[Percutaneous endoscopic discectomy in the treatment of patients with degenerative diseases of the lumbosacral spine]

[Outcomes of lumbar decompression microsurgery]

BACKGROUND

Microsurgical decompression of the spinal root in patients with herniated intervertebral discs is the most common spinal surgery. However, most national and foreign studies devoted to assessment of postoperative outcomes contain no consensus on the timing of radicular pain syndrome relief after decompression and predictors of unfavorable outcomes.

OBJECTIVE

To determine the period of radicular pain syndrome relief after microsurgical decompression and to identify clinical and neuroimaging predictors of unfavorable postoperative outcomes.

MATERIAL AND METHODS

The study included 58 patients aged 26-73 years with clinical manifestations of L5 radiculopathy following compression by L4-L5 herniated disc. We assessed neurological status, functional state (Oswestry Disability Index) and fatty infiltration of paravertebral muscles. Results. Isolated radicular pain was observed in 31% of patients, combination of pain syndrome and sensory disorders - 17%, pain syndrome and motor disorders - 24%, pain syndrome, sensory and motor disorders - 28% of patients. Duration of disease until surgery was significantly longer in women (p=0.030). Complete relief of radicular pain immediately after surgery was observed in 24 (48%) patients. Sixteen (32%) patients had persistent pain syndrome for up to 1 month. Relief of radicular pain on the first postoperative day was significantly more common in patients without motor disorders (p<0.014). The outcomes of microsurgical decompression did not depend on duration of disease (p=0.551), sex (p=0.794), age (p=0.491) and degree of fatty infiltration of paravertebral muscles (p=0.686).

CONCLUSION

Radicular pain regresses within 4 weeks after microsurgical decompression. The predictor of unfavorable postoperative outcomes (long-standing pain syndrome and no functional improvement) is any preoperative motor impairment.

[Two treatment approaches for lumbar disc herniation and sequester migration to the second and third McCulloch's windows: transpedicular and translaminar sequestrectomy (ridit analysis)]

A ridit analysis of results of transpedicular endoscopic and translaminar microsurgical surgeries for sequester migration to the second and third McCulloch's windows was carried out. The authors assessed pain syndrome, quality of life and neurological impairment.

OBJECTIVE

To compare the outcomes of transpedicular and translaminar sequestrectomy for lumbar disc herniation and sequester migration to the second and third McCulloch's windows.

MATERIAL AND METHODS

We analyzed treatment outcomes in 51 patients with lumbar disc herniation and severe sequester migration. We assessed lumbar and leg pain syndrome using then visual analogue scale, neurological impairment using the adapted Nurik scale and quality of life using the Oswestry questionnaire and the MacNab scale in early postoperative period, as well as in 2 weeks, 6 and 12 months after surgery. Ridit analysis was used for statistical processing of data.

RESULTS

Transpedicular sequestrectomy was performed in 24 patients, translaminar sequestrectomy - in 27 cases. Groups were comparable by gender, size and location of sequestration, somatic and neurological status, as well as pain severity. There was a higher probability of back (0.39) and leg (0.364) pain regression, neurological recovery (0.446) and improvement of quality of life according to the Oswestry questionnaire (0.389) after transpedicular surgery. According to the MacNab scoring system, excellent and good results were obtained in 84.21% and 15.79% of patients in 6 months after transpedicular surgery. In the second group, excellent, good and satisfactory results were obtained in 63%, 25.9% and 11.1% of patients, respectively.

CONCLUSION

Herniated intervertebral discs with severe sequester migration should be divided in accordance with localization of the main sequestration. Transpedicular endoscopic approach is advisable for sequester in the third and rarely the second McCulloch's windows. Translaminar microsurgical approach is preferred for sequestration in the second and rarely the third McCulloch's windows. Clinical outcomes after translaminar microsurgical sequestrectomy and transpedicular endoscopic surgeries are similar. However, postoperative back and leg pain regression, neurological recovery and improvement of quality of life according to the Oswestry scoring system are more common after transpedicular surgery.

[Neurosurgery in Moscow: clinic - institute - ational center]

In 1929, a surgeon N.N. Burdenko and a neurologist V.V. Kramer founded the first neurosurgical clinic in Moscow, which was reorganized to the Institute of Neurosurgery in 1932. The Institute has come a long way through military and peaceful years, overcoming all sorts of obstacles. It has constantly developed, built, and modernized, and now this is the National Medical Research Center of Neurosurgery. In this article, we describe the history of the Institute/Center and its staff who have had a significant impact on the development of domestic and global neurosurgery.