Tactics of surgical treatment of multilevel discosis of the lumbar spine

INTRODUCTION. This article describes the experience of performing surgical operations on the lumbar spine with multilevel degenerative changes. The study included 105 patients aged 18 and over. The study included patients with multilevel intervertebral hernias in the lumbar region, including various combinations of conditions such as multilevel discosis with instability of the spinal motor segment, central and lateral stenosis, as well as pathologies of the arched joints. Patients underwent various decompression and stabilization operations, using transpedicular implants, dynamic implants, a combination of them or without fixation. According to the results of the evaluation of treatment, using a Visual Analog Scale and the Oswestry Disability Index (ODI), there was a significant improvement in the quality of life of patients, expressed in a decrease in pain, a decrease in neurological disorders and an increase in the level of daily activity.
MATERIALS AND METHODS. The results of surgical treatment in 105 (100 %) patients were analyzed, including 47 (44.1 %) women and 58 (60.9 %) men operated on the basis of the Polenov Neurosurgery Institute – the branch of Almazov National Medical Research Centre for multilevel discosis of the lumbar spine in the period from 2019 to 2022. Given the presence of these pathologies, all patients are divided into 2 groups. Group 1 included 47 (44.76%) patients, the choice of treatment method was TPF with interbody fixation; the 2nd group included 58 (54.3%) patients, the choice of treatment method was interosseous dynamic fixation with decompression of the spinal canal and decompression of the spinal canal without fixation.
RESULTS. All patients underwent surgical treatment. With the correct choice of the surgical method, a regression of neurological symptoms is observed, which allows the patient to return to work and the usual daily workload.
CONCLUSION. A well-chosen treatment method contributes to the rapid return of patients to their professional activities and normal physical activity. Individualization of surgical tactics allows minimizing the risks of postoperative complications, such as migration of metal structures, recurrence of hernia and infectious processes. A personalized approach ensures a shorter and more effective rehabilitation period, reducing recovery time and improving overall treatment outcomes. The creation and application of an individualized approach to surgical treatment, taking into account clinical symptoms, the results of X-ray examination and neurophysiological examination data, can significantly increase the effectiveness of surgical interventions in patients with multilevel discosis in the lumbar spine.

1. Podchufarova E. V., Yakhno N. N., Alekseev V. V., Avedisova A. S., Chakhava K. O., Ershova E. M. et al. Chronic pain syndromes of lumbosacral localization: the significance of structural musculoskeletal disorders and psychological factors. Pain. 2003;(1):38–43. (In Russ.).

2. Krutko A. V., Baikov E. S., Konovalov N. A., Nazarenko A. G. Segmental spinal instability: unsolved problems. Russian Journal of Spine Surgery. 2017;14(3):74–83. (In Russ.). Doi: 10.14531/ss2017.3.74-83. EDN: PDXQEN

3. Lutsik A. A., Sadovoy M. A., Krutko A. V., Epifantsev A. G., Bondarenko G. Yu. Degenerativedystrophic diseases of the spine. Novosibirsk. Novosibirsk branch of the publishing house “Nauka”; 2012. 264 p. (In Russ.).

4. Kuznetsov V. F. Handbook of vertebroneurology: clinic, diagnostics. Minsk: Belarus; 2000.

5. Destandau J. Endoscopic surgery of lumbar disc herniation. A study of 1562 cases. Russian Journal of Spine Surgery. 2006;(1):050–054. (In Russ.). Doi: 10.14531/ss2006.1.50-54. EDN: WBQPWN.

6. Galiano K., Obwegeser A. А., Gabl M. V., Bauer R., Twerdy K. Long-Term Outcome of Laminectomy for Spinal Stenosis in Octogenarians. Spine. 2005;(3):332–335. Doi: 10.1097/01.brs.0000152381.20719.50.

7. Vazan M., Gempt J., Meyer B., Buchmann N., Ryang Y.-M. Minimally invasive transforaminal lumbar interbody fusion versus open transforaminal lumbar interbody fusion: a technical description and review of the literature. Acta Neurochir (Wien) 2017;159(06):1137–1146. Doi: 10.1007/s00701-017-3078-3.

8. Walker C. T., Xu D. S., Godzik J., Turner J. D., Uribe J. S., Smith W. D. Minimally invasive surgery for thoracolumbar spinal trauma. Ann Transl Med. 2018;6(06):102. Doi: 10.21037/атм.2018.02.10.

9. Fu Y.-S., Zeng B.-F., Xu J.-G. Long-term Outcomes of Two Different Decompressive Techniques for Lumbar Spinal Stenosis. Spine. 2008;33(5):514–518. Doi: 10.1097/BRS.0b013e3181657dde.

10. Arestov S. O., Gushcha A. O., Kashcheev A. A. Specific features of technique and long-term results of portal endoscopic procedures in lumbosacral disk herniations. Burdenko’s Journal of Neurosurgery. 2011;75(1):27–33. (In Russ.). Doi: 10.1097/01.bsd.0000211268.43744.2a. EDN: PIZFER.

11. Schwab F., Benchick el-Fegoun A., Gamez L., Goodman H., Farcy J.-P. A Lumbar Classification of Scoliosis in the Adult Patient: Preliminary Approach. Spine. 2005;30(14):1670–1673. Doi: 10.1097/01.brs.0000170293.81234.f0.