The prophylactics of the epidural scar after discectomy at failed back surgery syndrome in lumbar osteochondrosis

Abstract

Abstract: The proposed method of saving the yellow ligament in discectomy differs from existing ones with that, that in it pereformed the edge arcotomy of higher and lower archs with the help of Kerrison’s instrument; the yellow ligament exempts from its attachment to the bone structures with the saving it to the lateral edge of the vertebra at the site of facet joints with the length of about 4 mm. yellow ligament is taken by the ligature, and after the disc removal returns to its original position and fixed to the surrounding tissues. Keywords: failed back surgery syndrome, discectomy, preservation of yellow ligament, epidural scars. The failed back surgery syndrome is a condition charac‑terized by postoperative pain in the lower back and/or leg with a various degree of functional disability, which reduces the quality of life and labour activity of the patient.Herniated discs are among the most frequent patho‑logical substrates of this disease and are largely responsible for the development of the group compressive syndromes requiring surgical treatment. Observed in recent years, the increase in surgical activity the treatment of compression forms of lumbar osteochondrosis actively contributes to the development and improvement of operational methods [4, 190–192; 11, 262–263].According to some authors, the incidence of epidural scars reaches 8–25% among other reasons of unsatisfactory outcomes at a distant period of lumbar discectomy [3, 159; 6, 64–67; 14, 287–288]. Epidural scars in the postoperative period due to compression of neural structures contributes to chronic pain, is quite difficult to treat, leading to a signifi‑cant percentage of disability of patients and serious economic losses [7, 26–32; 10, 89].Mechanisms of excessive formation of connective tis‑sue in the epidural space in response to the surgical trauma are still not completely investigated. Significantly it is not clear why under the same conditions in patients after sur‑gery developed either are entirely absent epidural scars of varying severity.It is early considered that fibrous tissue grows into the epidural space from the damaged disk. In the works of Laroc and Macnab the main cause of scars is the migration of fi‑broblasts, mostly from corrupted when accessed paraspinal muscles. Additional factors stimulating the development of scar adhesions may be products of blood disinteration, hence there is the need to put drainage after the operation. In the first 3 weeks in the surgery area is formed granulation, and then fibrous tissue with the formation of epidural scar. Scar tissue “in the place of surgery in varying degrees, is de‑veloping three months later” [10, 89].By 6 months, swelling in the epidural space completely replaced by scars, which may slightly decrease in volume in the first year after the operation. Not always the severity of epidural scars is “proportional” to pain syndrome that may be the result of the degree of compression of the spine of the scar adhesions periradicular and different capabilities of the applied x‑ray diagnostic methods in the postopera‑tive period.A method is developed for predicting the severity of epi ‑dural scars by taking into consideration anthropometric, im‑munological and immunogenetic data that take into account about 20 different indicators. The disadvantage of using this method is that it allows for an uncertain prognosis [8, 68–73].You can solve the problem intraoperatively. Intraoperative topical application of urokinase, mitomycin‑ C, tissue plasmin‑ogen activator, hyaluronic acid, corticosteroids, radiation ther ‑apy did not lead to the expected results [2, 507–513; 5, 68].Some authors use a piece of hemostatic sponge on