前方髄核摘出術よりみた径皮的髄核摘出術の位置付け，他術式との比較検討

Abstract

We have experienced 2201 cases surgically treated for lumbar disc herniation from 1976 to 1993. Treatments included 22cases of anterior nucleotomy (AN), 29 with anterior discectomy (AD) and 38 cases of percutaneous nucleotomy (PN) from 1986. Of these 18 cases of AN, 25 of AD and 36 of PN were clinically evaluated using the JOA score.The post-operative results were as follows:Average improvement rate was 77.8%, 72.7% and 55.6% in AN, AD and PN respectively. Excellent and good rates were 89%, 88% and 69%. A satisfactory rate was achieved in 83%, 76% and 72% of patients respectively.Postoperative merits were in order of AN, AD and PN. As a rule AN and AD are considered extensive major surgery due to the abdominal incision and general anesthesia, but the average operation time is 20 minutes and duration of return to former professional activities (sport and job) is with in 3 to 6 weeks. Therefore AN and AD are better procedures for lumbar disc herniation than PN.On the other hand there are many reports that the results of PN are not so satisfactory, therefore the indication must be discreet and not extensive. We have indicated cases with higher intradiscal pressure and less disc degeneration because of the need for intradiscal decompression.The best indication is intradiscal herniation. Furthermore many authors report that the technique is an intermediate procedure between surgery and conservative treatment, but PN is almost the same as surgical treatmert due to its disc damage and accidental complications.