Posterior discectomy discectomy

In recent years, with the development of endoscopic techniques, the application of small incision and microsurgical lumbar discectomy has been largely replaced by posterior lumbar discectomy. For some cases of extreme lateral disc herniation, endoscopic or lateral approach can be used for endoscopic lumbar discectomy. Treatment of diseases: lumbar disc herniation Indication Posterior discectomy for discectomy is applicable to: 1. It is most suitable for the lumbar disc herniation which protrudes from the nucleus pulpus to the posterior aspect of the intervertebral space. 2. Disc herniation combined with spinal stenosis with thickening of the ligamentum flavum. Contraindications 1. Lumbar disc herniation of the lateral disc. 2. Disc herniation with lateral recess stenosis and intervertebral foramen stenosis. 3. Disc herniation combined with degeneration or isthmus, leading to lumbar instability caused by simultaneous treatment. 4. Exploratory surgery with unclear diagnosis of disc herniation. With the development of minimally invasive devices and minimally invasive techniques, the scope of indications for MED has been expanded. 1, 2, and 3 of the above contraindications have become relatively contraindicated in a few skilled physicians. Preoperative preparation 1. MRI examination to determine the prominent site, with or without nucleus pulposus to the pedicle and below. 2. Preparation of surgical instruments and corresponding matching disc mirror systems. Surgical procedure Positive perspective Orthotopic perspective determines the horizontal projection of the disc and marks it. 2. Incision Conventional disinfection, laying a single, take the 1cm of the median line on the protruding side of the nucleus pulposus to make the incision about 2.5cm long. Cut the skin, subcutaneous and back fascia. If local anesthesia is used, anesthesia can be performed with 1% lidocaine. 3. Reveal the lamina gap The bone knife was inserted into the interlamellar space along the direction of the iliac spine muscle fibers, and the interlaminar holes and the soft tissues on the upper and lower lamina were peeled outward. Insert the working channel sleeve with the blunt stripper inner core into the interlaminar hole, place the working sleeve, remove the inner core blunt stripper, connect and adjust the light source system, and then use the nucleus pulposus to view the field of view. The soft tissue inside is cleaned up, revealing the ligamentum flavum and the upper and lower vertebral margins between the lamina. At this point, the nerve stripper can be inserted into the lamina and then fluoroscopy to confirm the surgical gap. 4. Reveal the intervertebral disc The vertebral plate rongeur was used to remove the lower edge of the lamina of the upper vertebra to the ligament of the ligamentum flavum, so that one end of the ligamentum flavum was free, and the ligamentum flavum was separated from the dura mater and removed. At this point, the dura mater can be seen, and the dura mater can be revealed by pulling the dura mater and the nerve root in the midline direction with the nerve root pull hook. At this time, if necessary, the lateral ligamentum ligament can be removed by the laminar rongeur. 5. Remove the prominent nucleus pulposus The posterior longitudinal ligament or annulus of the protruding portion was cut with a circular saw at the protruding portion of the intervertebral disc or a sharp knife, and the protruding intervertebral disc tissue was removed with a nucleus pulposus. 6. Suture incision Rinse the incision with isotonic saline (depending on the intraoperative bleeding to determine whether to place the drainage strip). Remove the working channel casing. Suture the back fascia, subcutaneous and skin. complication 1. Nerve root injury and cerebrospinal fluid leakage In the disc microscopy, the nerve root is not recognized and accidentally injured, and there is little dural tear which causes cerebrospinal fluid leakage. 2. Local bleeding Due to the large veins or protrusions of the nerve roots, the epidural venous plexus becomes thick and easily damaged, resulting in local bleeding. More can absorb it by yourself.