Clinical efficacy of peripheral nerve release under microscope in the treatment of residual neurological symptoms after lumbar disc herniation

doi:10.3877/cma.j.issn.2095-9141.2024.02.004

Abstract

Abstract:

Objective

To explore the clinical efficacy of peripheral nerve release under the microscope in the treatment of residual neurological symptoms in patients with lumbar disc herniation (LDH) after surgery.

Methods

Eighty-nine patients with residual neurological symptoms after LDH surgery admitted to Neurosurgery Department of Jinjiang Hospital from January 2017 to June 2022 were randomly divided into treatment group (46 cases) and control group (43 cases). The control group received conservative treatment mainly with electroacupuncture, while the treatment group received peripheral nerve release surgery. The visual analogue scale (VAS), Japanese Orthopedic Association (JOA), and the modified Macnab efficacy score standard were used to evaluate the pain, motor function, and excellent rate of clinical efficacy of two groups; Serum C-reactive protein (CRP) and tumor necrosis factor-α (TNF-α), interleukin (IL)-6 and IL-8 levels of two groups before and after treatment were compared; the correlation between clinical efficacy, treatment plan, and concentration of inflammatory factors were analyzed.

Results

The treatment group ultimately included 41 cases with 5 cases of dropout, while the control group ultimately included 39 cases with 4 cases of dropout. There was no statistically significant difference in gender, age, average disease duration, and lumbar process location between the two groups (P>0.05). There was no statistically significant difference in VAS and JOA scores between the two groups before treatment (P>0.05); After 2, 4, and 6 weeks of treatment, the VAS score of the treatment group was lower than that of the control group, and the JOA score was higher than that of the control group, and the concentration levels of serum CRP, TNF-α, IL-6, and IL-8 were significantly lower than those of the control group, the differences were statistically significant (P<0.05). The excellent and good rate of the treatment group after 6 weeks of treatment was higher than that of the control group, and the rebound rate was lower than that of the control group, with statistical significance (P<0.05). The results of multiple stepwise regression equation showed that the clinical efficacy (JOA score) was closely related to the treatment measures (electroacupuncture and peripheral neurolysis), and negatively correlated with the concentration of inflammatory factors.

Conclusion

Microscopic peripheral neurolysis can improve residual neurological symptoms in LDH patients after surgery, and is expected to become a new approach for the treatment of LDH.

Key words: Lumbar disc herniation, Residual neurological symptoms, Rehabilitation treatment, Peripheral neurolysis and decompression, Clinical effect, Inflammatory factors

Weichuan Dai, Xieli Guo, Zhongning Fang, Wenhua Cai, Tiansheng Hong, Xiayang Tian. Clinical efficacy of peripheral nerve release under microscope in the treatment of residual neurological symptoms after lumbar disc herniation[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2024, 10(02): 84-90.

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References 29

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因素	治疗组（n=41）	对照组（n=39）	χ²/t值	P值
性别			0.283	0.804
男	23	22
女	18	17
年龄（岁，±s）	39.54±12.69	38.12±13.43	0.486	0.628
病程（d，±s）	35.91±4.82	34.34±4.25	1.542	0.127
腰突部位			0.222	0.895
L3/4	8	7
L4/5	21	22
L5/S1	12	10

因素	治疗组（n=41）	对照组（n=39）	χ²/t值	P值
性别			0.283	0.804
男	23	22
女	18	17
年龄（岁，±s）	39.54±12.69	38.12±13.43	0.486	0.628
病程（d，±s）	35.91±4.82	34.34±4.25	1.542	0.127
腰突部位			0.222	0.895
L3/4	8	7
L4/5	21	22
L5/S1	12	10

组别	例数	VAS评分				JOA评分
组别	例数	治疗前	治疗后2周	治疗后4周	治疗后6周	治疗前	治疗后2周	治疗后4周	治疗后6周
治疗组	41	5.82±1.75	2.24±1.28	0.94±0.28	0.84±0.21	10.56±2.73	22.36±1.46	25.01±1.54	27.01±1.72
对照组	39	5.94±1.23	4.34±0.45	4.06±1.23	4.72±1.08	10.32±2.96	10.65±1.15	13.18±1.61	11.08±1.21
t值		0.353	18.918	15.822	34.000	0.377	37.718	33.591	47.687
P值		0.725	<0.001	<0.001	<0.001	0.707	<0.001	<0.001	<0.001

组别	例数	VAS评分				JOA评分
组别	例数	治疗前	治疗后2周	治疗后4周	治疗后6周	治疗前	治疗后2周	治疗后4周	治疗后6周
治疗组	41	5.82±1.75	2.24±1.28	0.94±0.28	0.84±0.21	10.56±2.73	22.36±1.46	25.01±1.54	27.01±1.72
对照组	39	5.94±1.23	4.34±0.45	4.06±1.23	4.72±1.08	10.32±2.96	10.65±1.15	13.18±1.61	11.08±1.21
t值		0.353	18.918	15.822	34.000	0.377	37.718	33.591	47.687
P值		0.725	<0.001	<0.001	<0.001	0.707	<0.001	<0.001	<0.001

组别	例数	优	良	可	差	优良率（%）
治疗组	41	23	14	2	2	90.24
对照组	39	2	3	7	27	12.82
χ²值						48.045
P值						<0.001

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