Analysis of the reasons for the poor efficacy of percutaneous laminectomy herniation in the treatment of lumbar disc herniation in the elderly people
Objective:To explore the influence factors of poor efficacy of percutaneous intervertebral forameno-scopic protrusion removal(TESSYS technique)for the treatment of lumbar disc herniation(LDH)in the elderly.Methods:A total of 431 elderly patients with lumbar disc herniation admitted to the Pain Department of Tianjin First Central Hospital from January 2019 to March 2022 were selected.All the enrolled patients were treated with percutaneous foraminoscopic TESSYS technique for lumbar disc herniation removal and nerve root release decompression.The modified MacNab evaluation criteria were used to evaluate the surgical effect 12 months after surgery.According to the results of the last follow-up,the patients were divided into good effect group(307 cases)and poor effect group(124 cases).Multivariate logistic regression analysis was used to analyze the reasons that might affect the surgical effect.Results:By the final follow-up in 12 months after surgery,there were 175 cases of excellent,132 cases of good,85 cases of acceptable,and 39 cases of poor,with an excellent rate of 71.23%and an overall clinical effectiveness rate of 90.95%.Compared with the preoperative period,the VAS score for low back pain,VAS score for lower limb pain,ODI score,JOA score and GAD-7 score of the good group at 3 days after surgery and at 1,3,6 and 12 months after surgery were significantly improved.Logistic regression analysis showed that the patient's body mass index,protrusion calcification,endplates inflammation,protrusion of the neighbouring segments,and psychiatric factors were independent risk factors for the poor outcome of percutaneous TESSYS in the treatment of lumbar disc herniation in the elderly.Conclusion:Patient body mass index,herniation calcification,endplate inflammation,adjacent segment herniation,and psychiatric factors are independent risk factors for the efficacy of percutaneous intervertebral foramenoscopy TESSYS technique in treating lumbar disc herniation in the elderly.
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