The patient, male, 50 years old, developed waist pain without obvious inducement 8 months ago and presented progressive aggravation. After more than 20 days, he presented radiating pain of the right lower limb from the back of the thigh to the outside of the lower leg. He was treated in a third-grade a hospital in Beijing and was given symptomatic physiotherapy, with slight relief. During 8 months, the intermittent onset of lumbago, progressive aggravation, 5 days ago in a third grade hospital in the city, lumbar mri examination: lumbar disc herniation.
For further treatment, the patient was admitted to the surgical clinic of our hospital. Chief physician Sun Qinghe understand the patient's condition in detail, and further for the physical examination, physical examination found that patients with physiological curvature, 4/5 lumbar spine tenderness obviously, right next to the vertebral ligaments tenderness and lower limb radiation to the lateral crus and to the right foot back, right leg straight leg-raising and strengthening the positive, lower limb activity is a bit limited, sacroiliac department, right back thigh, calf of the lateral strain, foot dorsum skin feels numb, 踇 toe back stretch muscle abate level iv, more than physical examination did not see abnormalities. Auxiliary examination of lumbar mri showed lumbar disc herniation 4/5, which was initially diagnosed as lumbar disc herniation.
Due to the patient's repeated pain in the waist for 8 months and the unsatisfactory effect of conservative treatment in the other hospital, director sun qinghe, deputy director xie zhongwei, doctor mu shuo and other medical personnel agreed to the feasibility of minimally invasive surgical treatment after discussion, the surgical program: percutaneous foraminal endoscopic l4/5 intervertebral disc extraction + nerve release. In order to achieve better results of surgical treatment, ding yu, chief physician of orthopedics department of Beijing navy general hospital, and lu zhengcao, chief physician of surgery guidance were specially invited. Under the guidance of director ding yu, deputy director xie zhongwei led the surgical team to successfully perform percutaneous foraminal foramen l4/5 intervertebral disc removal and nerve release for the patient. During the operation, the herniated disc tissue could be clearly seen, and the surgical team used a special surgical instrument to remove the herniated disc tissue, which significantly relieved the pain symptoms of the patients during the operation. He was able to get out of bed the second day after surgery and has been discharged.
According to xie zhongwei deputy director introduction, lumbar intervertebral disc herniation is very common, but most patient does not take so seriously however, simply point says: as long as the pain is in oneself can bear inside limits, won't go to a hospital to accept treatment! In fact, this is not a good consciousness, each lumbar disc patients specific situation is not the same, general situation will not cause paraplegia, but serious or will lead to lower limb paralysis, so we have to pay attention to! In guang 'an hospital, every Wednesday afternoon, Saturday morning will invite Beijing navy general hospital orthopaedic big bar for public welfare consultation, friends in need can call 8018999 to make an appointment.
At the same time, the solution of the director said, as a kind of common disease, lumbar disc prolapse its treatment has been extensive research, the traditional approach after open surgical trauma, gradually developed a variety of minimally invasive surgery such as ozone, collagenase injection, percutaneous laser ablation of nucleus pulposus, posterior intervertebral disc under micro endoscopic surgery (med), but these techniques or by indirect decompression, curative effect is not exact, or still need to destroy the rear structure, is now gradually withdrew from the people's horizons. In the treatment of lumbar intervertebral disc herniation, only local infiltration anesthesia can be used to directly decompress the herniation under the view, without the need to bite the lamina, destroy the paravertebral muscles and ligaments, without interference with the spinal canal nerve root, and the amount of trauma bleeding is small. Transforamen technique is applicable to most disc diseases, including lumbar disc herniation, lumbar spinal stenosis, spinal spondylolisthesis, infectious diseases of the spine, and some intradural benign tumors.
Percutaneous foramina is a minimally invasive surgical method for the treatment of lumbar disc herniation, which is suitable for various types of lumbar disc herniation, discogenic low back pain, postoperative recurrence of lumbar disc herniation and even lumbar spinal stenosis.
(1) the operation is performed under local anesthesia without general and partial anesthesia, and postoperative recovery is fast.
(2) the operation was completed under fluoroscopy monitoring, which maximally ensured the safety of the operation;
(3) the operation channel is only thick and thin, and the patient can walk on the ground on the day after the operation, which has the smallest trauma and the fastest recovery in similar operations.
(4) the incision was small (about 0.7 cm) and the spinal structure was basically intact.
Advantages compared with traditional minimally invasive techniques and open surgery:
(1) the paravertebral muscle and soft tissue need not be damaged;
(2) no posterior laminae fenestration or expanded decompression is required, and no damage is caused to the bone structure of the lumbar spine.
(3) only part of the upper articular process was removed and the expanded intervertebral foramen entered the spinal canal;
(4) no need to retract the dural sac or nerve root, only directly remove the herniated disc tissue;
(5) thermosetting and wrinkling molding of annulus fibrosus fractures can maximize the integrity of annulus fibrosus and the height of intervertebral space, thus helping to prevent long-term recurrence;
(6) the whole operation is carried out under local anesthesia, which not only has no worry about nerve root injury, but also can communicate with patients at any time to ensure surgical safety and postoperative efficacy;
(7) small incision and little intraoperative bleeding;
(8) traditional minimally invasive technique can only perform ablation of nucleus pulposus, but can not perform excision of prominent nucleus pulposus, which affects postoperative efficacy.
(9) patients can get out of bed on the day or the next day after surgery, which has little impact on daily life.
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