Abstract
Objective. To assess feasibility of the proposed anterior decompression and stabilization surgery without meningoradiculolysis for recurrent herniation of the lumbar intervertebral disc. Material and Methods . Prospective randomized controlled study involved comparative evaluation of two essentially different surgical interventions performed in 130 patients with recurrent disc herniation during 2005-2012. The control group included 62 patients who underwent posterior decompression and stabilization surgery with meningoradiculolysis for the removal of herniated disc. The study group included 68 patients who underwent the proposed anterior decompression and stabilization surgery, which differs by an obligate opening of the spinal canal and intervertebral foramen to remove the disc herniation through an anterior approach without meningoradiculolysis. Results . Immediate results of anterior and posterior decompression and stabilization operations are comparable, though posterior interventions are more frequently associated with iatrogenic injury to posterior nerve roots caused by intervertebral implant insertion and meningoradiculolysis required before the disc herniation removal. Long-term outcomes of anterior operations are reliably better. Conclusion . Anterior decompression and stabilization operations for recurrent disc herniation compare favorably to posterior ones, since they are less traumatizing to the nerve roots and prevent herniation recurrence and epidural fibrosis progression.
Highlights
The study group included 68 patients who underwent the proposed anterior decompression and stabilization surgery, which differs by an obligate opening of the spinal canal and intervertebral foramen to remove the disc herniation through an anterior approach without meningoradiculolysis
Immediate results of anterior and posterior decompression and stabilization operations are comparable, though posterior interventions are more frequently associated with iatrogenic injury to posterior nerve roots caused by intervertebral implant insertion and meningoradiculolysis required before the disc herniation removal
[Bulatov AV, Kozlov DM, Krutko AV, et al Efficacy of minimally invasive decompression and stabilization in surgical treatment of recurrent pain after lumbar spine surgery
Summary
To assess feasibility of the proposed anterior decompression and stabilization surgery without meningoradiculolysis for recurrent herniation of the lumbar intervertebral disc. The control group included 62 patients who underwent posterior decompression and stabilization surgery with meningoradiculolysis for the removal of herniated disc. The study group included 68 patients who underwent the proposed anterior decompression and stabilization surgery, which differs by an obligate opening of the spinal canal and intervertebral foramen to remove the disc herniation through an anterior approach without meningoradiculolysis. Immediate results of anterior and posterior decompression and stabilization operations are comparable, though posterior interventions are more frequently associated with iatrogenic injury to posterior nerve roots caused by intervertebral implant insertion and meningoradiculolysis required before the disc herniation removal.
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