Abstract
Background. Highly migrated disc herniations are usually localized in the area of pars interarticularis medially to the vertebral pedicle. Removal of disk herniations of this localization is a difficult technical task.The study objective is to demonstrate the effectiveness of the transpedicular endoscopic discectomy in the treatment of patients with highly migrated disc herniations.Materials and methods. The results of treatment of 12 patients with Macnab zone herniations who were in hospital from 2016 to 2018 were analyzed. All patients underwent transpedicular endoscopic sequestrectomy.Results. Leg pain after surgery regressed in all patients from the initial 7.41 points (visual-analog scale) to 0.67 points by the end of the 1st day, and it was 0.35 points a year later. The average level of back pain by VAS before surgery was 5.25, on the 1st day after surgery – 1.25 points, 1 year after – 0.67 points. Neurological disorders completely regressed in 10 (91.6 %) patients, there were a slight residual L4 dermatome hypesthesia in 2 patients, without disrupting their quality of life. The average Oswestry Disability Index before surgery was 69.17, and 1 year after surgery was 14.12. There were no complications and reoperations.Conclusion. Transpedicular endoscopic discectomy allowed us to achieve good treatment results in patients with migration of a lumbar hernia by the pedicle. It can be a safe and effective alternative to the transforaminal or interlaminar endoscopic technique.
Highlights
Migrated disc herniations are usually localized in the area of pars interarticularis medially to the vertebral pedicle
The study objective is to demonstrate the effectiveness of the transpedicular endoscopic discectomy in the treatment of patients with highly migrated disc herniations
Leg pain after surgery regressed in all patients from the initial 7.41 points to 0.67 points by the end of the 1st day, and it was 0.35 points a year later
Summary
Грыжи с высокой степенью миграции, как правило, локализуются в области межсуставной части позвонка медиальнее ножки. Цель исследования – оценить эффективность метода транспедикулярной эндоскопической секвестрэктомии в лечении пациентов с грыжами, характеризующимися высокой степенью миграции. Проанализированы результаты лечения 12 пациентов с грыжами поясничного отдела позвоночника с миграцией в зону Макнаба, находившихся на стационарном лечении в 2016–2018 гг. Средняя интенсивность боли в ноге к концу 1‐х суток после операции снизилась с 7,41 до 0,67 балла по визуальноаналоговой шкале, а через 1 год составила 0,35 балла. Средняя интенсивность боли в спине оценивалась до операции в 5,25 балла, в 1‐е сутки после нее снизилась до 1,25 балла, через 1 год – до 0,67 балла. Ключевые слова: транспедикулярная эндоскопия, грыжи с высокой степенью миграции, малоинвазивная хирургия, грыжи поясничного отдела позвоночника. Транспедикулярное эндоскопическое удаление грыж поясничного отдела позвоночника с высокой степенью миграции. Ochapovsky, Ministry of Health of the Krasnodar Region; 167 1 May St., Krasnodar 350086, Russia
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