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The study objective is to assess the effectiveness of interlaminar decompression in patients with degenerative lumbar stenosis.Materials and methods. A prospective study was conducted among 100 patients with degenerative lumbar stenosis. All patients were operated, interlaminar decompression of the symptomatic side was made. Outcomes were assessed by using a visual analogue scale and Oswestry questionnaire 1 and 2 years after surgery. Among patients with an unsatisfactory result, the cause of the unsatisfactory outcome was studied.Results. One year after surgery a satisfactory result was noted in 71 patients, and 2 years after surgery a satisfactory result was noted in 67 patients. The following causes of unsatisfactory outcome were found in 33 patients: 9 – spinal canal restenosis, 2 – herniated disc at the operation level, 4 – the facet syndrome, 4 – development of clinical instability, 3 – pain in the opposite leg (there was no pain before the operation), 2 – development of delayed radiculopathy, 9 – decompensation of concomitant diseases (4 – coxarthrosis, 3 – gonarthrosis, 2 – chronic ischemia of the lower extremities). Among the risk factors for restenosis, statistically significant relationship was found only with the presence of spondylolisthesis.Conclusion. Interlaminar decompression is an effective surgical option in patients with degenerative lumbar stenosis. The presence of spondylolisthesis is a risk factor for the inefficiency of this operation.Conflict of interest. The authors declare no conflict of interest.Informed consent. All patients gave written informed consent to participate in the study
The study objective is to assess the effectiveness of interlaminar decompression in patients with degenerative lumbar stenosis.Materials and methods. A prospective study was conducted among 100 patients with degenerative lumbar stenosis. All patients were operated, interlaminar decompression of the symptomatic side was made. Outcomes were assessed by using a visual analogue scale and Oswestry questionnaire 1 and 2 years after surgery. Among patients with an unsatisfactory result, the cause of the unsatisfactory outcome was studied.Results. One year after surgery a satisfactory result was noted in 71 patients, and 2 years after surgery a satisfactory result was noted in 67 patients. The following causes of unsatisfactory outcome were found in 33 patients: 9 – spinal canal restenosis, 2 – herniated disc at the operation level, 4 – the facet syndrome, 4 – development of clinical instability, 3 – pain in the opposite leg (there was no pain before the operation), 2 – development of delayed radiculopathy, 9 – decompensation of concomitant diseases (4 – coxarthrosis, 3 – gonarthrosis, 2 – chronic ischemia of the lower extremities). Among the risk factors for restenosis, statistically significant relationship was found only with the presence of spondylolisthesis.Conclusion. Interlaminar decompression is an effective surgical option in patients with degenerative lumbar stenosis. The presence of spondylolisthesis is a risk factor for the inefficiency of this operation.Conflict of interest. The authors declare no conflict of interest.Informed consent. All patients gave written informed consent to participate in the study
Цель исследования -оценить эффективность электростимуляции спинного мозга в лечении пациентов с дегенеративным стенозом позвоночного канала на поясничном уровне. Материалы и методы. Под наблюдением находились 20 пациентов с симптомным стенозом. Критерием исключения пациентов из исследования было наличие механической осевой боли в поясничной области. Большинству пациентов (n = 18) было отказано в проведении открытой декомпрессии ввиду тяжелой сопутствующей соматической патологии, а 2 пациента сами отказались от вмешательства. Всем пациентам имплантировали эпидуральный электрод для тестовой электростимуляции спинного мозга. Критериями оценки результатов вмешательства были интенсивность болевого синдрома, оцениваемого по визуально-аналоговой шкале, и дистанция, которую пациент мог пройти без остановок. Исходы оценивали через 8 дней и через 6 мес после операции. Удовлетворительным результатом считали снижение интенсивности боли на 50 % и более. Результаты. Удовлетворительный результат тестовой электростимуляции получен у 18 пациентов, и в дальнейшем всем этим пациентам была имплантирована система для постоянной электростимуляции спинного мозга. Средняя оценка интенсивности боли в поясничной области на фоне электростимуляции снизилась с 4,2 до 3,1 балла, а в ноге -с 7,2 до 2,2 балла. Средняя дистанция, преодолеваемая без остановок, увеличилась с 58 до 245 м. При этом моторный компонент нейрогенной хромоты уменьшился только у 1 пациентки. На фоне регресса корешковых болей главным фактором, ограничивающим преодолеваемое расстояние, стали жалобы на одышку и боль за грудиной, свидетельствующие о декомпенсации сердечной недостаточности. До имплантации системы для электростимуляции только у 3 пациентов способность к ходьбе не была ограничена, на фоне электростимуляции таких пациентов стало 7. Заключение. Электростимуляция спинного мозга является эффективным паллиативным пособием у пациентов с дегенеративным стенозом позвоночного канала на поясничном уровне.
The article is devoted to the issues of etiology, pathophysiology and clinical manifestations of spinal stenosis of the lumbar spine. The possibilities of modern instrumental diagnostics of the disease are described, the differential clinical diagnosis of lumbar stenosis is presented. The paper presents a detailed classification of spinal stenosis. The modern therapeutic tactics of the disease are described, indications for the surgical treatment of the disease are given. Modern methods of surgical treatment of stenosis are briefly and schematically described: decompression (microsurgical and endoscopic), interspinous fixation, stabilization (dorsal and ventral) and epidural stimulation of the spinal cord. The data on the immediate and long-term results of surgical methods of treatment are presented. The authors also presented their experience in the treatment of spinal stenosis of the lumbar spine. The use of differentiated surgical treatment tactics in 85–90 % of cases provides good and excellent results in the treatment of lumbar stenosis.
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