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KMID : 0377619730250060683
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Korean Jungang Medical Journal
1973 Volume.25 No. 6 p.683 ~ p.688
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Surgery of Ruptured Lumber Intervertebal Disc Under Local Anesthesia
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Abstract
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Much attention has been paid in the past several years in handling the patient who has severe lumbago and sciatica in order to get an accurate and complete relief of the pain. It is important for the surgeon to clarify that what exactly cause such pain or trouble.
Conservative treatment with rest should be attempted for the patient before the surgery decided. If there is no adequate effect and if there showed a persistent pain associated with neurological signs one should decide the surgery.
To confirm the accurate pain origin during the surgery, electronic and mechanical stimulations on and around the nerve root must be mandatory with The patient under local anesthesia. These stimulations should also be applied on posterior longitudinal ligament, annulus fibrosus, lateral part of Jig.. flavum and dura.
Patient is placed in the operating table in lateral position so that some clinical tests including Lasegue´s maneuver and active pelvic motion could be attempted during the disc exploration.
A total number of 405 cases with ruptured or protruded lumbar inter. vertebral discs operated on from 1964 to July 1973 are presented.-. Male is dominantly affected in this group. Among the age range from 17 to 78 year-old, young adult,31-40 years of age,is invoked most often. 95.6% of total cases had hemilaminectomy, more on left side than right side and 21. 1% of the cases had bilateral hemilaminectomy and only 4.4% of the cases had total laminecto´my.
Almost all cases of the total group have revealed an excellent result, some chronic cases had reopening because there showed to have marked adhesion around the nerve root. Two cases turned out later to have a malignancy involved the roots although they had temporary improvement of the pain post operatively. There showed no operative mortality.
Advantages by this method are:
1. No special pre-Op- or post-Op. care required.
2. Patient is placed in lateral position at ease during surgery.
3. Myelography is not necessarily required.
4.The surgery can be applicable in aged or illed patients.
5. No blood transfusion or IV infusion is required except for the bad conditioned patient.
6. Through the communication with the patient during the surgery, pain can easily be detected by means of Lasegue´s test, pelvic motion, coughing, mechanical stimulation as well as electronic stimulation.
7. Minimal or no mortality.
8. Early ambulation can be started immediately after the surgery or in a few days post-operatively.
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