Transpedicular fixation (TPF) as a method of posterior fusion is currently the most common, reliable and economically justified option of spinal fusion in various diseases and injuries of the lumbar spine, having more than half a century of history. As a result of the search for less invasive and more effective methods of fixation of the spinal segments to improve the results of surgical treatment, shorten the hospitalization, and reduce the number of perioperative complications, an approach involving fusion with rigid implant from the anterior (ALIF) was developed. Objective. To analyze the immediate and long-term results of treatment of single-level herniated discs by total removal of the intervertebral disc using anterior access with a rigid spondylodesis (ALIF) and the method of posterior discectomy, spondylodesis and transpedicular fixation (TPF). Materials and methods. A prospective cohort study was conducted. The study included patients after total intervertebral disc removal by the ALIF method and patients after discectomy and TPF. The achieved result was evaluated using radiological tests, as well as using standardized questionnaires and surveys. Results. After the surgery, patients in both groups showed a significant reduction in pain on the NRS scale. Patients from the first group had 4 to 0 for back and 8 to 0 for leg, patients from the second group had 6 to 4 for back and 8 to 0 for leg. The quality-of-life assessment by ODI scale also showed a positive trend from 36 to 4 in the first group and from 22 to 12 in the second group. Clinically, the result of surgical treatment was rated as excellent 5 in the ALIF group and as good in the TPF group 4 on the modified subjective assessment scale Macnab. Conclusion. The ALIF method as a decompression-stabilizing surgical aid is less traumatic. The less invasive nature of the technique was confirmed by significantly shorter surgical intervention time, smaller volume of intraoperative blood loss, and a shorter period of hospitalization. In the long-term period, statistically significant differences were obtained indicating that the ALIF method is more effective than TPF.
LONG-TERM RESULTS OF ANTERIOR SPINAL FUSION WITH VASCULARIZED RIB GRAFT FOR SEVERE KYPHOSCOLIOSIS IN NEUROFIBROMATOSIS
