Accurate nerve orientation before microendoscopic discectomy for lumber disc prolapse

OBJECTIVE To assess the safety and efficiency of using computerized tomography myelography (CTM) and computerized tomography discography (CTD) to accurately orientate the nerve before micro endoscopic discectomy (MED). METHOD Eighty-seven patients with lumber disc prolapse, 54 males and 33 females, aged 35.6 +/- 3.0, underwent MED. Before operation, 85 patients underwent CTM, 11 patients underwent CTD, and 2 were treated with nerve root opacification and blockade. The effects, including the rate of improved JOA score (RIS), numerical analogous pain score (NAPS) of low back, Odom's standard, blood loss during operation, start walking time, etc. were observed. RESULTS The JOA score was 18.2 +/- 3.3 before operation, and increased to 23.8 +/- 4.6 during the follow-up, with a JOA improvement rate of 58.7% +/- 4.2%. According to the Odom's standard, the outcome was excellent in 59 cases, good in 26 cases, OK in 3 cases, and poor in 1 case, with an excellence rate of 95.5%. The value of NAPS was 1.8 +/- 0.4 before operation, not significantly different from that during follow-up (1.7 +/- 0.3, P = 0.607). The average start walking time after operation was (2.38 +/- 0.21) days, the average recovery time was (12.1 +/- 2.2) days, the incision size was (1.86 +/- 0.04) cm, the surgical time was (72.2 +/- 12.4) min, and the average blood loss during operation was (47.5 +/- 4.6) ml. CONCLUSION Using CTM and CTD to accurately orientate the diseased disc and nerve root before MED decreases the possibility of nerve damage, operation time and blood loss during operation, and improves the outcomes, so it is recommendable.