关键词: 椎间盘移位, 腰痛, 皮肤开窗术, 治疗结果

Abstract: Objective To investigate the impact of the signal changes of lumbar endplate and vertebral body,namely Modic change,to the curative effect of fenestration with excision of nucleus pulposus to lumbar intervertebral disc protrusion. Methods We collected 78 patients of lumbar intervertebral disc protrusion who were treated by fenestration with excision of nucleus in our hospital,the patients were divided into two groups according to Modic changes or not on MRI of lumbar spinal,47 cases in group A,MRI showed no Modic changes,and 31 cases in group B,including 11 cases of Modic type Ⅰ changes on the endplate and vertebral body showed by MRI,17 cases of Modic type Ⅱchanges, and 3 patients of Modic type Ⅲ changes,patients' visual analogue scale( VAS)and Oswestry disability index(ODI)before operation and one year after operation were analyzed statistically. Results The preoperative VAS score and ODI score of patients in group A and B had no significant difference,and these scores were improved significantly one year after surgery. At follow-up of one year after surgery,VAS score of group A was(0. 99 ± 0. 23)scores,and the score of group B was(2. 21 ± 0. 69)scores,the score of group A was better than that of group B(P﹤0. 01);ODI score of group A was(6. 13 ± 1. 12)scores, and the score of group B was(9. 05 ± 2. 54)scores,the score of group A was better than that of group B (P﹤0. 01). At the preoperative and one year after surgery,there were no significant difference in patients with different types of Modic changes on VAS scores and ODI scores. Conclusion Fenestration with excision of nucleus pulposus was one of the effective ways of treatment to lumbar intervertebral disc protrusion. Modic changes on the endplate and vertebral body may be one of the reasons affecting the relief of lumbar pain after surgery.

Key words: intervertebral disc displacement, low beck pain, skin window technique, treatment outcome