Пункційна лазерна мікродискектомія в лікуванні великих гриж поперекового відділу хребта

M. M. Zorin

doi:10.26641/2307-0404.2013.2.15948

Authors

M. M. Zorin Medical Center "Endoscopic neurosurgery", Ukraine

DOI:

https://doi.org/10.26641/2307-0404.2013.2.15948

Keywords:

intervertebral disc hernia, puncture laser microdiscectomy

Abstract

Degree of hernia size influence on final result of PLME in 34 patients with discogenic neurocompressive lumbar spinal syndrome was detected. In medical center "Endoscopic Neurosurgery" from 2006 to 2010 we examined and treated 34 patients with hernia size from 6 to 8 mmby CT data. Patients were from 19 to 49 years of age. Average age was 35.9 ± 1.5 years. Males – 16 (47.1%), females – 18 (52.9%). Disease duration – 5.53 ± 0.44 months with duration of last exacerbation – 1.87 ± 0.21 months. Duration of conservative therapy is 4.6 ± 2.1 weeks. During survey and objective examination we determined pain syndrome intensity, pain location, degree of spinal static – dynamic function disorder. Neurological examination determined severity of sensory and motor disorders. Pain syndrome intensity, quality of life in patients before and after surgery, surgery effectiveness were determined by common scales: VAS, OSWESTRY, Roland - Morris, McNab. Before PLME we evaluated preoperative spondylograms performed with functional load. Height of intervertebral fissure was determined by these images. By SCT and MRI datawe measured hernia size, its shape and location as well as intervertebral disk dehydration degree. For PLME performance we used neodymium laser with aluminum garnet (Dorinyer Fibertom Medilas 4060) with wave-length of 1.06 micrometers. In the next period of observation after PLME its effectiveness was 79%, and in 3-5 years - 76%. At the same time it must be emphasized that 75% of patients with discogenic neurocompressive lumbar spinal syndrome significantly and for a long time improved their life quality avoiding more traumatic surgery. Satisfactory results with PLM use in the nearest future could be obtained in 79% of patients, in the remote term - in 76% of patients with large hernia size.

References

Баринов А.Н. Невропатический болевой син¬д-ром при болях в спине // Трудный пациент. – 2011. – Т. 9, № 1. – С. 17-23.

Зозуля Ю.А. Хирургическое лечение нейро-компрессионных пояснично – крестцовых болевых синдромов / Ю.А. Зозуля, Е.Г. Педаченко, Е.Н. Слынь-ко. – К.: УИПК «ЕксОб», 2006 – 348 с.

Лазерная хирургия межпозвонковых дисков: учебное пособие / Л.Д. Сак, Е.Х. Зубаиров, М.В. Ше-метова; под ред. проф. А.И. Козеля.- Магнитогорск, 2002. – 78 с.

Практическая нейрохирургия: руководство для врачей / под ред. Б.В. Гайдара. – СПб.: Гиппократ, 2002. – 648 с.

Продан А.И. Дегенеративные заболевания поз-воночника / А.И. Продан, В.А. Радченко, Н.А. Корж. – Харьков.: ИПП «Конраст», 2007. – с. 272.

Пункционная лазерная дискэктомия при дис-когенных пояснично-крестцовых радикулитах / Е.Г. Пе¬даченко [и др.] // Клинич. хирургия. – 1998. – №6. – С. 14-26.

Сак Л.Д. Чрескожная эндоскопическая нуклео-томия нижнепоясничных дисков: обзор литературы / Л.Д. Сак, Е.Х. Зубаиров, А.И. Козель // Хирургия поз-во¬ночника. – 2005. - №1. – С. 74 – 84.

Хижняк М.В. Малоинвазивная хирургия дис-когенных нейрокомпрессионных синдромов пояснич-ного отдела позвоночника: автореф. дис. на соискание учен. степени д-ра мед. наук: спец. 14.01.05 / М.В. Хижняк – К., 2006. – 39 с.

Эндоскопическая лазерная декомпрессия меж-позвонковых дисков / Мусалатов Х.А. [и др.] // Акту-альные вопросы лазерной медицины и операционной эндоскопии: материалы. науч.- практ. конф. - М., 1994. - С. 151-153.

Abramovitz Y.N. Complications of surgery for discogenic disease of the spine / Y.N. Abramovitz // Neu-ro¬surgery Clin. North Am. – 1993. – Vol 4, N 1. – P.167-176.

Barauh J.K. Lancinating pain in post-lami¬nec-tomy chronic sciatica / J.K. Barauh // Acta Neurochir. – 1985. – Vol. 76, N 3-4. – P.129-130.

Gibson J.N. Surgical interventions for lumbar disc prolapse: updated Cochrane Review / J.N. Gibson, G. Waddell // Spine. – 2007. – Vol. 32, N 16. – P. 1735-1747.

Laser engineering of spine discs / Sobol E. [et al.] // Laser Physics.- 2009.- Vol. 19, N 4. – P.825-835.

Laser regeneration of spine discs cartilage: me-chanism, in vivo study and clinical application / Sobol E. [et al.] // Light-Activated Tissue Regeneration and The-rapy: Proceedings of Conference. – London: Springer, 2008. – P.259-266.

Laser shaping of composite cartilage grafts / Heli-donis E. [et al.] // Am. J. Otolaryngology. – 1993. – Vol. 14, N 6. – P.410-412.

Lavyne M.H. Complications of percutaneous laser nucleolysis / M.H. Lavyne // J. Neurosurg. – 1992. – Bd. 76, H. 6. – S. 1041.

Singh V. Percutaneous lumbar disc decom-pression / V. Singh, R. Derby // Pain Physician. – 2006. – N 9. – P. 139-146.

Spinal Disorders: Fundamentals of Diagnosis and Treatment / N. Boos, M. Aebi // Spinal Disorders. – Elsevier, 2008. – P. 18-56.

Tassi G.P. Comparison of results of 500 micro-discectomies and 500 percutaneous laser disc decom-pression procedures for lumbar disc herniation / G.P.Tassi // Photomed Laser Surg. – 2006. – Vol. 24, N 6. – P.694-697.

The history of spinal surgery for disc disease: an illustrated timeline / I. Castro, D.P.Santos, H. Christoph Dde, J.A. Landeiro // Arq. Neuropsiquiatr. – 2005. – Vol. 63, N 3A. – P.701-706.

Transforaminal percutaneous endoscopic lumbar discectomy for upper lumbar disc herniation: clinical outcome, prognostic factors, and technical consideration / Y. Ahn, S.H. Lee, J.H. Lee, J.U. Kim [et al.] Acta Neu-rochir. – 2009. – Vol. 151, N 3. – P.199-206.

Barinov AN. Nevropaticheskij bolevoj sindrom pri boljah v spine. Trudnyj pacient. 2011;9(1):17-23.

Zozulja JuA, Pedachenko EG, Slyn'ko EN. Hirur-gicheskoe lechenie nejrokompressionnyh pojasnichno – krestcovyh bolevyh sindromov. K: UIPK «EksOb». 2006;348.

Sak LD, Zubairov EH, Shemetova MV, pod red Kozelja AI. Lazernaja hirurgija mezhpozvonkovyh dis-kov: uchebnoe posobie. Magnitogorsk. 2002;78.

pod red Gajdara BV. Prakticheskaja nejro¬hirur-gija: rukovodstvo dlja vrachej. SPb: Gippokrat. 2002;648.

Prodan AI, Radchenko VA, Korzh NA. Dege-nerativnye zabolevanija pozvonochnika. Har'kov: IPP «Konrast». 2007;272.

Pedachenko EG. Punkcionnaja lazernaja diskjek-tomija pri diskogennyh pojasnichno-krestcovyh radiku-litah. Klinich hirurgija. 1998;6:14-26.

Sak LD, Zubairov EH, Kozel' AI. Chreskozhnaja jendoskopicheskaja nukleotomija nizhnepojasnichnyh diskov: obzor literatury. Hirurgija pozvonochnika. 2005;1:74-84.

Hizhnjak MV. Maloinvazivnaja hirurgija disko-gennyh nejrokompressionnyh sindromov pojasnichnogo otdela pozvonochnika: avtoref dis na soiskanie uchen stepeni d-ra med nauk: spec 14.01.05 K. 2006;39.

Musalatov HA. Jendoskopicheskaja lazernaja dekompressija mezhpozvonkovyh diskov. Aktual'nye voprosy lazernoj mediciny i operacionnoj jendoskopii: materialy nauch-prakt konf M. 1994;151-3.

Abramovitz YN. Complications of surgery for discogenic disease of the spine. Neurosurgery Clin North Am. 1993;4(1):167-76.

Barauh JK. Lancinating pain in post-laminectomy chronic sciatica. Acta Neurochir. 1985;76(3-4):129-30.

Gibson JN, Waddell G. Surgical interventions for lumbar disc prolapse: updated Cochrane Review. Spine.2007;32(16):1735-47.

Sobol E. Laser engineering of spine discs. Laser Physics. 2009;19(4):825-35.

Sobol E. Laser regeneration of spine discs carti-lage: mechanism, in vivo study and clinical ap¬plication. Light-Activated Tissue Regeneration and Therapy: Pro-cee¬dings of Conference. Springer. 2008;259-66.

Helidonis E. Laser shaping of composite cartilage grafts. Am J Otolaryngology. 1993;14(6):410-2.

Lavyne MH. Complications of percutaneous laser nucleolysis. J Neurosurg. 1992;76(6):1041.

Singh V, Derby R. Percutaneous lumbar disc de-compression. Pain Physician.2006;9:139-46.

Boos N, Aebi M. Spinal Disorders: Fundamentals of Diagnosis and Treatment. Spinal Disorders. Elsevier. 2008;18-56.

Tassi GP. Comparison of results of 500 micro-discectomies and 500 percutaneous laser disc decom-pression procedures for lumbar disc herniation. Photomed Laser Surg. 2006;24(6):694-7.

Castro I, Santos DP, Christoph Dde H, Landeiro JA. The history of spinal surgery for disc disease: an illus-trated timeline. Arq Neuropsiquiatr. 2005;63(3A):701-6.

Ahn Y, Lee SH, Lee JH, Kim JU. Transforaminal percutaneous endoscopic lumbar discectomy for upper lumbar disc herniation: clinical outcome, prognostic factors, and technical consideration. Acta Neurochir. 2009;151(3):199-206.