Affiliation:
1. Polenov Neurosurgical Research Institute, branch of the Almazov National Medical Research Centre
Abstract
Objective. Analysis of literature data of modern neurosurgical techniques in the treatment of lumbar disc herniation; clarification of the features of surgical tactics and results during microsurgical, endoscopic methods and laser thermoplastic of the intervertebral disk. Methods. A retrospective analysis of the results of conventional microdiscectomy (228 cases), laser disc decompression (22 observations) and percutaneos endoscopic discectomy (4 observations) for lumbar disc herniation from 2016 to 2018. The results of surgical treatment was assessed according to the Oswestry Disability Index (ODI), Visual Analog Scale (VAS), modified MacNab criteria, and morphometric data of MRI and CT scans during the preoperative and postoperative periods, as well as 6 and 12 months after surgery. Results. The result of the study was a comparison of the literature data with those obtained in our clinic in the treatment of patients using all the indicated methods. On our material, we received confirmation of the feasibility and perspectivity of using minimally invasive methods in the treatment of lumbar disc herniation with low probability of recurrence and repeated treatment for pain. Also agree with the statement that the techniques have limited application, especially with instability in the VMS and multilevel lesion. Conclusion. Endoscopic discectomy, as well as laser disc decompression, are minimally invasive methods of treatment lumbar disc herniation, and have become an alternative to open lumbar microdiscectomy, as they allow minimizing surgical trauma, the effects of surgery, and quickly regress pain syndrome, contributing to early post-operative activation of the patient. A personalized approach in the treatment of lumbar disc herniation is based on the competent selection of patients and the clarification of a number of factors in determining.
Publisher
Arterialnaya Gipertenziya
Reference24 articles.
1. Merzhoev AM, Gulyaev DA, Singaevsky SB, et al. Percutaneous endoscopic transforaminal removal of upper lumbar hernias// Russian neurosurgical journal named after prof. A. L. Polenov. — 2017;4: 23–30. In Russian [Merzhoev A.M., Gulyaev D.A., Singaevskii S.B. i dr. Perkutannoe endoskopicheskoe transforaminal'noe udalenie verkhnikh poyasnichnykh gryzh // Rossiiskii neirokhirurgicheskii zhurnal im. prof. A. L. Polenova. — 2017;4: 23–30.]
2. Yakovenko IV, Ivanova NE, Kondakov EN, et al. Polenov Neurosurgical Research Institute: from the creation of a service to the latest neurosurgical technologies. // Translational Medicine. — 2015;2(5): 30–38. In Russian [Yakovenko I.V., Ivanova N.E., Kondakov E.N. i dr. Rossiĭskiĭ nauchno-issledovatel'skiĭ neĭrokhirurgicheskiĭ institut im. prof. A. L. Polenova: ot sozdaniya sluzhby do noveĭshikh neĭrokhirurgicheskikh tekhnologiĭ. // Translyatsionnaya meditsina. — 2015;2(5): 30–38.]
3. Liu C. Percutaneous endoscopic lumbar discectomy and minimally invasive transforaminal lumbar interbody fusion for massive lumbar disc herniation / C. Liu, Y. Zhou // Clinical Neurology and Neurosurgery. — 2019;176: 19–24. DOI: 10.1016/j. clineuro.2018.10.017.
4. Ebeling U, Reichenberg W. Results of microsurgical lumbar discectomy. Review of 485 patients/ Acta Neurochir. 1986;81: 45–52.
5. Fritsch EW, Heisel J, Rupp S. The failed back surgery syndrome: reasons, intraoperative findings, and long-term results: a report of 182 operative treatments // Spine. — 1996;21: 626–633.