Early efficacy of endoscopic translaminar and intervertebral foraminal approaches in the treatment of lumbar disc herniation

Objective:To investigate the early efficacy of two approaches for lumbar disc herniation under spinal endoscopy.Methods:45 cases of lumbar disc herniation were divided into interlaminar approach(27 cases)and intervertebral foramen approach(18 cases)according to different surgical approaches.Postoperative pain visual analogue scale(VAS)was used.Japanese Orthopaedic Association(JOA)lumbar spine score(JOA)and modified Macnab criteria were used to evaluate the postoperative outcome.Results:(1)VAS score.There is no interaction effect between the access mode and the time factor(F=0.620,P=0.603).There were statistically significant differences in pain VAS scores between preoperative and postoperative time points,that is,there was a time effect(F=2157.488,P=0.000).The overall VAS scores of the two groups were compared,and the difference was not statistically significant,that is,there was no grouping effect(F=2.610,P=0.114).The VAS score of pain in both groups decreased with time,and the differences between the two groups were not statistically significant before surgery,at discharge,1 month after surgery and 3 months after surgery(t=0.067,P=0.947;t=1.415,P=0.164;t=0.564,P=0.575;t=0.442,P=0.660);JOA score.There is no interaction effect between the access mode and the time factor(F=1.296,P=0.280).The difference of JOA score between preoperative and postoperative time points was statistically significant,that is,there was a time effect(F=1464.830,P=0.000).JOA scores of the two groups showed an increasing trend with time,and the differences between the two groups were not statistically significant before surgery,at discharge,1 month after surgery and 3 months after surgery(t=0.067,P=0.947;t=1.415,P=0.164;t=0.564,P=0.575;t=0.442,P=0.660);(2)The improved Macnab standard was used to evaluate the excellent and good rate at 3 months after surgery.In the interlaminar group,12 cases were excellent,13 cases were good and 2 cases were fair.The excellent and good rate was 92.6%.In the intervertebral foramen group,7 cases were excellent,10 cases were good and 1 case was fair.The excellent and good rate was 94.4%.The overall excellent and good rate of the two groups was 93.3%.Conclusion:Both approaches can achieve satisfactory efficacy in the treatment of lumbar intervertebral disc herniation,which is worthy of clinical application.However,for beginners,l5-s1 lumbar disc herniation is more suitable for intervertebral disc approach,so as to achieve satisfactory efficacy.

Protection of Photoactivity of Photosensitizers by Amphiphilic Polysaccharide Micelles

Photosensitizer （photosan）-encapsulated micelles were prepared by self-assembly of Photosan with two amphiphilic polysaccharide derivatives, including the cholesteryl conjugated sodium alginate derivative （CSAD） and the deoxycholic acid group conjugated chitosan derivative （DA-Chit）. The results of UV-Vis and fluorescence spectroscopy indicated that the hydrogen bonding strength dominated the micelle formation. Methyl viologen was used as a model quencher of photosan. Using the steady-state fluorescence technology, the quenching constants were determined to be 2.05, 1.88 and 0.30 L/mmol for the free photosan, the photosan-CSAD micelle and the photosan-DA-Chit micelle, respectively. This suggested that photosan was protected from quenching of methyl viologen by the polysaccharide micelles. In addition, the protection effect of the photosan-DA-Chit micelle was significantly stronger than that of the photosan-CSAD micelle. The photosan-DA-Chit micelle is thus anticipated for protection of photoactivity of photosan during the blood circulation process in vivo.