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.
, Jun-Hyeok Song, Myung-Hyun Kim, Hyang-Kwon Park, Sung-Hak Kim, Kyu-Man Shin, Dong-Been Park Lumbar disc herniations at the L1-L2, L2-L3, and L3-L4 level are rare. The purpose of this study is to observe the variable clinical finding of upper lumbar disc herniations and to provide proper treatment modality.
Between 1998 Jan. and 1999 Dec., seventeen patients with upper lumbar disc herniations who were undergone surgery in our institute were retrospectively evaluated. Patients were evaluated based on following factors : age, sex, aggravating factor, symptoms and signs type of disc herniation, type of surgery, and outcome of post-surgery.
The incidence of lumbar disc herniation at the level of L1-2, L2-3 and L3-4 is 6.1% with declining frequency as the level ascends. The peak age incidence is 6th decade in both sex. Preoperative symptomes and signs are variabe. In sixteen cases, posterior approach was done. In these cases, twelve cases were performed microscopic partial hemilaminectomy, and four cases with spinal stenosis were performed total laminectomy and posterior screw fixation with bone fusion. In one case, lateral extracavitary approach was done. In results of operation, fourteen cases showed more than good grade(82%).
The age incidence of lumbar disc herniations at the level of L1-2, L2-3 and L3-4 older than lumbar disc herniations at the lower level of L4-5 and L5-S1. The signs and symptoms are variable. In our cases, most of the patients were performed posterior approach with microscopic partial hemilaminectomy except the patients combined spinal stenosis. One case was performed a lateral extracavitary approach because the risk of the cord and cauda equina injuries. The prognosis of upper lumbar disc herniations after treatment with only microscopic partial hemilaminectomy and diskectomy is comparable with the prognosis of lumbar disc herniations at the lower level.
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