Objective. To define optimal pathogenetic surgical techniques for pain syndrome recurrence after lumbar discectomy. Materials and Methods. The study included 176 patients operated on for pain syndrome recurrence. Decompressive and decompressive-stabilizing (posterior or anterior interbody fusion, dynamic fixation with DYNESYS instrumentation) reoperations were performed. The results were followed for 3 to 24 months. The dynamics of neurologic status and pain syndrome intensity were assessed with visual-analog scale and Osvesty index. Results. The main causes of pain syndrome recurrence were a herniation of the operated disc (52.8 %) and its combination with degenerative stenosis (9.7 %). Degenerative stenosis alone was a cause of pain recurrence in 21.6 % of cases. Hernia recurrence of the operated disc caused a pain syndrome more frequently within 2 years after surgery. Degenerative stenosis both alone and in combination with operated disc hernia occurred more often in a later follow-up period. Hypertrophic articular processes and vertebral arches, osteophytes, thickened yellow ligament and peridural fibrosis were the pathomorphologic substrate of stenosis. Fibrous changes were revealed intraoperatively in all cases. Peridural fibrosis never was a single cause of neurovascular compression but always was combined with other stenosing factors. Treatment results were better in patients who underwent decompressive-stabilizing surgery. Repeated recurrences of pain syndrome occurred in 9.8 % of cases after surgical decompression and in 1.4 % after decompressivestabilizing surgery. Conclusion. Decompressive-stabilizing surgery with posterior interbody fusion is a pathogenetical and technically adequate surgical treatment of pain syndrome recurrence after lumbar disc hernia removal.
Objective. To identify natural radiological parameters of degenerative spinal motion segments and biochemical changes in intervertebral disc tissues, which have a significant connection with the hernia recurrence after microdiscectomy. Material and Methods. The MRI, radiography and biochemical parameters of the nucleus pulpous and annulus fibrosus tissues from patients operated for L4-L5 and L5-S1 herniation were assessed and statistically analyzed. Two groups of patients were examined: Group I (n = 50)-with recurrent hernias, Group II (n = 50)without recurrence during three years. Results. Significant correlation was observed between recurrent lumbar disc herniation after microdiscectomy and the following biomechanical parameters: height of the intervertebral disc (p = 0.001; r = 0.69), segmental sagittal range of motion (p = 0.001; r = 0.61), lumbar lordosis (p = 0.001, r = 0.78), stage of the intervertebral disc degeneration (p = 0.001; r = 0.46), and type of hernia (p = 0.001, r = 0.45). The quantitative and qualitative characteristics of proteoglycans/glycosaminoglycans of the nucleus pulposus and annulus fibrosus differed significantly in patients of the studied groups, but significant correlation with recurrent hernias was not found (r < 0.3). Conclusion. The preserved intervertebral disc height, hypermobility of the spinal motion segment, the smoothness of the lumbar lordosis, moderate intervertebral disc degeneration, and the disc protrusion have significant connection with the recurrence of lumbar intervertebral disc herniation after microdiscectomy.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.