Aleksandr Timofeyevich Khudyaev
◽
Sergey Vladimirovich Lyulin
◽
Elena Nikolayevna Schurova
Objective. To determine a rational surgical strategy and approach to the treatment of patients with degenerativedystrophic disorders of the lumbar spine by percutaneous endoscopic discectomy. Material and Methods. Percutaneous endoscopic nucleotomy was applied in surgical treatment of 60 patients. Out of them 46 patients had L4–L5 intervertebral disc herniation, 7 patients had L3–L4 intervertebral disc herniation, 2 patients – L4–L5 hernia relapse after microdiscectomy, 1 patient – ossificated foraminal hernia at L3–L4, 3 patients – unstable degenerative spondylolisthesis at L4 level, and 1 – the same at L3. Complex examination of patients included acquisition of complaints and anamnestic data, general clinical, neurological, laboratory, and radiologic evaluation. All patients had CT images, in 10 cases they were added by MRI, and in 16 cases – by CT myelography. Pain syndrome intensity was assessed by digital rating and visual-analogue scales allowing the analysis of pain at rest, in motion, and at night. Results. Pain syndrome was arrested in 51 patients. Two patients showed residual radicular syndrome in the early postoperative period, and seven patients – residual reflex pain syndrome. Three months after the operation moderate reflex pain syndrome was observed in 6 cases, radicular syndrome in no one case. No aggravation of neurological deficit occured at the later follow-up period. Conclusion. Percutaneous endoscopic nucleotomy is a minimal invasive technique for lumbar disc hernia removal which reduces hospitalisation terms and risk of postoperative complications.
Risk Factors for Reoperation in Patients Treated Surgically for Intervertebral Disc Herniation
