The intervertebral disc has an important role in the spinal biomechanics. The influence of lumbar discectomy on the disc space height is still uncleared. This study was performed to evaluate the long term influence of lumbar discectomy on intervertebral disc space height.
The author analysed the disc space height in 25 patients who had performed open discectomy for the disc herniation at least two years age. The height was compared with that of unoperated disc and evaluated the role of discectomy in the change of disc space height.
The decrease of disc space height was 3.3mm in average. The loss of anterior height was 4.1mm and that of posterior height was 2.5mm. This discrepancy was statistically significant(p<0.05). Although the difference of disc height loss in each disc space was not significant. the loss in L4-5 disc space was greater than that of other disc space.
These data suggest that lumbar discectomy accelerate the loss of disc height and influence the process of vertebral degeneration by change of spinal biomechanics in long term period.
The patient of herniated intervatebral disc of lumbar spine was treated as conservatively and did respond well in majority. But in patient who had not responded to conservative therapy, opeative method was performed such as open discectomy, chemonucleolysis, or automated percutaneous lumbar discectomy.
Open discectomy is useful for most patients but still carries the risk of general anesthesia and risk to sofi tissues. joints. nerves, and the invariable production of epidural fibrosis. Chemonucleolysis was introduced by Smith in 1964 as an alternative method but, it carries many complications such as anaphylaxis, subarachnoid hemorrhage, transverse myelitis, and severe back pain. Because of reducing this complications automated percutaneous lumbar discectomy has been advocated as an alternative treatment of herniated intervertebral disc in selected patients.
Twenty patients with symptomatic lumbar disc herniation were treated with automated percutaneous lumbar discectomy from August 1989 to October 1991 in Ewha Women University Hospital. They were followed up for more than 12 months. Changes in the objective and subjective signs and aymptoms of patients were examined preoperatively and postoperatively.
The results were as follows :
1) Age was ranged from 14 to 54 years with average 30 years, and 12 males and 8 females.
2) LA-5 was the most commonly involved level(80%).
3) In MRI classification subannular herniation was 11 cases and subligamentous herniationwas 4 cases.
4) Average duration of procedure was 31 minutes. and average amount of tissue aspirated was 3.9cc and average hospitalization period was 5 days.
5) Clinical results were satisfactory in 85% and unsatifactory in 15% of patients.
6) Unsatisfactory results were combined stenosis, insufficient removal of disc material, or recurred herniation of interverebral disc.
7) There was no significant complications postoperatively.
From this results, automated percutaneous lumbar discectomy is a good treatment method for selected cases of lumbar dsic herniation.
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