Although there are many kinds of minimally invasive procedures for lumbar disc herniation, they can be broadly divided into two categories – interventional disc surgery treatment and endoscopic lumbar discectomy.
Interventional disc surgical treatments include: collagenase lysis, percutaneous excision and suction, laser vaporization (PLDD), plasma nucleoplasty, ozone, radiofrequency ablation, etc.
Endoscopic lumbar discectomy includes: trans-posterior microendoscopic lumbar discectomy, and percutaneous laminectomy with foraminotomy.
I. Comparison of laminar foraminoscopic techniques and interventional disc therapy.
Interventional disc treatment is indirect decompression, only for some cases of inclusive herniation, cannot completely remove the diseased nucleus pulposus especially the tissue compressing the nerve, cannot repair the broken fibrous ring, and the necrotic tissue needs to be absorbed naturally by the body, which is long, painful and has a high recurrence rate.
Intervertebral foraminoscopy technology has the following characteristics compared with it.
1, the same small trauma, without destroying the paravertebral muscles, ligaments, without biting off the vertebral plate, does not affect the stability of the spine.
2.Overcome the shortcomings of the former in treatment effect, and the efficacy is consistent with microscopic discectomy.
3, endoscopic direct vision operation, can clearly observe the spinal canal and nerves, but will not cause interference, high safety.
Second, the comparison of intervertebral foraminoscopic technique and discoscopic surgery.
The indications for discoscopic surgery (MED) are the same as those for minimally invasive discectomy under the microscope. The surgical approach and treatment process of discoscopic surgery are consistent with small incision open surgery, and both involve implementation of laminar opening, stripping of muscles and ligaments, interference with the spinal canal, and distraction of nerves (to a lesser extent than open surgery).
The intervertebral foraminoscopy technique has the following characteristics in comparison.
1.No need to destroy the paravertebral muscles and ligaments, no need to bite off the vertebral plate, and no influence on the stability of the spine.
2.It is suitable for the treatment of extreme posterolateral type lumbar disc herniation and discogenic pain.
3.Less postoperative scar tissue and less likely to form nerve root adhesions.
Thus, it seems that intervertebral foraminoscopic technique has the advantages of the other two types of surgery and discards their disadvantages.
Third, since there are so many advantages, can foraminoscopic surgery replace other minimally invasive surgeries?
The answer is no. Because.
1. Intervertebral foraminoscopic surgery is not a panacea, there are indications and contraindications. In other words, although the indications are very broad, foraminoscopic surgery cannot be used for all patients.
2. Intervertebral discoscopic surgery is not eliminated. For example, for patients with central canal stenosis combined with lateral saphenous fossa stenosis, discoscopic surgery is very effective, while foraminoscopic surgery is out of reach.
3, the surgical treatment of lumbar degenerative disc disease should follow the principle of “stepwise treatment”. For patients with mild degeneration, interventional treatment methods are still valuable.