Abstract
Objective. To analyze clinical effectiveness of repositioning decompression of the dural sac and to justify a differentiated approach to the decompression for traumatic spinal stenosis caused by damages of lower thoracic and lumbar vertebral bodies. Material and Methods . A total of 103 adult patients with injuries of the lower thoracic and lumbar spine accompanied by traumatic spinal canal stenosis were treated: 76 patients were included in the study group and 27 - in the control group. All patients underwent decompressive-stabilizing surgery with transpedicular fixation. In the study group, the priority was given to indirect repositioning decompression (more 50 %), in the control group - decompressive laminectomy (100 %). Results . In the study group, long-term results of treatment were assessed as good in 38 (79.2 %) cases, satisfactory - in 8 (16.7 %), and poor - in 2 (4.2 %). In the control group, good results were obtained in 13 (72.2 %) patients, satisfactory - in 4 (22.2 %), and poor - in 1 (5.6 %). Conclusion . Differentiated approach to decompression of the dural sac in patients treated for lower thoracic or lumbar spine injuries and traumatic spinal canal stenosis allowed avoiding laminectomy in 53.9 % of patients in the study group and performing anterior decompression consisting of subtotal corpectomy 1.9 times less often than in the control group.
Highlights
Differentiated approach to the treatment of patients with fractures of lower thoracic and lumbar vertebral bodies and traumatic spinal stenosis A.A
To analyze clinical effectiveness of repositioning decompression of the dural sac and to justify a differentiated approach to the decompression for traumatic spinal stenosis caused by damages of lower thoracic and lumbar vertebral bodies
Differentiated approach to decompression of the dural sac in patients treated for lower thoracic or lumbar spine injuries and traumatic spinal canal stenosis allowed avoiding laminectomy in 53.9 % of patients in the study group and performing anterior decompression consisting of subtotal corpectomy 1.9 times less often than in the control group
Summary
To analyze clinical effectiveness of repositioning decompression of the dural sac and to justify a differentiated approach to the decompression for traumatic spinal stenosis caused by damages of lower thoracic and lumbar vertebral bodies. Differentiated approach to decompression of the dural sac in patients treated for lower thoracic or lumbar spine injuries and traumatic spinal canal stenosis allowed avoiding laminectomy in 53.9 % of patients in the study group and performing anterior decompression consisting of subtotal corpectomy 1.9 times less often than in the control group. На сегодняшний день достаточно четко сформулированы общие принципы лечения нестабильных повреждений нижнегрудного и поясничного отделов позвоночника, которые требуют выполнения декомпрессии дурального мешка, репозиции травмированного отдела позвоночника, надежной стабилизации и пластической реконструкции опорных вентральных структур травмированных позвоночно-двигательных сегментов (ПДС) [2, 5, 7, 11, 15, 16]. Вто же время по вопросу выполнения декомпрессии дурального мешка единого мнения нет. Цель исследования – анализ клинической эффективности репозиционной декомпрессии дурального мешка и обоснование дифференцированного подхода к выполнению декомпрессии при повреждениях тел нижнегрудных и поясничных позвонков, сопровождающихся травматическим стенозом позвоночного канала
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