Discectomy Treatment of special types of technical improvements of lumbar disc herniation with
【Abstract】 Objective To investigate the disc microscopy (Microendoscopic Disectomy MED) Treatment of special types of improved methods of lumbar disc herniation with, in order to optimize the surgical procedure to improve the efficiency of operation. Way since the original equipment to the central-
type prominent hyperplasia with calcification or osteophyte processing difficult or can not do, developed a series of
special auxiliary equipment and the technology corresponding improvement and optimization. In response to these changes, also with the method of operation MED corresponding improvement and optimization. Results A total of 606 cases of
patients with central prominent of which 121 cases, with calcification or osteophyte proliferation of 485 cases. All patients had surgery with the smooth, with no transit to open surgery, no place intervertebral infection, the operating time 30 ~ 60 min, an average of 45 min. Conclusion discectomy techniques for improved methods of operation take the appropriate co-ordination with the doctors be able to
successfully complete the surgical procedure, effectively improve the operation efficiency, further optimization and
promotion of MED technology significance.
Key words discectomy; improved methods; surgery with
MED technology combines the principles of open surgery and minimally invasive micro-endoscopic technology, is
currently the treatment of lumbar disc herniation surgery
better way, but since the original equipment, mainly for the simple design of lumbar disc herniation, central Type prominent, with calcification or osteophyte proliferation, and other special cases dealing with difficult or impossible to
deal with, so that the clinical application of this technology is limited. Based on the above, I developed the L-type into
the hospital device, arc-shaped annular cutter series of
special assistive devices and the corresponding improved method . In order to adapt to this change, we also MED surgical patients with the corresponding methods of improvement and optimization, and since 2001 03 ~ 2007
03 treatment of patients with central type 121 cases outstanding, with calcification or osteophyte hyperplasia in
485 patients with cases. Are reported below.
1 Data and methods
1.1 General information on 606 cases of this group, the male 327, female 279 cases. Age 21 to 76 years, with an average 43.5 years of age. Duration of 1 month to 30 years, an
average of 3 years and 2 months. 121 cases of central prominence, with calcification or osteophyte proliferation of 485 cases. Highlight the gap: L3-4 space 55 cases, L4-5 space
239 cases, L5-S1 space 302 cases. All patients had varying
degrees of waist, leg pain or numbness symptoms. All patients prior to CT or MRI scan and lumbar lateral films.
1.2.1 The pre-surgery patients with preoperative visits to understand the illness and psychological intervention in
order to eliminate the patient's tension, fear, in which patients with a good mental state for surgery.
Equipment Equipment preparation: the day before surgery equipment sterilization, in addition to the lens, cable, optical fiber using fumigation sterilization, other devices (including home-made devices) can use high-temperature
autoclave. Discectomy surgery was checking systems and C-arm
X-ray machine operation.
1.2.2 with the surgical methods and intraoperative
Tour nurses for: assisting anesthetists for anesthesia,
the establishment of intravenous access. Placed in operation to help position the patient prone to take place, with two vacant strip foam pad to make the abdomen in order to reduce interference on respiratory and bleeding, regulate
multifunctional operating table, so that lumbar spine showed "convex" type, in order to increase vertebral plate gap width, to facilitate operative. Disinfection, shop towels later guided needle positioning, and use C-arm X-ray machine
perspective confirmation. To help install the free arm fixation, connection cables, optical fiber and so on.
Nurses with the device: When the surgeon-guided needle
incision along the back of the skin and fascia, the turn passes to expand the work of pipes and channels. Into the
spinal canal with no pre-bending electrocoagulation hemostasis in preparation for the timely replacement of hours into the spinal canal and the hook straight coagulation suction tube. Separation, bite except yellow ligament and some lamina, dura
mater and nerve roots exposed and exposed protrusion, adhesion can be used in case they have home-made hook knife-like
adhesion adhesion separator sets of hooks to organize and cut off, open the fibrous ring, with medullary Nuclear pliers
remove the nucleus with a homemade knife handle outstanding arc annulus fibrosus annulus fibrosus, or calcified tissue, if accompanied by hyperplasia of posterior marginal osteophytes, then use self-made L-type into the device (the head by the
non-slip bottom treatment) break even, and highlight the central-type devices can be used to enter the L-type (smooth
underside of the head) in the posterior longitudinal ligament space before treatment, protrusion, or calcified tissue can be directly tie into the intervertebral space or the first re-use
clamp nucleus out. Probe, cleaning nerve root channel, flushing, bleeding, with a long needle in the intervertebral space self-injection of gentamicin 80000 units, with the incision closed with absorbable suture thread. Reposted
elsewhere in the paper for free download http://
A total of 606 cases of patients in this group, of which
121 cases of central prominence, with calcification or osteophyte proliferation of 485 cases. All patients had
surgery with the smooth, with no transit to open surgery, no place intervertebral infection, the operating time 30 ~ 60 min, an average of 45 min, intraoperative blood loss, 5 ~ 120 ml, an average of 30 ml. Clinical evaluation according to MacNab criteria : pain, activities freely, in order to excellent; dual back or leg pain, does not affect their normal work and life, for good; intermittent pain and dysfunction, affecting the normal work and life, but the functions are improvement, as can be; pain-free to reduce the functional
improvement or no significant improvement is required re-
operation for the worse. In accordance with the standards and quality in this group of cases 596 cases, in 6 cases and poor in 4 cases.
3.1 of central prominence to have unilateral radicular symptoms generally use a single method of approach in dealing with protruding arc when the fibrous ring in addition to using knives were also used his head into the underside of a smooth L-type handles contralateral highlight the objects, passing into the device when you should pay attention to the underside of the head characteristics of the transmission annular knife hammer must also be ready, because in cutting all the force of impact with a short trip in order to improve security. To have bilateral radicular symptoms into the road is a dual method , processing with Victoria-based ring knife.
3.2 with calcification or osteophyte proliferation of the calcified tissue is mainly used a knife along the edge of
curved annular processing, cutting and exhausted immediately passed out with a tooth clamp nucleus. Improved methods of using bone knife abandoned peck addition to (injury, easy bleeding) to deal with osteophyte proliferation approach and
use of L-type into the device (the head by anti-slip bottom
surface processing) to proliferative osteophyte way tie, but also quickly without bleeding, simple and practical.
MED hemostasis 3.3 The main difficulty is surgery to stop bleeding within the spinal canal and equipment at any time the nurse to keep electrocoagulation forceps head clean, timely and clear the coking material, so as to avoid burning when the
adhesions involved give rise to new bleeding. Once the spinal canal bleeding occurs, attention should be highly concentrated and closely cooperate with bleeding operation, and promptly prepare gelatin sponge and filling equipment, smoking a good rinse salt water in order to maintain clear vision.
3.4 The technical requirements of the technical
requirements of a higher MED patients to participate in tour operations and equipment necessary for nurses through specialized training, familiar with the technology, knowledge, technique's habits and characteristics and use home-made
device [4,5] . Postoperative treatment equipment should be annular knife in the head with the tube set is good, in order to maintain edge sharpness.
An improved method disc mirror technology has solved the treatment of central prominent calcification or osteophyte
proliferation of mergers and other special types of lumbar disc herniation-related problems and the method adopted for the corresponding operation co-ordination with the doctors be
able to successfully complete the surgical procedure to further optimize the operability of the MED technique effectively improves the efficiency of operation extends the range of applications to further enhance its comprehensive performance.
 Liao Middle East, the Yangzi Kun, Wan Li. MED
surgery after treatment with self-made instruments
longitudinal ligament calcification and osteophytes Masuda health [J]. Chinese Journal of Minimally Invasive Surgery, 2005,5 (5): 369.
 Sung WR, Daniel H, Alderto L, et, al Endoscopic Foraminotomy using MED system in cadaveric specimens. Spine, 2000,25:26.
 Liao, the Middle East, Wang Bing, Yang Zikun. Discectomy improved method of treatment of central lumbar disc herniation [J]. China Endoscopy Journal, 2004,10 (12): 73.
 SUN. Discectomy for the treatment of lumbar disc herniation with [J]. Chinese Journal of Nursing, 2002,37 (3): 234.
 Lifu Yi, Hu, Guo Lectra. After discectomy for the treatment of patients with lumbar disc herniation surgery with [J]. Journal of Nursing, 2004,11 (6): 31. Reposted elsewhere in the paper for free download http:/ /