Minimally invasive treatment for lumbar disc herniation

For diseases such as lumbar disc herniation, many patients will choose conservative treatment methods, but some patients with more serious conditions will also choose surgical treatment. Among the surgical methods for treating lumbar disc herniation, minimally invasive surgery can be said to be a relatively mature treatment technology. So do you know how minimally invasive surgery is performed on patients with lumbar disc herniation? Here are the main steps.

Main steps

1. Carefully analyze the patient's condition and imaging data again before surgery to ensure the correctness of the surgery;

2. Determine the surgical target and approach: The approach is divided into lateral approach and posterior approach. Yao Yuanlin believes that according to different conditions of patients, the lateral approach should also choose "one arrow to the target method" or "four masters at the same time method";

3. Prone position, routine disinfection, draping and local anesthesia;

4. Under C-arm fluoroscopy, place the guide puncture needle at the target site, gradually insert the working catheter, and establish a working channel;

5. Place the intervertebral foraminal endoscope to observe the tissue structure under the endoscope, avoid nerves and blood vessels, and distinguish the ligaments, annulus fibrosus and nucleus pulposus;

6. Perform intervertebral disc nucleus pulposus staining and/or dural sac angiography when necessary;

7. Observe while flushing, and remove the protruding nucleus pulposus or annulus fibrosus after confirming that everything is correct;

8. Use bipolar electrocoagulation or plasma to clean the working wound. For an ozone-resistant transforaminal endoscopic endoscope, 33-38ug/ml of ozone can be injected through the special inlet on the endoscope for better results. Remove the working catheter, suture the incision, and bandage the wound with sterile gauze.

Precautions

1. When clinical manifestations do not match imaging data, minimally invasive endoscopic lumbar discectomy is not recommended;

2. The most important thing to do at the posterior entrance is to prevent epidural hematoma, stop bleeding adequately, and observe carefully for bleeding.

The suture can be removed;

3. If you encounter nerves, blood vessels, or dural sacs under the microscope, do not forcefully remove the protrusions. Instead, try to gently rotate the working channel to find a suitable working wound surface;

4. Anesthesia should be shallow rather than deep, and certainly not excessive;

5. If the "Four Gentlemen Simultaneous Method" is used for the lateral approach, the needle tip should be placed in the middle of the lateral side of the intervertebral foramen.

The pipe cannot enter the loop;

6. If you use the "one arrow to the target method" for the side route, it is best to insert the needle from a calculated fixed point and then move the needle down 2-3mm.