Method of transforaminal endoscopic microdiscectomy in the treatment of patients with lumbar herniated disc
Keywords:herniated disc, transforaminal endoscopic microdiscectomy, lumbar osteochondrosis
AbstractBackground. Surgical treatment for lumbar herniated disc has changed significantly in recent years. And although microdisectomy is considered the “gold standard”, numerous methods and their modifications have appeared today, the authors of which seek to minimize the trauma of surgical access, without reducing the radicality of the operation. The purpose of the study was to evaluate the effectiveness of transforaminal endoscopic microdiscectomy, to identify the disadvantages and advantages of this method based on the results, and to determine the main indications and contraindications for this operation. Materials and methods. Ninety-eight patients with lumbar herniated disc were examined, they subsequently underwent transforaminal endoscopic microdiscectomy in the spine surgery clinic of the State Institution “Institute of Traumatology and Orthopaedics of the National Academy of Medical Sciences of Ukraine” from September 2018 to April 2019. Quantitative and qualitative assessment of pain syndrome was carried out using a visual analogue scale, quality of life — with Oswestry low back pain disability questionnaire. Evaluation of the results was carried out before the surgery and 4 weeks after it. Results. The use of endoscopic microdiscectomy in the treatment of patients (n = 98) with lumbar herniated disc made it possible to improve the quality of their life, which is confirmed by the results of the Oswestry survey (a decrease from 42.1 ± 3.2 % to 20.1 ± 2.9 %). When comparing preoperative visual analogue scale data (7.3 ± 1.2 points) and data 4 weeks after surgery (1.5 ± 0.9 points), a significant improvement in the level of pain was revealed in patients in the short terms. Assessing the complications, we noted the following. At the initial stages of the technique development, 2 (2.04 %) patients did not have a complete elimination of hernial protrusion material due to the lack of experience, and a significant sequestration migration along the canal, which led to repeated surgery. In 3 cases (3.06 %) at the L5-S1 level in patients with an asthenic physique, transforaminal access was not possible due to the high location of the iliac wing, which led to an open surgery. In 2 (2.04 %) individuals with the initial manifestations of instability, clinical symptoms of the latter intensified in 6 and 8 months that manifested itself in an increased back pain without neurological deficit, which required transpedicular fixation. In 2 (2.04 %) patients, intraoperative damage to the dura mater occurred. This complication had no effect on the treatment results. Conclusions. Among the advantages of the endoscopic transforaminal microdiscectomy technique one should note minimal soft tissue damage and minimal contact with nerve structures, fast postoperative recovery, minimal risk of infectious complications.
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