Summary. Although the microdiscectomy techniques for surgical treatment of a herniated disk are improved, the share of poor outcomes after the lumbar pain syndrome treatment remains high. Objective: to improve the outcomes of patients with lumbar spine osteochondrosis complicated with a herniated disk. Materials and Methods. The retrospective analysis of 54 patients with a lumbar herniated disk, who underwent surgical treatment from 2019 till 2020 at the Spine Surgery Department of the SI “Institute of Traumatology and Orthopedics of NAMS of Ukraine”. The age of patients varied from 23 to 78 years (mean age – 41.1±11.7 years). Results. We assessed the outcomes using VAS, Oswestry, and Nurick scales on the first day after the surgery, one month, and six months after it. VAS of the lower back pain syndrome declined on average from 5.9±1.59 to 3.4±1.55 on the first day after the surgery, to 1.7±1.1 in a month, and to 2.5±2.1 six months after the surgical treatment. The surgery eliminates radiculopathy and reduces radicular pain according to VAS on average from 8.5±1.17 to 1.3±1.04 on the first day after the surgery, to 1.5±1.0 in a month, and to 1.4±1.6 six months after it. The quality of life according to ODI improved on average from 74.4±5.12 before the surgery to 29.7±9.6 in a month and to 9.6±9.2 six months postoperatively. As of the discharge, 55.6% of patients demonstrated their nervous system's function recovered to the stage I and 38.9% – to the stage II. The long-term follow-up has shown positive dynamics in all the patients: the complete regress of neurologic symptoms in 74.4% and improved conditions – in 25.6% of patients. Conclusions. Surgical treatment of a herniated lumbar disk with the microdiscectomy method ensures the fulfillment of the fundamental nerve rootlet decompression by fenestrotomy, disctomy, or discectomy, and excision of the hernia, including sequestrated one. The positive dynamics of the pain syndrome scores, life quality, and neurological disorders is significant (р<0.05) and substantiates the efficiency of the treatment.
Currently, insufficient attention is being paid to an issue of the necessary anti-osteoporotic therapy after percutaneous vertebroplasty for vertebral fractures associated with osteoporosis, which leads to premature termination of medical treatment and worsening of the treatment results in this group of patients. An objective of the research is to study the results of treatment of patients with vertebral fractures associated with osteoporosis, depending on the use of anti-osteoporotic therapy. The results of percutaneous vertebroplasty of 91 postmenopausal women aged 50-90 years, depending on the use of anti-osteoporotic therapy during the postoperative period were analysed. An assessment was made according to the dynamics of pain syndrome using the Visual Analogue Scale (VAS), the Quality of Life Scale by J.R. Gaughen to estimate the patient's mobility and a need for pain medication. The results of the treatment were assessed 3 and 6 months after the percutaneous vertebroplasty. Bone mineral density was measured using Dual-energy X-ray absorptiometry 6 month after the treatment. Anti-osteoporotic therapy, which was prescribed for all patients comprised calcium supplements, antiresorbents and in D-hypovitaminosis – alfacalcidol or cholecalciferol. Only half of the patients followed the recommendations – 46 (50.6%), while the rest of the patients stopped the therapy in 2-3 months due to the improvement of their condition. In the main group of patients, where necessary anti-osteoporotic therapy was administered, significant reduction of pain syndrome and increase in quality of life during 3 and 6 months’ observation period were revealed. In the group of patients where prescribed anti-osteoporotic therapy was not adhered, significant reduction of pain syndrome and increase in quality of life in the observation period 3 months was revealed but deterioration in the form of pain syndrome increase and decrease in quality of life in the observation period of 6 months occurred. Effectiveness of anti-osteoporosis therapy, with regard to measuring bone mineral density can be reliably confirmed only in the main group. Intraoperative and postoperative complications occurred up to 5.5%, and generally did not require further treatment and did not affect the overall treatment result. Thus, it was revealed that to ensure a stable effect after the surgery, long-term prescription of anti-osteoporosis therapy is needed.
Актуальность. Удаление межпозвоночных грыж является наиболее частой плановой операцией в хирургии позвоночника. Несмотря на высокую технологичность операций по поводу грыж межпозвоночных дисков, до настоящего времени сохраняется большое количество неудовлетворительных послеоперационных результатов. Материалы и методы. Проведен анализ данных клинических наблюдений хирургического лечения 54 пациентов с грыжами межпозвоночных дисков, которые находились на стационарном лечении в клинике хирургии позвоночника со спинальным (нейрохирургическим) центром ГУ «Институт травматологии и ортопедии НАМН Украины» в период с 2019 по 2020 г. Результаты. Среди наших наблюдений ликворея из поврежденных оболочек дурального мешка отмечалась в одном случае (1,9 %). В структуре осложнений поясничной микродиск-эктомии в раннем послеоперационном периоде выраженный болевой синдром после операции наблюдался у 11,1 % больных; неврологические нарушения с парезом стопы, которые были до операции, сохраняются у 5,6 %; увеличение двигательных нарушений, обусловленных проведением микродискэктомии в раннем послеоперационном периоде, не отмечалось; вторичное заживление послеоперационной раны отмечено у 6 (11,1 %) больных, спондилодисцита не было. Выводы. Причинами повторного хирургического вмешательства у пациентов после первичной микродискэктомии в отдаленном периоде являются рецидив грыжи межпозвонкового диска — 4 случая (7,4 %) и нестабильность оперированного сегмента — 1 случай (1,9 %).
Summary. Relevance. Despite the long-term use of microdiscectomy (OLM) for the surgical treatment of lumbar disc herniation, the recent rapid development of endoscopic methods has significantly increased their popularity. Objective: to evaluate the outcomes of surgical treatment of disc herniation in the lumbar spine using different methods (microdiscectomy vs. endoscopy) according to the VAS and Oswestry scales. Materials and Methods. The analysis of outcomes of 54 patients who underwent a standard microdiscectomy (mean age 41.1±11.7 years; 23 (42.6%) male and 31 (47.4%) female patients) was compared to the analysis of 35 patients after two – monoportal (n=13) and bi-portal (n=22) – modifications of endoscopic nucleotomy (mean age 43.1±13.1 years; 22 (75.9%) male and 13 (24.1%) female patients). Results. No significant difference appeared between these two groups of methods. Lumbar pain values according to VAS dropped from 5.9±1.59 to 3.4±1.55 on the first day after the surgery, and to 2.5±2.1 six months thereafter in the OLM group, compared to the decrease from 8.7±5.3 to 3.6±0.9 on the first after-surgery day and to 2.6±2.0 six months later after the endoscopic methods. Radicular pain according to VAS decreased on average from 8.5±1.17 to 1.3±1.04 on the first day after the surgery and to 1.4±1.6 six months later in the first group, compared to the decrease from 6.9±1.3 to 4.3±1.0 on the first day and to 2.2±1.9 six months thereafter in the second group. The quality of life in the OLM group according to the ODI improved on average from 74.4±5.12 before treatment to 29.7±9.6 in 1 month and to 9.6±9.2 six months after the surgery, compared to the score of 48.8±9.7 before treatment, 32.5±8.3 one month after the surgery, and 9.0±8.4 six months after the surgery (р<0.05) in the group of endoscopy. Conclusions. Significantly similar outcomes of treatment of patients with lumbar disc herniation using both endoscopic techniques and microdiscectomy were found. Regularities of reduction of radicular and lumbar pain syndrome on the VAS scale and improvement of quality of life on ODI at different follow-up terms for each of the groups have been established. The advantage of endoscopic surgical techniques over microdiscectomy, which reduces the duration of hospitalization with the same clinical effect, was found. Prospects for further research are to develop a differentiated approach to the treatment of this pathology.
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