Differentiated tactics of surgical treatment of intervertebral disc herniation complicated by spinal canal stenosis
Keywords:intervertebral disc herniation, spinal canal stenosis, surgical treatment
Objective: to conduct a retrospective analysis and evaluate the results of various methods of surgical treatment of patients with intervertebral disc herniation (IDH), which is complicated by spinal canal stenosis (SCS) of the lumbar spine.
Materials and methods: 80 patients (36 (45%) men and 44 (55%) women) with a diagnosis of IDH complicated by SCS took part in the study. The average age of patients is under 50 years. All patients were operated on in the neurosurgery department of Zaporizhzhya Regional Clinical Hospital between 2016 and 2020. Patients were divided into two groups depending on the area of the spinal canal and the method of surgical treatment. Group A (n=20) – relative SCS, area of the spinal canal – 75‒100 mm2, the presence of IDH >6 mm (according to magnetic resonance imaging). These patients underwent a standard microdiscectomy. Group B (n=60) ‒ absolute SCS, spinal canal area <75 mm2, the presence of IDH <6 mm (according to magnetic resonance imaging). This category of patients underwent surgery with wide decompression of the spinal canal and stabilization of the spinal motion segment using the method of interbody and transpedicular fixation of the corresponding spinal motion segment. The postoperative follow-up period is up to 6 months. A visual analogue scale was used to assess the pain syndrome in the lower limb and back and the degree of its reduction in the postoperative period. The impact of surgical treatment on the quality of life of patients with IDH complicated by SCS was assessed using the Oswestry Disability Index questionnaire (ODI).
Results. Before the operation in group B, an inversely proportional dependence of the pain syndrome level on the visual analogue scale on the age of the patients (p<0.05) and the duration of the disease (p<0.05) was recorded. No such dependence was found in group A. In both groups, a significant decrease in pain syndrome was noted at the end of the first day after surgery, with a further gradual decrease until the end of the observation period. When comparing groups at the end of the first day after surgery, after 3 and 6 months, no statistically significant differences were found (p>0.05). In both groups, a significant decrease in the Oswestry index was registered immediately after surgery and its further decrease until the end of the follow-up period. When comparing the groups at the end of the first day after the operation, after 3 and 6 months, no statistically significant differences were found (p>0.05), but preoperative Oswestry index was significantly higher in group B, (р=0.04 according to the Mann‒Whitney test).
Conclusions. In group A, the treatment effectiveness of patients reached 80‒85%, in the observation period on the 3 and 6 months. In group B, the treatment effectiveness of patients was also high and amounted to 75‒80%, in the observation period on the 3 and 6 months. Thus, taking into account the high variability of clinical and morphological changes in patients with IDH complicated by SCS, it is optimal to use differentiated surgical treatment tactics.
2. Sakai Y, Ito S, Hida T, Ito K, Harada A, Watanabe K. Clinical outcome of lumbar spinal stenosis based on new classification according to hypertrophied ligamentum flavum. J Orthop Sci. 2017 Jan;22(1):27-33. [CrossRef] [PubMed]
4. Zhang Y, An HS, Tannoury C, Thonar EJ, Freedman MK, Anderson DG. Biological treatment for degenerative disc disease: implications for the field of physical medicine and rehabilitation. Am J Phys Med Rehabil. 2008 Sep;87(9):694-702. [CrossRef] [PubMed]
6. Cheung JPY, Kao PYP, Sham P, Cheah KSE, Chan D, Cheung KMC, Samartzis D. Etiology of developmental spinal stenosis: A genome-wide association study. J Orthop Res. 2018 Apr;36(4):1262-1268. [CrossRef] [PubMed]
7. Wu B, Tian X, Shi C, Jiang C, Zhang J, Zhan G, Xie D. Clinical Outcomes of "U" Route Transforaminal Percutaneous Endoscopic Lumbar Discectomy in Chronic Pain Patients with Lumbar Spinal Stenosis Combined with Disc Herniation. Pain Res Manag. 2021 Jan 19;2021:6657463. [CrossRef] [PubMed] [PubMed Central]
8. Azimi P, Mohammadi HR, Benzel EC, Shahzadi S, Azhari S, Montazeri A. Decision-making process in patients with lumbar spinal canal stenosis. J Neurosurg Sci. 2017 Aug;61(4):388-394. [CrossRef] [PubMed]
9. Skolasky RL, Wegener ST, Maggard AM, Riley LH 3rd. The impact of reduction of pain after lumbar spine surgery: the relationship between changes in pain and physical function and disability. Spine (Phila Pa 1976). 2014 Aug 1;39(17):1426-32. [CrossRef] [PubMed]
10. Malmivaara A, Slätis P, Heliövaara M, Sainio P, Kinnunen H, Kankare J, Dalin-Hirvonen N, Seitsalo S, Herno A, Kortekangas P, Niinimäki T, Rönty H, Tallroth K, Turunen V, Knekt P, Härkänen T, Hurri H; Finnish Lumbar Spinal Research Group. Surgical or nonoperative treatment for lumbar spinal stenosis? A randomized controlled trial. Spine (Phila Pa 1976). 2007 Jan 1;32(1):1-8. [CrossRef] [PubMed]
11. Deyo RA, Gray DT, Kreuter W, Mirza S, Martin BI. United States trends in lumbar fusion surgery for degenerative conditions. Spine (Phila Pa 1976). 2005 Jun 15;30(12):1441-5; discussion 1446-7. [CrossRef] [PubMed]
13. Steurer J, Nydegger A, Held U, Brunner F, Hodler J, Porchet F, Min K, Mannion AF, Michel B; LumbSten Research Collaboration. LumbSten: the lumbar spinal stenosis outcome study. BMC Musculoskelet Disord. 2010 Nov 2;11:254. [CrossRef] [PubMed] [PubMed Central]
14. Poetscher AW, Gentil AF, Ferretti M, Lenza M. Interspinous process devices for treatment of degenerative lumbar spine stenosis: A systematic review and meta-analysis. PLoS One. 2018 Jul 6;13(7):e0199623. [CrossRef] [PubMed] [PubMed Central]
15. Atlas SJ, Keller RB, Robson D, Deyo RA, Singer DE. Surgical and nonsurgical management of lumbar spinal stenosis: four-year outcomes from the maine lumbar spine study. Spine (Phila Pa 1976). 2000 Mar 1;25(5):556-62. [CrossRef] [PubMed]
16. Klingler JH, Hubbe U, Scholz C, Krüger MT. Facet-Sparing Decompression of Lumbar Spinal Stenosis: The Minimally Invasive Bilateral Crossover Approach. J Neurol Surg A Cent Eur Neurosurg. 2021 May;82(3):278-284. [CrossRef] [PubMed]
18. Mroz TE, Lubelski D, Williams SK, O'Rourke C, Obuchowski NA, Wang JC, Steinmetz MP, Melillo AJ, Benzel EC, Modic MT, Quencer RM. Differences in the surgical treatment of recurrent lumbar disc herniation among spine surgeons in the United States. Spine J. 2014 Oct 1;14(10):2334-43. [CrossRef] [PubMed]
19. Machado GC, Ferreira PH, Yoo RI, Harris IA, Pinheiro MB, Koes BW, van Tulder MW, Rzewuska M, Maher CG, Ferreira ML. Surgical options for lumbar spinal stenosis. Cochrane Database Syst Rev. 2016 Nov 1;11(11):CD012421. [CrossRef] [PubMed] [PubMed Central]
How to Cite
Copyright (c) 2023 Tymur А. Ksenzov, Mykhaylo. V. Khyzhnyak
This work is licensed under a Creative Commons Attribution 4.0 International License.
Ukrainian Neurosurgical Journal abides by the CREATIVE COMMONS copyright rights and permissions for open access journals.
Authors, who are published in this Journal, agree to the following conditions:
1. The authors reserve the right to authorship of the work and pass the first publication right of this work to the Journal under the terms of Creative Commons Attribution License, which allows others to freely distribute the published research with the obligatory reference to the authors of the original work and the first publication of the work in this Journal.
2. The authors have the right to conclude separate supplement agreements that relate to non-exclusive work distribution in the form of which it has been published by the Journal (for example, to upload the work to the online storage of the Journal or publish it as part of a monograph), provided that the reference to the first publication of the work in this Journal is included.