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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