Surgical treatment of the lumbar disc herniation complicated by lumbar spinal stenosis
DOI:
https://doi.org/10.25305/unj.182625Keywords:
lumbar disc herniation, lumbar spinal stenosis, lumbar spine, surgical treatmentAbstract
Degenerative disc diseases of the lumbar spine are a relevant medical and social problem. Annually, about 8 % of the population lose their ability to work because of spinal pain, and of the total number of disability cases, 40 % are associated with pain in the lumbar region. Common causes of lumbar spine pain are disc herniation and spinal canal stenosis. There are rare cases of their combination (15–45 %). The lumbosacral spine has a tendency to develop intervertebral disc herniation due to the peculiarities of biomechanics and is, therefore, the main cause of spinal surgery among adults. The clinical picture depends on several factors: the location of the herniated disc, the size and direction of the hernia, the diameter of the spinal canal at this level, the presence of concomitant stenosis and its variant. The purpose of surgical treatment of degenerative disc diseases in the lumbar spine is to carry out complete decompression of the roots of the cauda equina with minimal anatomical destruction of the structures of the spine. An adequate understanding of anatomical ratios and optimal volume of bone resection make it possible to minimize access, reduce traction and surgical traumatization of nerve structures, which ensures effective postoperative rehabilitation of patients.
The paper covers the issues of etiology, pathophysiology and surgical treatment of disc herniation complicated by concomitant spinal canal stenosis. The reviews the literature and recent researches of the most optimal methods of surgical treatment of this pathology. The lack of uniform approaches to the surgical treatment of discs herniation complicated by spinal canal stenosis indicates the urgency of the problem and requires further scientific research.
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