Microscopic Lumbar Discectomy

Micro-lumbar discectomy for the surgical treatment of disc herniation in children. The intervertebral disc at any part of the spine may cause nucleus pulposus or annulus fibrosus or both to protrude into the spinal canal or intervertebral foramen due to trauma or degeneration. About 90% of those occur in lumbar discs. The cause of this is not fully understood. It is considered to be related to the following factors: 1 insufficient nutrition of the intervertebral disc; 2 degenerative changes; 3 various traumas. Although clinically more common in 30 to 50 years old manual workers or usually lack of exercisers, children can also develop disease. The vertebral cartilage plate of the vertebral body has not yet fully fused with the vertebral body. The annulus of the intervertebral disc is elastic and not easy to tear, but the intervertebral joint is slack and the activity is larger than that of the adult. The structure of the psoas and ligaments is relatively weak. When a sudden rotational stress acts on the lower back, the cartilage plate at the posterior edge of the vertebral body can be torn. Therefore, patients with disc herniation in children have a history of acute waist injury. The clinical manifestations were mainly acute low back pain with sciatica, positive straight leg raising test and strengthening test, abnormal knee or Achilles tendon reflex. X-ray anteroposterior can show lumbar scoliosis, lateral anterior lumbar lordosis disappears, the intervertebral space of the lesion can be narrow, and the vertebral body can have a narrow front and back width. Myelography, CT or MRI is helpful in establishing diagnosis and localization. Non-surgical treatment is first considered in the treatment, because in the early stage of the injury, there is traumatic inflammatory edema and hyperemia in the herniated disc and the compressed nerve root. Therefore, the purpose of treatment is to relieve or control the local inflammatory process, which can be closed with local tender points, gentle massage, physiotherapy, pelvic traction and absolute bed rest. Surgical treatment is considered only if the non-surgical treatment is ineffective. Curing disease: Indication Micro-lumbar discectomy is suitable for micro-lumbar discectomy compared with conventional surgery, the illumination, magnification and viewing angle are improved during the operation, while the intraoperative exposure is greatly reduced, the tissue separation is less, and the postoperative pain is light. Short hospital stay, micro-lumbar discectomy may replace the standard laminectomy as the first choice for the treatment of lumbar disc herniation. For specific indications, see the removal of lumbar disc herniation from the lamina. Contraindications See the aforementioned removal of the lumbar disc herniation of the lamina. Preoperative preparation A surgical microscope with a 400mm lens, a special hook, a 1mm 45° angle vertebral plate rongeur, a micronucleus pliers and a nerve root pull with attractive function. See the aforementioned removal of lumbar disc herniation for laminectomy. Surgical procedure Incision An incision is made between the superior and inferior spinous processes in the intervertebral space of the lesion, usually 2.5 cm long. 2. Reveal Cut the subcutaneous tissue, carefully electrocoagulate and stop bleeding, cut the fascia along the midline with an electric knife, insert the periosteal stripper, gently peel the muscles and fascia outwards under the periosteum along the spinous processes and lamina, and re-coagulate and stop bleeding. Use your finger to touch the intervertebral space, place a small lumbar hook, adjust the microscope, confirm the ligamentum flavum and lamina, and carefully remove the superficial yellow ligament with a 15th blade under the microscope magnification of 25 times, then separate it with Penfield No. 4 The device is worn to break through the ligamentum flavum, and the movement is gentle to prevent the dura mater from being worn. Then, the ligamentum ligament is bitten in the direction of the surgeon with a 45° angled 1mm vertebral rongeur, and the lamina, facet joint and its joint capsule are completely preserved. The epidural was probed with a 90° blunt hook and the nerve root was determined by means of a nerve hook. The nerve root hook is inserted under the nerve root, and the suction hole is turned to the inner side, and the nerve root of the suction tube is grasped with the thumb and the finger to pull the tail of the hook. 3. Remove the intervertebral disc After retracting the nerve root, a white, fibrous, avascular disc is seen. A small annulus tear was seen under the microscope, the fiber ring rupture was enlarged with a No. 4 Penfield separator, and the nucleus pulposus was removed with a miniature nucleus pulposus. Check for nucleus pulposus fragments near the nerve roots and the dura mater. The fascia and skin are sutured as usual. complication 1. Injury nerve roots It was not performed according to the conventional operation method. When the nerve root was not retracted, it was eager to remove the intervertebral disc or the visual field was unclear and forced operation. 2. Damage to the dura mater The ligamentum flavum has many adhesions to the dura mater. When the operation is not careful, it is easy to be damaged and the cerebrospinal fluid leaks. In this case, the side of the operating bed should be shaken and repaired immediately. 3. Intra-abdominal vascular injury This is a very dangerous surgical complication. The main reason is that when the nucleus pulposus is bitten, the surgeon mistakes the nucleus pulposus to the front too much, and the anterior longitudinal ligament penetrates into the peritoneum, damaging the mesenteric vessels and the common arteriovenous fistula. If the patient's blood pressure suddenly drops during surgery, the possibility of this complication should be considered. The abdominal puncture should be performed. If the blood is withdrawn, the laparotomy should be performed immediately to repair the damaged blood vessel. 4. Epidural hematoma Due to incomplete bleeding during surgery. It usually appears within 3 days after surgery, and the expression of perianal sensation is lost or the area of the original pain disorder is enlarged. In severe cases, there are large and urinary incontinence. In this case, surgical exploration should be performed in time to remove the hematoma. 5. Intervertebral space infection The patient showed an increase in body temperature after 3 to 5 days after surgery, and increased white blood cells. The patient developed burning pain in the lower back and lower extremities. In severe cases, even severe vibrations can induce severe pain, even if painkillers such as pethidine are difficult to achieve. Analgesic effect. At this time, a sufficient amount of effective antibiotics should be used until the body temperature and blood image return to normal. At the same time, the lower limb traction restriction activity is applied, and the back muscle training is suspended. It usually takes 3 months to move to the ground.