Clinical study on microsurgical treatment of lumbar disc herniation assisted by METRx system

Objective To explore the techniques and curative effect of microsurgical procedures assisted by minimal exposure tubular retractor system (METRx) in the treatment of lumbar disc herniation (LDH). Methods A total of 51 LDH patients, including 24 patients with L4-5 herniation and 27 patients with L5-S1 herniation, underwent discectomy assisted by METRx system. The operation time, intraoperative blood loss, postoperative complications and hospital stay were recorded. Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the degree of low back pain before operation, one week, 3 months after operation, and in the last follow-up. Lumbar MRI was used to evaluate the decompression of spinal canal. Results The success rate of operations in 51 cases was 98.04% (50/51). The average operation time was 125 min, the average intraoperative blood loss was 50 ml, the mean hospital stay was 5 d, all patients were followed up for 6-48 months (average 24 months). Compared with preoperation, both VAS and ODI scores decreased significantly one week after operation (P = 0.036, 0.029), 3 months after operation (P = 0.018, 0.023) and in the last follow-up (P = 0.007, 0.013). The improvement rate of ODI was 35.37% in the last follow-up. No infection, postoperative cerebrospinal fluid (CSF) fistula, neurological defects or incision infection was found. One patient presented acute abdominalgia on the 2nd day after operation, and was diagnosed as annexitis. One patient showed nerve root irritation symptoms after operation caused by thick nerve root during the surgery. They were cured after symptomatic treatment. Conclusions Microsurgical procedures for treating LDH assisted by METRx system can effectively relieve nerve root compression, protect the dural sac and nerve roots, and reduce surgical complications. DOI: 10.3969/j.issn.1672-6731.2016.04.008