[Individualized treatment of lumbar intervertebral disc herniation].
OBJECTIVE
To investigate the necessity, practicability for individualized treatment of lumbar intervertebral disc herniation and analyze its clinical effect.


METHODS
Five hundred and three cases of lumbar intervertebral disc herniation from March 2005 to March 2008 were individually treated by conservative treatment, minimal surgical procedures, open operation according to the protrusible size, rupture status of annular fibrosus, liberation or prolapse of disk tissue, accompanying conditions like spinal stenosis, spondylolisthesis or nerve involvement. Three hundred and ninety-three cases (male 189, female 204) were followed with an average age of 44.6 years old (range from 23 to 76). Among them, 210 cases were treated by conservative method, 145 cases by minimal surgical procedures and 38 cases by open operation. Therapeutic effect was evaluated by Macnab criteria.


RESULTS
The mean follow-up duration was 16 months (range from 3 months to 3 years). Therapeutic effect was noted as 346 of excellence, 29 of effective, 18 of ineffective. Excellence rate was 88%(346/393) and effective rate was 95% (375/393). No severe complication was found. The recurrence rate of conservative treatment, minimal surgical procedures, open operation was respectively 18.1% (38/210), 9.6% (14/145), 5.3% (2/38).


CONCLUSIONS
Conservative treatment is generally applied, its effect is reliable for patients of mild symptom. Minimal surgical procedures is applied more and more wide, the method will become prevalent. The indications for open operation became stricter and traditional surgical methods was challenged by less invasive methods. Individualized treatment basing on indication judgment was the most importance to improve therapeutic effect.
Han
Jian
J
Department of the Second Surgery, the First People's Hospital of Xianyang, Xianyang 712000, Shaanxi, China h120j@163.com
Tang
Yong-an
YA
Yin
Zhan-hai
ZH
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D008159:Lumbar Vertebrae / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function