Lumbar disc herniation is a common and frequent disease in orthopedics, three foreign scholars found 17, 8% of 467 autopsies with disc herniation, and 1/3 of autopsies over 40 years of age were found to have disc herniation, usually in manual laborers. Traditional open surgery is highly injurious, leaving nerve root adhesions, dural fibrosis, and lumbar instability in some cases, resulting in failure to relieve symptoms of low back pain, with at least 5-7% failure rate, and there is often no alternative method once it fails.
Percutaneous intervertebral disc collagenase lysis
Principle: Collagenase is a highly specific biocatalyst that dissolves collagen, thereby dissolving the intervertebral disc and relieving the nerve root compression by the protrusion.
History of treatment: It started abroad in the 1960s (1964) and was applied in China in the 1970s.
Efficacy: the excellent rate is about 85%
Indications.
1, clinical symptoms and signs
2, CT or MR confirmed diagnosis of restrictive disc herniation
3.Conservative treatment for 6 weeks is ineffective
4, best for patients under 50 years old
5, the corresponding indications
6.Recurrence after intervertebral disc surgery
7.Disc herniation with partial calcification
8, the treatment of symptom reduction can be made a second time as appropriate
Contraindications.
1, clinical diagnosis is not clear
2, combined with bony spinal stenosis or hypertrophy of the ligamentum flavum
3, combined with severe cauda equina symptoms
4.Severe degeneration, calcification or ossification of the protruding intervertebral disc
5, vertebral body more than II degree slippage
6, accompanied by spinal cord cavity, injury, tumor, etc.
7.Tendency to bleed
8, allergic constitution
9, pregnant women and children under 14 years old, etc.
10, suffering from serious chronic organic pathology
11.Psychiatric or intraoperative inability to cooperate
Complications
1, pain reaction: the degree of severity varies, generally 2-3 days to about a week, individual up to about 3 weeks, if the symptomatic treatment can not be relieved, the need for intervertebral disc opening decompression surgery.
2, chemical encephalomyelitis: collagenase into the subarachnoid cavity by mistake, in clinical practice from time to time, serious encephalomyelitis can lead to paralysis or even death.
3, allergic reactions: collagenase is a biological agent, what we have seen so far are some minor reactions such as hypothermia, skin flushing, etc. No special treatment is needed, no fatal allergic reactions have been reported so far.
4, vascular damage: damage to small blood vessels, not seen damage to large blood vessels reported.
5, nerve injury: injury to nerve roots
6.Intervertebral disc infection
7, punctured intestinal canal
Treatment methods.
Materials.
1.Puncture needle
2.Conventional sterilization items
3.Collagenase
Basic hardware requirements.
1.X-ray machine with TV
2.”C”-arm X-ray machine
3.CT
4.Purification and disinfection of the machine room
5, the basic items required for resuscitation
6.Doctors and nurses with clinical knowledge
Percutaneous intervertebral disc laser vaporization decompression
Principle: Using the surface effect of the strong laser in the biological effect of the laser on the human body, it causes rapid local warming and complete vaporization of the tissue – the disc vaporization reduces the pressure in the disc.
Treatment history: foreign countries began in the late 70s, domestic applications in the 90s.
Efficacy: the excellent rate is around 80-85%
Indications: roughly the same as other methods
Contraindications: disc prolapse or free, history of surgery or chemical lysis of the nucleus pulposus at the marker level, the rest is the same as other methods
Complications.
1, spinal cord compression – poor nucleus pulposus gas drainage
2, spinal nerve burn or puncture injury
3, bleeding (especially in the neck)
4, disc infection
5, pain
6, penetration of the intestinal canal
Treatment.
Materials.
1.Laser machine
2.Light-guiding fiber
3.Puncture needle with lateral hole
4, routine sterilization items
Basic hardware requirements: same as other methods
Percutaneous rotational discectomy (PLD)
Principle: Using a special suction system, the diseased disc is cut out and suctioned to achieve decompression.
Treatment history: foreign countries started in the mid-1970s, and most domestic countries started in the 1990s.
Efficacy: excellent rate of about 80-90%
Indications: roughly the same as other methods
Contraindications: same as laser vaporization method
Complications: Generally the same as other methods, but special attention should be paid to the large blood vessels damaged by the forward movement of the puncture needle when changing the patient’s position to prone.
Treatment method: (omitted)
Materials.
1.Electrical lumbar disc rotary cutting system
2.Conventional sterilized items
3.Puncture needle
Basic hardware requirements: same as other methods
Percutaneous intervertebral disc medical ozone injection therapy
Principle: Ozone has a strong oxidizing function, especially it can oxidize proteoglycans in the nucleus pulposus and destroy the nucleus pulposus cells, causing the nucleus pulposus to atrophy and thus decompress, and at the same time, ozone has a good anti-inflammatory and analgesic effect.
History of treatment: It started in the late 80s abroad and has been applied in China in recent years.
Efficacy: The excellent rate is around 80%
Indications.
1.Applicable to post-surgical open surgery syndrome (FBSS)
2, the rest of the same as other methods
Contraindications: roughly the same as other methods
Complications: 1.
1.No significant complications have been reported at home and abroad
2. Pain: disappears within minutes or even hours
3.Allergic reaction to ozone in the respiratory tract: such as chest tightness, dyspnea, corneal irritation
4. Possible complications during puncture similar to other methods
Summary and recommendations.
1, each of the four methods of treatment of disc herniation has its own advantages and disadvantages, each with its own characteristics
2, the four methods in the principle of the method, indications, contraindications, complications are more or less the same
3, the choice of methods.
Clinical data: age, symptoms, signs
1. The exact diagnosis of CT or MR
2, according to the above information comprehensive analysis, considering the surgical effect, degree of injury, cost, ease of operation, the number of complications, the patient’s psychological state and other decisions
3.In the case that the difference of surgical effect is not expected to be significant, we should choose a simple, low-cost, less complications, less damage, and choose a procedure that is acceptable to the patient when the patient is informed.
4, the author’s preference: from the comprehensive consideration of the safety of both doctors and patients, and the expected surgical effect is similar, ozone treatment of lumbar disc herniation should be preferred at present.
The reasons are as follows.
1, ozone not only effectively reduces the pressure within the disc, making the herniation shrink, but also has anti-inflammatory and pain-reducing effects, which is an incomparable advantage of other surgical procedures
2, ozone has strong ability to destroy the nucleus pulposus tissue, but has no significant adverse effects on the paravertebral tissue, and ozone is extremely unstable and can be decomposed into stable oxygen, so it will not cause secondary pollution and lasting tissue and organ damage
3, the operation is simple, no obvious damage, patient pain is light, can be outpatient treatment
4.Ozone has sterilization effect, which can greatly reduce postoperative disc infection
5.Ozone equipment is simple, the technology is easy to master and promote
6.The efficiency of ozone treatment for patients with open postoperative surgical syndrome (FBSS) is 88,8%.
7. The combined use of the two surgical procedures can complement each other’s advantages, and is currently used in China, but it is worthwhile to conduct further clinical research.