Minimally invasive neurosurgery of lumbar disc herniations
Abstract
OBJECTIVE: Analysis of literature data of modern neurosurgical techniques in the treatment of lumbar disc herniation; clarification of the features of surgical tactics and results during microsurgical, endoscopic methods and laser thermoplastic of the intervertebral disk.
METHODS: A retrospective analysis of the results of conventional microdiscectomy (228 cases), laser disc decompression (22 observations) and percutaneos endoscopic discectomy (4 observations) for lumbar disc herniation from 2016 to 2018.The results of surgical treatment was assessed according to the Oswestry Disability Index (ODI), Visual Analog Scale (VAS), modified MacNab criteria, and morphometric data of MRI and CT scans during the preoperative and postoperative periods, as well as 6 and 12 months after surgery.
RESULTS: The result of the study was a comparison of the literature data with those obtained in our clinic in the treatment of patients using all the indicated methods. On our material, we received confirmation of the feasibility and perspectivity of using minimally invasive methods in the treatment of lumbar disc herniation with low probability of recurrence and repeated treatment for pain. Also agree with the statement that the techniques have limited application, especially with instability in the VMS and multilevel lesion.
CONCLUSION: Endoscopic discectomy, as well as laser disc decompression, are minimally invasive methods of treatment lumbar disc herniation, and have become an alternative to open lumbar microdiscectomy, as they allow minimizing surgical trauma, the effects of surgery, and quickly regress pain syndrome, contributing to early postoperative activation of the patient.
About the Authors
A. V. GorodninaRussian Federation
A. M. Meredzhi
Russian Federation
Saint-Petersburg
A. V. Ivanenko
Russian Federation
Saint-Petersburg
A. Yu. Orlov
Russian Federation
Saint-Petersburg
A. S. Nazarov
Russian Federation
Saint-Petersburg
K. B. Abramov
Russian Federation
Saint-Petersburg
K. A. Samochernykh
Russian Federation
Saint-Petersburg
References
1. G. A. Asaturian. Immediate results of nucleoplasty in patients with lumbar intervertebral herniations / G. A. Asaturyan, P. V. Tunimanov // Creative Surgery and Oncology 2011, № 4.28–31
2. Мержоев А.М. Перкутанное эндоскопическое трансфораминальное удаление верхних поясничных грыж/ А.М. Мержоев, Д.А. Гуляев, С.Б. Сингаевский и соавт.// Российский нейрохирургический журнал имени проф. А.Л. Поленоваю — 2017, № 4 23 30
3. Shchedrenok V. V. The use of a diode laser in surgery of intervertebral discs in osteochondrosis of the vertebral column / Shchedrenok V. V., Ivanenko A. V., Sebelev K.I., Moguchaya O. V., Zevakhin S. V. // Herald of Surgery –2009, № 5, 42–43
4. Yakovenko IV Russian Research Neurosurgical Institute named after prof. A. L. Polenova: from the creation of a service to the latest neurosurgical technologies. / Yakovenko I. V., Ivanova N. E., Kondakov E. N., Ulitin A. Yu., Simonova I. A. // Translational Medicine — 2015; 2 (5): 30–38.
5. Andrews DW, Lavyne MH. Retrospective analysis of microsurgical and standard lumbar discectomy. Spine 1990; 15: 329–335.
6. Annertz M, Jönsson B, Strömqvist B, Holtås S. No relationship between epidural fibrosis and sciatica in the lumbar postdiscectomy syndrome.A study with contrast-enhanced magnetic resonance imaging in symptomatic patients. Spine (Phila Pa 1976) 1995;20:449–53.
7. Chao Liu. Percutaneous endoscopic lumbar discectomy and minimally invasive transforaminal lumbar interbody fusion for massive lumbar disc herniation/Chao Liu, Yue Zhou// Clinical Neurology and Neurosurgery –2019–176 – p19–24- doi:10.1016/j.clineuro.2018.10.017
8. Dandy WE. Loose cartilage from intervertebral disc simulating tumor of the spinal cord. Arch Surg 19: 660–672, 1929.
9. Ebeling U, Reichenberg W. Results of microsurgical lumbar discectomy. Review of 485 patients/ Acta Neurochir. 1986; 81: 45–52.
10. Fan Feng Qianqian Xu. Comparison of 7 Surgical Interventions for Lumbar Disc Herniation: A Network Meta-analysis./Fan Feng Qianqian Xu, Feifei Yan, Yuanlong Xie, Zhouming Deng, Chao Hu, MD2, Xiaobin Zhu, Lin Cai//-Pain Physician –2017 — №20 863 871
11. Ferrer E, Garcia-Bach M., Lumbar microdiscectomy: analysis of 100 consecutive cases. Its pitfalls and final results. Acta Neurochir. Suppl. 1988; 43: 39–43.
12. Fritsch E.W., Heisel J., Rupp S. The failed back surgery syndrome: reasons, intraoperative findings, and long-term results: a report of 182 operative treatments // Spine. — 1996. — Vol. 21. — P. 626–633.
13. Hermantin FU, Peters T. A prospective randomized study comparing the results of discectomy with those of video-assisted arthroscopic microdiscectomy. J. bone joint surgery 1999; 81: 958–965.
14. Jia Yue Bai. Percutaneous transforaminal endoscopic discectomy in the treatment of senior patients with lumbar degenerative disc disease/Jia Yue Bai, Wei Zhang, Xiangzhou Liu, Jinghang Cheng, Xianzheng Wang, Wenyuan Ding, Yong Shen// Experimental And Therapeutic Medicine –2019–17(1) — p874–882 — doi:10.3892/etm.2018.6996
15. Kato Y., Panjabi M.M., Nibu K. Biomechanical study of lumbar spinal stability after osteoplastic laminectomy // Journal of Spinal Disorders. — 1998. — Vol.11. — P. 146–150.
16. Kotilainen E., Gerber B. E., Knight M., Siebert W. E., eds. Clinical instability of the lumbar spine after microdiscectomy. Lasers in the Musculoskeletal System. — Berlin; Heidelberg; New York: Springer, 2001. — P. 241–243.
17. Lewis P.J., Weir B.K., Broad R.W., Grace M. G. Long-term prospective study of lumbosacral discectomy // Journal of Neurosurgery. — 1987. — Vol. 67. — P. 49–53.
18. Mixter WJ, Barr JS. Rupture of intervertebral disc with involvement of the spinal canal. N Eng J Med 211: 210–215, 1934
19. Nitesh Patel. Percutaneous Lumbar Laser Discectomy: Literature Review and a Retrospective Analysis of 65 Cases/Nitesh Patel, Vikram Singh// Photomedicine and Laser Surgery — 20148 — No10 — DOI:10.1089/pho.2018.4460
20. Nystrom B. Experience of microsurgical compared with conventional technique in lumbar disc operations. Acta Neurol Scand 1987; 76: 129–141.
21. Ruetten S., Meyer O., Godolias G. Epiduroscopic diagnosis and treatment of epidural adhesions in chronic back pain syndrome of patients with previous surgical treatment: first results of 31 interventions // Zeitschrift fu_r Orthopa_die Und Ihre Grenzgebiete. — 2002. — Vol. 140. — P. 171–175.
22. Rui Shi. Comparison of percutaneous endoscopic lumbar discectomy versus microendoscopic discectomy for the treatment of lumbar disc herniation: a meta-analysis/Rui Shi, Feng Wang, Xin Hong, Yun-Tao Wang, Jun-Ping Bao, Lei LiuXiao-Hu Wang, Zhi-Yang Xie, Xiao-Tao Wu//International Orthopaedics — 2018–43(4) — p923–937— doi: 10.1007/s00264-018-4253-8
23. Rutten S., Komp M., Godolias G. Spinal cord stimulation (SCS) using an 8-pole electrode and double-electrode system as minimally invasive therapy of the post-discotomy and postfusion syndromeprospective study results in 34 patients // Zeitschrift fu_r Orthopa_die Und Ihre Grenzgebiete. — 2002. — Vol. 140. — P. 626–631
24. Saeid Abrishamkar. Comparison of open surgical discectomy versus plasma-laser nucleoplasty in patients with single lumbar disc herniation///Saeid Abrishamkar, Masih Kouchakzadeh, Ahmad Mirhosseini, Homayoun Tabesh, Majid Rezvani, Amir Moayednia, Babak Ganjeifar, Amir Mahabadi, Elham Yousefi, Ali Mehrabi Kooshki / Journal of Research in Medical Sciences — 2015–20(12)- 1133–1137 — doi: 10.4103/1735–1995.172979
25. Schoeggl A., Maier H., Saringer W., Reddy M., Matula C. Outcome after chronic sciatica as the only reason for lumbar microdiscectomy // Journal of Spinal Disorders & Techniques. — 2002. — Vol. 15. — P. 415–419.
26. Sebastian Ruetten. Full-Endoscopic Interlaminar and Transforaminal Lumbar Discectomy Versus Conventional Microsurgical Technique/ Sebastian Ruetten, Martin Komp, Harry Merk, and Georgios Godolias// SPINE 2008–33(9) — p 931–939 — doi:10.1097/BRS.0b013e31816c8af7
27. Steinke CR. Spinal tumors: statistics on a series of 330 collected cases. J Nerv Ment Dis 1918; 47:418–26.
28. Stookey B. Compression of spinal cord due to ventral extradural chondromas: diagnosis and surgical treatment. Arch Neurol Psychiatry 1928; 20: 275–91.
29. Xijia Jiang.Clinical effects of transforaminal and interlaminar percutaneous endoscopic discectomy for lumbar disc herniation/ Xijia Jiang, Xindie Zhou, Nanwei Xu.//Medicine — 2018Nov97(48) — doi:10.1097/MD.0000000000013417
30. Gyu Yeol Ji. Safety and Effectiveness of Transforaminal Epiduroscopic Laser Ablation in Single Level Disc Disease: A Case-Control Study./ Gyu Yeol Ji, Jongsun Lee, Sang Won Lee, Bo Young Cho, Dong Won Ha, Young Mok Park, Dong Ah Shin// Pain Physician–2018; 21,643–650
Review
For citations:
Gorodnina A.V., Meredzhi A.M., Ivanenko A.V., Orlov A. ., Nazarov A.S., Abramov K.B., Samochernykh K.A. Minimally invasive neurosurgery of lumbar disc herniations. Russian Neurosurgical Journal named after Professor A. L. Polenov. 2020;12(3):5-11. (In Russ.)