly than that before operation(P<0.05). At final follow-up, the Pfirrmann scale showed an overall improvement rate of 30.5% at the operative segments, 56.5% no significant change, and 13.0% degeneration aggravation; and 8.7% overall improvement at the adjacent segments, 73.9% no significant change, and 17.4% degeneration aggravation. During the follow-up, there was no recurrence of intervertebral disc herniation, screw loosening, fracture, failure or other related complications. Conclusions: The Quadrant system assisted unilateral dynamic fixation combined with lumbar discectomy can achieve good clinical effects in the treatment of lumbar disc herniation through effectively maintaining the height of the intervertebral space and preserving the range of motion of the lumbar spine.