Surgical tactics for multilevel displacements of lumbar intervertebral discs
Purpose. To improve the results of surgical treatment of lumbar pain syndromes and radiculopathy caused by the multilevel displacement of the intervertebral discs in the lumbosacral spine.
Materials and methods. During 2014 through 2018, we examined and treated 3,045 patients with lumbar pain and radiculopathy caused by the displacement of the lumbar intervertebral discs. Seventy-two per cent of patients with the multilevel displacement of intervertebral discs were examined and treated in I.I. Mechnikov Dnipropetrovsk Regional Clinical Hospital, 21 % of patients — in the medical centre “Endoscopic Neurosurgery” and 7% of patients were operated in the medical centre “Clinic of Family Medicine”. The mean age of the patients was 42.6 ± 5.4 years. All patients underwent a neurological examination with functional tests, a computer and magnetic resonance imaging, spondylography, electroneuromyography. The effectiveness of the selected surgical treatment method was evaluated by VAS scale, static and dynamic spine function testing before the intervention and in 2–3 weeks, 2–3 months and in 3–5 years after surgery. The days of disability were taken into account.
Results. The patients underwent puncture laser microdiscectomy (PLM) and endoscopic microdiscectomy (EDE) (p<0.05) presented with the most significant relief of pain syndrome, and the microdiscectomy with instrumentation was associated with pain syndrome reduction at all stages. The indicators of static and dynamic function of the spine using the Schober test, lateroflexion, extension in the dynamics were also significantly better in patients after PLM and EDE in comparison with other methods of surgery. The lowest number of days of disability was observed in patients who underwent PLM (30.7 ± 6.3 days) and EDE (24.6 ± 5.2 days). Maximum number of days of disability was in 34 patients after microdiscectomy with instrumentation — 64.5 ± 10.7 days.
Conclusions. When choosing a surgical tactic for two hernias located at non-adjacent levels, the clinical manifestations and size of the second hernia should be crucial. When comparing the effectiveness of surgical treatment of multilevel hernias of the intervertebral discs in the lumbosacral spine, the best results were obtained using the methods of EDE and PLM.
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1. Gugliotta M, da Costa BR, Dabis E, Theiler R, Jüni P, Reichenbach S, Landolt H, Hasler P. Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study. BMJ Open. 2016 Dec 21;6(12):e012938. [CrossRef] [PubMed] [PubMed Central]
2. Kalinin A, Byvaltsev V. Relationship between vertebral metric parameters and outcome of surgical treatment of degenerative spondylolisthesis with multilevel lumbar intervertebral disc lesions. Hirurgiâ pozvonočnika. 2015;12(4):56-62. [CrossRef]
3. Sayson JV, Lotz JC, Parazynski SE, Chang DG, Healey RM, Hargens AR. Microgravity-Induced Back Pain and Intervertebral Disc Herniation: International Space Station Results. In Conference: 66th International Astronautical Congress. Jerusalem, Israel 2015 Oct. Available from: https://www.researchgate.net/publication/284086894
4. Xiaochuan L, Zhong CF, Tang JH, Liang RW, Luo SJ, Huang CM. The Effectiveness and Safety of Selective Lumbar Decompression in Diagnostic Doubt Patients: A Retrospective Control Study. Pain Physician. 2017 May;20(4):E541-E550. [PubMed]
5. Kokina MS, Filatova EG. [The analysis of results of surgical back pain treatment]. Rossijskij žurnal boli. 2012;(3-4):22-25. Russian. Available from: https://elibrary.ru/item.asp?id=20343061
6. Li H, Jiang C, Mu X, Lan W, Zhou Y, Li C. Comparison of MED and PELD in the Treatment of Adolescent Lumbar Disc Herniation: A 5-Year Retrospective Follow-Up. World Neurosurg. 2018 Apr;112:e255-e260. [CrossRef] [PubMed]
7. Segura-Trepichio M, Candela-Zaplana D, Montoza-Nuñez JM, Martin-Benlloch A, Nolasco A. Length of stay, costs, and complications in lumbar disc herniation surgery by standard PLIF versus a new dynamic interspinous stabilization technique. Patient Saf Surg. 2017 Nov 23;11:26. [CrossRef] [PubMed] [PubMed Central]
8. Tu Z, Wang B, Li L, Li Y, Dai Y, Lv G, Li T. Early Experience of Full-Endoscopic Interlaminar Discectomy for Adolescent Lumbar Disc Herniation with Sciatic Scoliosis. Pain Physician. 2018 Jan;21(1):E63-E70. [PubMed] Available from: https://www.researchgate.net/publication/322662715
9. Byvaltsev VA, Kalinin AA, Belykh EG, Sorokovikov VA, Shepelev VV. Optimization of segmental lumbar spine instability treatment using minimally invasive spinal fusion technique. Zh Vopr Neirokhir Im N N Burdenko. 2015;79(3):45-54. English, Russian. [CrossRef] [PubMed]
10. Paul CPL, Smit TH, de Graaf M, Holewijn RM, Bisschop A, van de Ven PM, Mullender MG, Helder MN, Strijkers GJ. Quantitative MRI in early intervertebral disc degeneration: T1rho correlates better than T2 and ADC with biomechanics, histology and matrix content. PLoS One. 2018 Jan 30;13(1):e0191442. [CrossRef] [PubMed] [PubMed Central]
11. Hong CC, Liu KP. A rare case of multiregional spinal stenosis: clinical description, surgical complication, and management concept review. Global Spine J. 2015 Feb;5(1):49-54. [CrossRef] [PubMed] [PubMed Central]
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