Clinical study on the treatment of discogenic low back pain by endoscopic "isolation zone" technique through pedicle-flavum tunnel

Abstract Objective: To explore the surgical strategy and clinical effects of the "isolation zone" technique through pedicle-flavum tunnel for the treatment of discogenic low back pain under percutaneous spinal endoscopy.Methods: From September 2017 to September 2020, the author treated patients with intervertebral discogenic low back pain with lateral approach percutaneous spinal endoscopic surgery under local anesthesia. The working channel is inserted through the anatomical pedicle-flavum tunnel and performed neuralization and corresponding segmental nerve roots are decompressed throughout the process, forming an "isolation zone" around the nerve root without contact with the nucleus pulposus and annulus fibrosus. The visual analogue scale (Visual Analogue Scale, VAS) and Oswestry Disability Index (ODI) of low back pain and pain around the buttocks were recorded before and 1, 3, 6, and 12 months after the operation, and the modified MacNab criteria were evaluated. curative effect. A total of 45 patients completed surgery and received complete postoperative follow-up.Results: The 45 patients in this group all completed the operation successfully. There was no patient who could not tolerate the pain of local anesthesia and was forced to interrupt. The operation time was 65 to 125 minutes, with an average of 94.71±17.67 minutes. The average follow-up time for all patients was 12-18 months. , An average of 13.6±1.9months, the VAS scores for lower back pain and pain around the hips were 6.95±1.02 before surgery, 2.64±0.71 at 1 month after surgery, 1.80±0.54 at 3 months after surgery, and at 6 months after surgery 1.42±0.50, 12 months after surgery, 1.27±0.45; Oswsetry dysfunction index was 72.84±5.95 before surgery, 35.11±5.30 at 1 month after surgery, 25.22±4.85 at 3 months after surgery, and 6 months after surgery It was 16.78±4.63, and it was 10.91±2.36 after 12 months. The VAS score and ODI index of low back pain, lower limb pain at different time points after operation were significantly improved compared with that before operation (P<0.01). The effect of modified MacNab was excellent in 24 cases, good in 13 cases, and fair in 8 cases. The excellent and good rate was 82.22%. Among them, 1 patient developed femoral nerve palsy after endoscopic surgery, and was given a conservative treatment plan for neurotrophic therapy, acupuncture and moxibustion, and functional exercise. The symptoms disappeared 4 weeks after the operation. One patient developed neck and back pain during the operation and was considered as a class. The hypertension of the spinal cord was treated with removal of water pressure and oxygen inhalation, and the symptoms disappeared after 30 minutes. There were no serious surgical complications such as permanent nerve damage and intervertebral space infection in all cases. Conclusion: Percutaneous spinal endoscopic "isolation zone" technology through pedicle-flavum tunnel is a minimally invasive spinal surgery technique for the treatment of discogenic low back pain with safe operation and satisfactory clinical results.