The application of 1 tangent line 2 midpoint vertical shift measurement method in the treatment of upper lumbar intervertebral disc herniation by percutaneous transforminal endoscopic discectomy

Abstract

Objective To evaluate the clinical effect and security of upper lumbar intervertebral disc herniation by endoscopic transforaminal decompression with 1 tangent line 2 midpoint vertical shift measurement method. Methods From June 2017 to August 2018, 20 orthopedic patients from Shanxi Province People's Hospital met single segment of upper lumbar disc herniation (L1/2 or L2/3) were included in the study with retrospective analysis. There were 13 males and 7 females, aged from 55 to 84 years, average 65.14 years. These patients underwent surgery using endoscopic transforaminal decompression. All surgeries were performed under full endoscope and nerve decompression was performed under direct vision to avoid the risk of nerve injury caused by direct puncture and catheterization .The 1 tangent line 2 midpoint vertical shift measurement method was used to determine the bypass distance and puncture point on MRI transection. Average operative was analyzed.The clinical symptoms of the included patients were evaluated by VAS and ODI c at 3 and 6 months after surgery, and the overall clinical efficacy was evaluated by the MacNab score. Results All the 20 patients had good wound healing after surgery, no ureter and kidney injury and other complications, and recovered well. On the second day, they all wore waist activities, performed proper functional exercise, and were discharged from the hospital 3 days after surgery. Average operative time was (72.13±23.01)min. The Mac Nab scores were excellent in 14 cases (70%), good in 5 cases (25%), generally good in 1 case (5%). The overall optimal rate was 95%. Pre-op VAS was 65.15±7.16, ODI was 45.17%±10.54%. Post-op 3 months VAS was 22.02±9.64, ODI was 16.51%±8.35%. Post-op 6 VAS was 10.13±9.61, ODI was 11.65%±5.93%. The VAS and ODI were significantly improved compared with the preoperative values, and these differences were statistically significant (all P values<0.01). Conclusions In the treatment of upper lumbar intervertebral disc herniation by percutaneous transforaminal endoscopic discectomy, the 1 tangent line 2 midpoint vertical shift measurement method is safe and reliable to locate the bypass distance and puncture point, which can achieve a better clinical effect. Key words: Intervertebral disc displacement; Percutaneous endoscopic lumbar discectomy; Upper lumbar intervertebral disc herniation; Surgical planning; Preoperative measurement