Concurrent high heat reaction in the treatment of lumbar disc protrusion by intervertebral conpore: a report

With the continuous development of spinal minimally invasive technology, transdermal intervertebral lens technology has been widely used in the treatment of lumbar disc protrusion, and has achieved a goodclinicalefficacyDuan Xiaofeng and other reports, by the transdermal intervertebral disc protruding myelin disc removal surgery treatment lumbar disc protrusion trauma is small, safe and effective, quick postoperative recovery, but for its surgical complications are reported lessJhala and Mistry and Xu Baolong and Ma Xinlong reported that the main complications were vertebral gap
infection, nerve root damage, rupture of the epidural sac, abdominal organs and largevascularinjury, device rupture, spinal hypertension, postoperative residual pain, postoperative blood seepage, postoperative recurrence and degenerationHuang Karen and other reports, intervertebral intraoculated surgical complications are mainly postoperative nerve root pain allergy, epidural tearing, surgical failure, hyperencephalosis hydraulicRecently, I branch in the bureau for a lumbar disc protrusion patients under the intervertebral disc protrusion disc protrusion removal surgery, the operation and high heat reaction, is reported as follows1Medical recordspatient, male, 71 years old, admitted to hospital for "three years of numbness in the lower left limb, aggravated by 1 month"Patients 3 years ago due to fatigue after the left lower limb pain numbness, mainly for the left calf outside and left toe, by Wuwei CityAcupunctureHospital Pain Departmentdiagnosisfor lumbar disc protrusion, and after treatment with the target radio frequency relief1 month before the patient tired left lower limb pain numbness, walking down the left calf outside and left toe involved pain numbness, bed rest slightly betterNo stool disorderadmission to the hospital, check the body T 36.5 degrees C, P 71 times/min, HR 197 times/min, BP 120/83 mm Hg (1mm Hg: 0.133 kPa), admission to the ward,chronic diseasesLumbar movement and rotation is limited, L4 to S1 vertebraside tenderness, left L4 to 5 vertebraside tenderness is obvious, and radiation to the left lower limbStraight leg raised the test left side 30 degrees angle positive, strengthen the test positive; Pear-shaped muscle pull test positive on the left and right sideThe muscle tension of the double lower limbs is normal, and the knee reflection on both sides and the ankle reflection are symmetrically drawn outThe shallow sensation of the left calf and the outside of the foot is reduced, and the papyress are not drawn2Auxiliary examinationlumbar vertebral MRI shows L4 to 5 disc protrusion, L5 nerve root pressure (Figure 1);Figure 1 (1) MRI sadumlet shows L4-5 intervertebral disc protrusion and vertebral stenosis, arrow refers to the left rear protru
sion of the L4-5 intervertebral disc preoperative
; 3 Treatment and after before the first use of C-arm x-ray machine perspective positioning, take the rear outside into the road, in the waist 4 to 5 vertebrae gap in the middle line left side open 12 cm identified as the body table puncture point, with 0.5% lidocaine (lidocaine) 10 ml plus 0.25% bupivacaine 10 ml layer-by-layer anaesthetic to joint protrusion, with a No 18 puncture needle into the back of the protruding myelin core, through the puncture needle into the guide wire and gradually set up a working sleeve, placed in the intervertebral hole mirror In the bureau hemp downstream L4 to 5 intervertebral disc myelin core removal, nerve root loose, vertebral forming (Figure 2) in two hours in the continuous application of physiological saline 12,000 ml (Ji'an Zhongcai Biotech Co., Ltd., production batch number 171 115) flushing The operation lasted 2 h At the end of the operation, when the patient turned over flat, the main complaint cold, the temperature under the armpit 38.4 degrees C, take the ice bag cold allowance, drinking warm water, cotton quilt and other measures, but the patient then appeared cold, headache, dizziness, nausea, vomiting, peripheral pain, and then under armpit temperature 39.8 degrees C, electrocardiogram show bp 150/100 mm Hg, P 136/min Dexamethasone injection 10 mg intravenous injection, anisodamine injection 10 mg intramuscular injection, midazolam injection (midazolam injection) 2 mg intravenous injection, ondanseron 4 mg intravenous injection, continue to give oxygen absorption 1.5 L/min the routine of rapid blood testing, after 15 min the cold gradually improved, the temperature under the armpits 38.5 degrees C Considering the patient's old age and infirmity and the special surgical site, prevent given sodium cephalosporin (cephazolin sodium) 1.5 g to 20 min intravenous injection After 30 min, the patient's chill, dizziness, nausea, vomiting and other symptoms gradually disappeared, the temperature under the test 38.5 degrees C, 1 h after the temperature of 37.2 degrees C, returned to the ward to continue electrocardiogram monitoring The body temperature under the armpits is 36.8 degrees C after 1.5 h The condition was stable at night Figure 2 The nerve root after the loose solution under the intervertebral hole mirror
The next morning check room, the patient self-described the left lower limb pain numbness significantly reduced, walking down the left calf outside and left toe involved pain disappeared, still feel numb, no discomfort Check: T 36.7C, BP120/75 mm Hg, P 79times/min, HR 20 times/min; lumbar vertebral activity is unrestricted, lumbar rata and vertebrae with no tenderness, no radiation pain; straight leg lift test left 60 , right negative; 4 words negative to the left and right side; pear-shaped muscle pull test positive on the left and right side; normal muscle tone of both lower limbs, two-sided knee reflection, ankle reflection symmetrically drawn; left calf and foot outside the outer side of the shallow feeling is still reduced, the papyrmoste is not drawn Review the blood routine and check that C-reactive protein (C-reactive protein, CRP), blood sink, calcitonin are normal Given the residual symptoms of the left calf and the outer side of the foot shallow sensory recovery is slow, give oral mecobalamine tablets (mecobalamine tablets) 0.5 mg/times, 3 times/d; gabapentin) 0.3 g/times, 3 times/d After the 3rd morning of the operation to check the room, the patient self-described the pain of the left lower limb basically disappeared, left calf and left foot outside the back still feel numb, the rest of the discomfort Check body T 36.6 degrees C, BP 116/78 mm Hg, P 69 times/min, HR 18 times/min Review blood routine, CRP, blood sinking normal, after-examination of the body before After surgery 4 d patients left lower limb pain disappeared, numbness significantly relieved after discharge At discharge, check-up T 36.5C, BP 120/80 mm Hg, P70/min, HR 19/min, before the remainder Review blood routine, CRP, blood sink are normal Discharge instructions continue oral above the drug for 1 month, with the lumbar muscle function exercise After 1 week after discharge follow-up 1 time, continuous follow-up 1 month, the patient's vital signs are stable, there is no fever, headache and other discomfort, left lower limb pain disappeared, but still left calf and foot outside the shallow feeling decreased