Soleus muscle H-reflex monitoring in endoscopic surgery under general anesthesia percutaneous interlaminar approach

Abstract

The clinical value of soleus muscle H-reflex monitoring in general anesthesia percutaneous interlaminar approach was investigated. A total of 80 cases with unilateral L5-S1 disc herniation between January 2015 and October 2016 were randomly divided into control group (without soleus muscle H-reflex monitoring, n=40) and observation group (with soleus muscle H-reflex monitoring, n=40). Results showed that the operation time of the observation group was shorter than that of the control group (P<0.05), and the blood loss during the operation was less than that of the control group (P<0.05). The length of postoperative hospital stay was shorter than that of the control group (P<0.05). At 24 h after operation, the amplitude of H-reflex in diseased side soleus muscle was significantly lower than that in healthy side (P<0.05). The preoperative, postoperative and 24 h postoperatively, the latency of H-reflex in diseased side soleus muscle was shorter than that of healthy side (P<0.05). The latency and amplitude of H-reflex latency in soleus muscle were significantly lower (P<0.05), and the height of intervertebral space in observation group was significantly higher than that in control group (P<0.05). The total percentage of postsurgical sensory dysfunction, dyskinesia, post-root canal stenosis, disc herniation and cerebrospinal fluid leakage was lower than that of the control group (P<0.05). Japanese Orthopaedic Association score of the observation group was significantly higher at 1 month, and 1 year after operation lower than the control group (P<0.05). Taken together, soleus muscle H-reflex monitoring can effectively reduce the damage to the nerve roots under percutaneous endoscopic intervertebral endoscopic surgery under general anesthesia, improve the accuracy of surgery, reduce the complications, shorten the operation time and reduce the surgical bleeding, which is more beneficial to patients smooth recovery.

Comparing the Effectiveness and Safety Between General Anesthesia versus Epidural Anesthesia for Percutaneous endoscopic lumbar discectomy

“…When conservative treatment fails and disease progression, surgical [18] may be required. Percutaneous transforaminal endoscopic discectomy is a minimally invasive technique for lumbar disc herniation, comparable to open surgery and microendoscopic lumbar discectomy for [18,19] in terms of e cacy.At the same time, it has the advantages of small incision, less bleeding, fast postoperative recovery, and early wake up [11,20,21] . Clinically, epidural and general anesthesia are commonly used for percutaneous transforaminal endoscopic discectomy, but the feasibility, safety and effectiveness of epidural and general anesthesia in patients undergoing percutaneous endoscopic lumbar discectomy are still Therefore, we performed a retrospective cohort study evaluating which type of anesthesia had a better clinical outcome.…”

“…General anesthesia General anesthesia GA) and epidural anesthesia (EA) are commonly used in various endoscopic surgeries for [5,6] , and previous studies reported that most clinicians use general anesthesia in order to achieve comfortable and good anesthesia effect.Although patients treated with general anesthesia do not experience pain, they are unconscious and unable to sense neurological damage [7] .Some patients receiving treated epidural anesthesia can not tolerate the pain during surgery [8] .Monitoring of spinal nerve function may provide protective anesthesia against general nerve injury [9][10][11] .However, additional equipment, personnel, and medical costs limit the adoption of the technology to [12] .In recent years, epidural anesthesia has been recommended in percutaneous endoscopic lumbar discectomy to avoid nerve damage because it allows the surgeon to determine whether the nerve root is injured [9,13] based on timely feedback from the patient.How to better manage pain during percutaneous transforaminal endoscopic discectomy has become a major clinical problem facing spine surgeons.…”