Introduction. Lumbar disc herniation is a frequent pathology and surgical target. Endoscopic discectomy becomes more popular due to minimally invasive surgical technique. There is a deficit of scientific papers dedicated to analysis of potential for endoscopic discectomy depending on the specifics of spinal anatomy and degenerative changes.The purpose of the study was to evaluate the efficacy of transforaminal endoscopic discectomy (TED) in comparison with microdiscectomy (MD) and to specify factors determining complications and failures.Materials and methods. The authors performed randomized controlled study where main group of patients included data on prospective examination of 101 patients after TED procedure for lumbar intervertebral disc herniation. Age of patients ranged from 19 to 81 years with average of 41,4±12,6 years. Control group included data of retrospective examination of 153 patients that were operated by the same surgeon in the period from 201 till 2104 with microdiscectomy procedure. Age of patients ranged from 18 to 77 years with average of 47,8±11,3 years. Inclusion criteria were as follows: surgical procedure at the same level of the primary intervertebral herniation. Exclusion criteria were: degenerative spinal canal stenosis, spondylolisthesis, spine deformity.Results. Clinical outcomes after TED demonstrated no difference from MD procedure. No factors of significant influence on outcomes after surgical procedure were observed. The main group was characterized by more cases of revisions and conversions of endoscopic into open procedures (13,9%) which was related to mistakes in transforaminal approach due to features of intervertebral joints and foramina anatomy resulting in impossibility to achieve adequate spinal canal decompression.Conclusion. Transforaminal endoscopic discectomy is an effective and safe method of lumbar intervertebral herniation treatment. Complications and failures during learning curve of endoscopic procedure are associated with technique drawbacks as well as with mistakes in planning and performing the approach. Congenital alignment of lumbar spine with specific patterns of facets and foramina anatomy dictate technical difficulties with transforaminal approach.
The aim of the study was to evaluate the possibility of US navigation for Radiofrequency denervation (RFD) of the lumbar facets.Material and methods. The authors performed a prospective controlled cohort study which included 50 patients with chronic pain syndrome who underwent RFD LIII-SI facets on both sides. The main group (US) included 25 patients, who underwent US guided navigation with FScontrol of the correct placement of the cannula prior to ablation. In the control group (FS) the RFD was performed only under FS control. Patients were selected after preliminary test block of medial branch with 50% pain reduction from the baseline. Patients with overweight, spinal deformity, pronounced degenerative changes, spinal stenosis and developmental anomalies were not included in the study. For the evaluation of outcomes, the numeric pain scale NRS-11 and the Oswestry index (ODI) were used, the accuracy of the cannula position was assessed and factors determining the accuracy were searched.Results. As a result of the intervention, there was a significant decrease of NRS-11 and ODI criteria in both groups (p0.001), a positive outcome was achieved in 18 (72%) of US patients and 16 (64%) of FS patients, p = 0.564. Of the 200 attempts to position the cannula under the ultrasound control, 169 (84.5%) were successful, in most cases (187 out of 200, 93.5%) at least 3 attempts were required to reposition the cannula. The average time for performing the procedure under the ultrasound control was 47.3±1.13 minutes. The facet angle and procedure level were defined as predictors of the cannula positioning accuracy, odds ratio 0.93 (95% CI 0.894–0.963) and 0.51 (95% CI 0.32–0.805), respectively.Conclusion. RFD of lumbar facet under ultrasound navigation allows to achieve a relatively high accuracy of the cannula position into the zone of passage of the articular branch. The navigation capabilities are reduced at the level of LV and SI vertebrae due to structural features of the joints, namely coronary orientation of the facets with the formation of a narrow space between the transverse and upper articular process, which create difficulties for scanning. The disadvantage of ultrasound control is the lengthy procedure and the need for repeated reinsertion of the cannulae worsening the patient’s tolerance of procedure.
Федеральное государственное бюджетное учреждение «Российский ордена Трудового Красного Знамени научно-исследовательский институт травматологии и ортопедии имени Р.Р. Вредена» Министерства здравоохранения Российской Федерации, г. Санкт-Петербург, Россия; 2 Федеральное государственное бюджетное учреждение «Всероссийский центр экстренной и радиационной медицины им. А.М. Никифорова» МЧС России, г. Санкт-Петербург, Россия; 3 Федеральное государственное бюджетное образовательное учреждение высшего образования «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Министерства здравоохранения Российской Федерации, г. Санкт-Петербург, Россия 4 Федеральное государственное автономное учреждение «Национальный научно-практический центр нейрохирургии имени академика Н.Н. Бурденко» Министерства здравоохранения Российской Федерации г. Москва, Россия Pulsed radiofrequency ablation of dorsal root ganglions in the treatment of postsurgical radicular pain
Purpose: to study the influence of spinopelvic parameters on the risk of sacroiliac joint (SIJ) dysfunction development and prognosis of its treatment in patients with degenerative-dystrophic diseases of lumbosacral spine. Patients and methods. Prospective nonrandomized study included 197 patients: 79 patients with SIJ syndrome verified by the test block (main group) and 118 patients with other causes of low back pain (control group). In the main group the treatment tactics consisted of intraarticular injections of glucocorticosteroids and radiofrequency SIJ denervation. The result was deemed positive when pain intensity reduction made up 50% by Numerical Rating Scale (NRS-11) and/or 20% by Oswestry Disability Index (ODI) with effect preservation for 12 months and more. Pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS) and lumbar lordosis (LL) were measured. PI-LL difference was calculated as well as PT/PI and SS/PI ratio, type of posture by P. Roussouly and leg length discrepancy were assessed.Results. Positive treatment results were achieved in 63 (79.75%) patients from the main group. The comparison of 2 groups showed that the main risk factor was the index of PT/PI ratio the odds ratio 6.39 (95% confidence interval (CI) 2.19-8.33; p=0.021) for the risk of SIJ dysfunction development and 4.1 (95% CI 1.98-5.86; p=0.031) for the negative treatment prognosis with that index threshold of 0.28 and 0.32, respectively.Conclusion. The detected reliable dependence between the retroversion degree and SIJ dysfunction development and treatment prognosis may become the basis for new additional studies
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