Needle-knife technique with 68 patients with lumbar disc herniation

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Referred to as lumbar disc herniation herniation is common disease. I clinic from July 2008 ~ June 2009, using a small knife Zhu gap in the lumbar spine lesions, the lateral recess, intertransverse ligament at the release, and with manual therapy to relieve nerve compression, improve microcirculation and eliminate aseptic inflammation of the nerve stimulation. The clinical observation of 68 cases, results were satisfactory, are as follows.
Materials and Methods
1. General Information of this group 36 males and 32 females, aged 23 to 76 years; which L4 ~ L530 cases, L5 ~ S124 patients, L3 ~ L42 cases, L4 ~ L5 and L5 ~ S18 cases, L3 ~ L4 and L4 ~ L52 cases. side of a square of 50 cases, 18 cases of central type; course of 30 days to 21 years.
2. Diagnosis and exclusion criteria used <<cure disease diagnosis based on improved standards>> [1] based on the diagnosis of lumbar disc herniation: ?? often history of trauma or back pain;
 low back pain to one side or both sides of radiation to the leg or lower limb lateral dorsal, activity increase, reduce bed; straight leg raising test was positive, weak thumb dorsiflexion;
 imaging: CT or MRI examination revealed the site of lumbar disc herniation (segments) and the degree of image in all cases data of consistent diagnostic criteria for lumbar herniation. and exclude the following cases:
spondylolisthesis, fractures, tuberculosis, tumors were;
non-those great prominence;
prominent nucleus were no severe calcification and ossification;
those without cauda equina injury ;
not associated with severe spinal canal stenosis.
3. Treatment
(1) needle knife surgery: Patients were prone position, the abdomen below the belly button pad for a small pillow height of about 20 cm. Skin routine disinfection, the skin entry point to 1% lidocaine for local anesthesia, four-step by knife Practice into the knife. In the ipsilateral side of the square for treatment, the treatments on both sides of the central type.
release interspinous ligament: Knife in the lesions of the middle segment of interspinous through the skin, ligaments ridge between direct spinal ligament , exploration, and a spinous process on the edge of the bone surface, close to the bone surface between the ridges 3 to 4 blade ligament release.
release the lateral recess: Knife in the lesion segment near the midline between the spinous process to open 0.5 1 cm at, through the skin, subcutaneous, erector spinae direct lamina, close to the bone for the medial lamina deep knife blade cut 3 to 4.
release intertransverse ligament: in the lesions on a segment midline spinous process tip is to open at 2.5 ~ 3.5 cm, the needle-knife puncture of transverse bone surface, bone surface in the transverse incision of the lower edge of peel intertransverse ligament.
knife surgery, pinhole 1 acupressure 3 minutes, when the pins without bleeding to Band-Aid covering pins.
(2) manual therapy: needle knife of surgery, according to the following methods to do manual therapy to patients.
led by the shaking means: take the patient prone position, two hands, head of the bed. Surgery patient who grabbed the two legs, forced the patient back led by the shaking, repeatedly shaking led by 3 to 5 times.
 lift by means: the patient prone, ipsilateral knee flexion 90 angle (central side bending). intraoperative overlapping of hands, right hand on the patient lumbar hypothenar interstitial lesions on the lower spinous process, a helper stand on the bed, grasp the patient ipsilateral leg (two legs grasping central), patients affected side (central to both sides) from the anterior superior iliac spine to mention 1 bed 3 cm, the surgeon suddenly Press firmly with both hands, anterior superior iliac spine when the patient reaches the bed, the assistant to the patient on the bed legs. After the repeat 15 to 20 times above the action.
oblique wrench method: Patient side, the affected side in the last, for the surgeon, contralateral limb extension, hip flexion knee lower limb. surgery for patients who single-handedly push the shoulders back elbow, and the other elbow, pull the Ministry of hip forward, both hands At the same time a sudden force, only once.
4. Evaluation standard recovery: low back pain disappeared, straight leg raising 80 ?? above the waist back to normal activities, to participate in the work. Markedly: significantly reduced low back pain, straight leg raising and lumbar function improved working and living without effects. Effective: low back pain reduced, straight leg raising, lumbar functional activities improved. invalid: no change or worsening symptoms and signs.
5. Treatment Results After six months follow-up, cured 57 patients (83.8%) were cured, 8 cases (11.8%), improved in 2 cases (2.9%), 1 patient (1.5%), the total effective rate was 98.5%.
Discussion
Principles of treatment of lumbar herniation is not the highlight of the disc tissue degeneration and recovery in situ, but to change the disc tissue and the relative position of the nerve root compression, to reduce or lift the nerve root, nerve root adhesions loosen and eliminate the nerve root inflammation, and thus relieve the symptoms [2]. Xieke Gong et al [3] treatment of lumbar intervertebral disc extrusion with spinal stenosis, surgery is only part of the yellow ligament and the vertebral bone, does not deal with herniated disc nucleus, as can low back pain or disappearance of symptoms, also confirmed that this treatment of lumbar herniation principle.
Scalpel lysis closed the gap by cutting off part of lumbar spine disease, the lateral recess at the yellow ligament, intertransverse ligament, nerve root transfer for the creation of loose traction conditions, the lifting of the nerve root compression, remove the cause disease factors, re-balance of biological forces, and the surgical removal of herniated disc nucleus [4] compared to a similar effect, but the knife closed release the cost of much lower risk than surgical removal. knife surgery , with slight shaking, carried by, oblique wrench method, so that the residual lesion can be further loosen adhesions, lift the nerve root compression. after the lesion proper rest help organizations speed up the absorption of aseptic inflammation, elimination of the chemical nature of nerve root irritation. The method for lumbar herniation, with good efficacy, low cost, adaptability and superiority, is the ideal treatment of lumbar herniation therapies.

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