Full-Endoscopic Isolation Zone Technique for the Treatment of Lumbar Disc Herniation

Summary

Here, we present a protocol for the "isolation zone" technique in the treatment of lumbar disc herniation (LDH) under full-endoscopic spine surgery (FESS), including intervertebral foramen formation, targeted catheterization, nucleus pulposus resection, and annulus fibrosus formation, which together completely block the pain from the nerve conduction pathway.

Abstract

Lumbar disc herniation (LDH) is a type of serious sinus or sciatic nerve dysfunction caused by nucleus pulposus protrusion and annulus fibrosus tears. Its clinical symptoms often include severe low back pain, limited lumbar movement, sciatic nerve pain in the lower limbs, and even cauda equina syndrome. The common treatment for LDH is a conservative treatment scheme involving medicine, rest, and physical therapy. However, if the conservative treatment scheme is ineffective, a surgical treatment approach is adopted. Traditional open lumbar surgery has some disadvantages, including the potential for severe surgical trauma, severe blood loss during the operation, instability of the lumbar spine, and loss of the lumbar motor unit. Among the minimally invasive surgical schemes, full-endoscopic spine surgery (FESS) is undoubtedly the most appropriate and has the advantages of minimal trauma, high safety, quick postoperative recovery, and the retention of the stable structure and the motor unit of the lumbar spine. However, simultaneously, incomplete removal of the nucleus pulposus and residual nerve dysfunction after surgery can occur. To avoid these shortcomings, we studied a specific spinal endoscopy technique, the "isolation zone" surgical strategy, which can effectively block the pain from the nerve conduction pathway by completely relieving the nerve compression and nerve dysfunction through the orderly treatment of the protruding nucleus pulposus, the fissure of the annulus fibrosus, the sinus nerve, and the surrounding inflammatory soft tissues.

Introduction

LDH is a common degenerative disease of the spine. LDH is accompanied by multifactorial changes, such as degeneration of the intervertebral disc and the surrounding structures. The interaction between multifactorial degeneration and the nervous system causes pain¹. The pain of this disease manifests as low back pain and leg pain, and sometimes LDH can be related to an inability to maintain the same posture or sensory-motor disorder of the lower limbs². The severe clinical symptoms of LDH bring great pain to the patients and represent a serious medical and social problem^3,

Protocol

The protocol follows the guidelines of the Ethics Committee of Cangzhou Central Hospital (No.: 20210205). Informed consent was obtained from the patients to include them, and the data were generated as part of this study.

1. Pre-operative preparation

1. Select patients according to the following inclusion and exclusion criteria.
   1. Follow the inclusion criteria mentioned below:
      1. Include patients with lower waist pain caused by long-term sitting, standing, walking, and waist activities, with or without typical sciatic nerve pain.
      2. Include patients with preoperative X-ray, CT, MRI, or....

Results

FESS with the "isolation zone" strategy was adopted in this study to treat LDH, and this method effectively relieved the patients' low back pain and/or sciatic nerve pain. For all the patients who underwent surgery under local anesthesia, the operation did not have to be interrupted because of unbearable pain. The VAS score, ODI index, and the excellent and good rates of the modified MacNab criteria from the previous study are shown in Table 1.

The MRI re-examinati.......

Discussion

LDH is a degenerative disease of the spine that seriously affects daily life and work. The main clinical manifestations are low back pain and sciatic nerve pain. Extreme waist movements, fixed posture, and physical labor can aggravate the symptoms^4,15. If conservative treatment cannot alleviate the clinical symptoms, minimally invasive methods are used to treat patients with LDH. Momenzadeh et al. used percutaneous laser disc decompression (PLDD) to treat 30 pati.......

Materials

Name	Company	Catalog Number	Comments
18 G puncture needle	tong lu	KB401.061
3.7 mm spinal endoscope	joimax	FS6342181C
4-0 nonabsorbent surgical suture	Johnson & Johnson	WB761
7.5 mm working channel	maxmore	1001-ES04
Bone drill	maxmore	1001-BD(001-005)	4 mm, 5 mm, 6 mm, 7 mm, 8 mm diameter
C-arm X-ray machine	GE	OEC one
Catheters	maxmore	1001-DC 001
Expansion guide rod	maxmore	1001-DC 002
Flexible bipolar radiofrequency	tian song	G8002.2
Guide wire	maxmore	1001-GW 003	1mm diameter
Nucleus pulposus forceps	maxmore	1001-EF 001 003	0°and 15°
Tom Shidi locator	maxmore	1001-TS 001