Author: Beijing North Orthopedic Hospital
lumbar disc herniation is one of the more common diseases, mainly because of the various parts of lumbar intervertebral disc ( nucleus, annulus and cartilage plate), especially in the nucleus, there are different degrees After the degenerative changes, the fibrous annulus of the intervertebral disc ruptures under the action of external forces, and the nucleus pulposus tissue protrudes (or protrudes) from the rupture to the rear or in the spinal canal, causing the adjacent spinal nerve roots to be stimulated or compressed, resulting in A series of clinical symptoms such as waist pain, numbness and pain in one leg or both legs. Lumbar disc herniation has the highest incidence of lumbar 4/5 and lumbar 5/sacral 1, accounting for about 95%. The age is 20-50 years old, and there is a trend of getting younger. Today, our hospital treated a 22-year-old patient with a huge lumbar disc herniation. Case sharing of
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patient Yang, female, 22 years old, was admitted to the hospital for 1 week due to waist and left lower limb pain. The patient usually carries small goods, and complained that there was no obvious inducement for the waist and left lower extremity pain, limited mobility, persistent dull pain, and the pain reflected to the left hip, left thigh, and left calf. Rest slightly improved, symptoms worsen after fatigue and cold, which seriously affects life and work. The patients and their family members came to our hospital for further diagnosis and treatment. The outpatient department gave the lumbar spine and MRI examination of the lumbar spine. The diagnosis was "lumbar disc herniation with radiculopathy" and was admitted to the hospital.
(Patient MRI)
Chief Physician Yang Tao of the Spine Department received the patient and found that the patient’s lumbar spine mobility was reduced and the spine extension could induce back pain and soreness and discomfort of the left lower extremity, near the L4-5 spinous process Slight tenderness, decreased pain in the outer skin of the left leg, 30 degrees on the left side of the straight leg elevation test, weakened tendon reflex and left knee tendon reflex.
Chief Physician Yang Tao analyzed the condition: combined with Yang's medical history, physical examination and imaging findings, Yang's diagnosis of lumbar disc herniation with radiculopathy was clear. There are indications for surgery: 1. The patient’s waist is accompanied by persistent pain in the left lower extremity, which affects life and work. 2. Physical examination: tenderness around the 4/5 spinous process of the waist, level 3 extensor strength of the left back and back, pain in the outer skin of the left calf Decrease, straight leg elevation test: 30 degrees on the left and 70 degrees on the right, strengthening test (+). 3. MRI of the lumbar spine showed that the lumbar 4/5 disc herniation compressed the nerves, and the electromyogram reported that the 5 nerve roots on the left side were damaged. 4. There are no obvious contraindications in the preoperative examination, and preparations for partial removal of lumbar 4/5 intervertebral discs, nerve decompression, and radiofrequency ablation under epidural analgesia under foraminal endoscope .
Director Yang Tao pointed out: intervertebral foraminoscopic surgery is suitable for all types of lumbar disc herniation, including central lumbar disc herniation, lumbar disc herniation on one side, lumbar disc nucleus prolapse downward and upward. It has the advantages of less trauma, quick recovery after operation, and low cost. The operation was carried out as scheduled. The operation lasted 2 hours. After the operation, the patient's waist and left lower limb pain were significantly relieved, and the left back extension strength was significantly increased. 3 days after the operation, the patient wore a waist circumference and got out of bed without obvious discomfort. One month after the patient was discharged from the hospital, the patient was followed up and learned that the patient’s waist and left lower extremity pain symptoms were significantly relieved, the left back extension strength was significantly increased than before, the patient’s sleep quality was good, the mental state was good, daily life has basically returned to normal, and the quality of life is obvious Increase. The
patient was followed up for 3 months after the operation. The patient’s waist and left lower limb pain disappeared, the left back extension strength was basically normal, the sleep quality was good, the mental state was good, and his daily life returned to normal.
Foraminoscope
is a safe, effective and patient-tolerable minimally invasive surgery. Its indications are as follows:
Indications :
01, extreme lateral lumbar disc herniation
02, simple lumbar disc Protrusion, without obvious calcification and spinal stenosis
03, sudden recurrence of lumbar disc herniation after open surgery.
04, Lumbar spinal stenosis with radicular symptoms,
05, lumbar disc herniation who cannot withstand open surgery due to other diseases
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