Intervertebral Herniation Research Articles

КОНСЕРВАТИВНЫЕ МЕТОДЫ ЛЕЧЕНИЯ ГРЫЖ МЕЖПОЗВОНКОВЫХ ДИСКОВ

In the modern world, herniated intervertebral discs are one of the most common pathologies, often occurring among the working-age population. Protrusion of the intervertebral disc beyond the cross-section of the vertebra can lead to severe pain (even disability) due to mechanical compression of the nerve root and, with extrusion of the nucleus pulposus, inflammatory reactions. Thus, to date, pain syndrome that has developed as a result of a hernia occurs in 9% of the world's population. Thus, the treatment of intervertebral hernias is one of the pressing problems of the modern world. Radical treatment - surgical, is associated with a number of complications and does not always lead to the desired results. For this reason, surgical treatment should be carried out only if conservative methods are ineffective, among which physiotherapy occupies a special place. The purpose of this work is a literary analysis of physiotherapy methods currently used for the treatment of herniated intervertebral discs and to determine their place in the complex therapy of this pathology. The review examines the nature of intervertebral hernias, some of the physiological reactions they cause, in particular, the mechanisms of pain syndrome formation are indicated. We also described in detail the main methods of physiotherapy currently used for herniated intervertebral discs, such as electrophoresis, balneological procedures, spinal traction; the mechanisms of their influence on the damaged intervertebral disc are indicated, allowing to eliminate or reduce the intensity of the pain syndrome; The need for an integrated approach in the treatment of the pathology under study was determined.

Influence of pulsed electromagnetic field on the course of intervertebral hernia of the cervical spine

BACKGROUND: A herniated disc of the cervical spine is a common cause of neck pain that results from leakage of the nucleus pulposus from the annulus fibrosus and creating pressure on the spinal cord and nerve roots.
 AIM: to study the effect of therapy with a pulsed electromagnetic field on pain, disability, psychological state and quality of life in intervertebral hernia of the cervical spine.
 MATERIALS AND METHODS: Patients were randomly divided into two groups, including group 1, who received therapy consisting of transcutaneous electrical nerve stimulation, thermal procedures, and pulsed electromagnetic field, and group 2, who received a false magnetic field in addition to transcutaneous electrical nerve stimulation and thermal procedures. Pain was assessed using a visual analogue scale (VAS). Other outcome measures were pain and disability (Neck Pain and Disability Scale), anxiety-depression (Hospital Anxiety and Depression Scale), and quality of life (Nottingham Health Profile). All evaluations were performed before treatment, at week 3, and at week 12 post-treatment.
 RESULTS: Significant improvements were found in scores for neck pain, disability, depression, anxiety, and quality of life in both groups after treatment compared with scores before treatment. However, when comparing changes within groups, significant improvements were only identified in VAS and Nottingham Health Profile sleep subparameters at week 12 post-treatment compared to pre-treatment.
 CONCLUSION: Pulsed electromagnetic field therapy in intervertebral hernia of the cervical spine can be safely used in conservative treatment as part of combined physiotherapy.

Simulation of the Mechanical Behavior of the Degradation L4-L5 Lumbar Spine

Degenerative changes in the lumbar spine significantly reduce the quality of life of people. To fully understand the biomechanics of the affected spine, it is crucial to consider the biomechanical alterations caused by degeneration of the intervertebral disc (IVD). Therefore this study is aimed at the development of a discrete element model of the mechanical behavior of the L4-L5 spinal motion segment, which covers all the degeneration grades from healthy IVD to its severe degeneration, and numerical study of the influence of the IVD degeneration on stress state and biomechanics of the spine. To analyze the effects of IVD degeneration on spine biomechanics we simulated physiological loading conditions using compressive forces. The results of modeling showed that at the initial stages of degenerative changes, an increase in the amplitude and area of maximum compressive stresses in the disc is observed. At the late stages of disc degradation, a decrease in the value of intradiscal pressure and a shift in the maximum compressive stresses in the dorsal direction are observed. Such an influence of the degradation of the geometric and mechanical parameters of the tissues of the disc leads to the effect of bulging, which in turn will lead to the formation of an intervertebral hernia.

Automatic localization and classification of intervertebral disc herniation using hybrid classifier

Lumbar disc herniation detection is challenging due to numerous problems, including a complex background, and small joints. Deep learning-based methods have set new benchmarks for much computer vision and pattern recognition research throughout the last five years. In this proposed work, a novel method for the localization of horizontal and vertical projection of Intervertebral Discs (IVDs) in lumbar spine MRI images based on YOLOv2-IVD (You only look once v2-Intervertebral Disc) is suggested, which includes Enhanced Visual Geometry Group 16 (EVGG16) as the YOLOv2 model's backbone. In this framework, features are taken from the ReLU 11, which is the output layer of EVGG16 modeland fed into the YOLOv2 model. Following that, the exact intervertebral discs are detected by finding the intersection of the IVDs localized horizontal and vertical projections, from which IVDs features are learned using Enhanced AlexNet (EAlexNet). It includes 8 weight layers and kernels 5×5,3×3 for classifying IVDs as normal or herniated, a process also known as disc herniation classification. Finally, the severity of the herniation, such as prolapse (mild) and extrusion (moderate), is determined by estimating the length of the intervertebral herniation disc, which has been achieved using basic image processing techniques such as thresholding and morphological segmentation methods. The proposed method is trained and validated using a real-world spine MRI image dataset obtained from a hospital. Also the results reveal that the proposed approach, attains a high accuracy of 93.59% for herniation detection, comfortably outperformed other state-of-the-art methodologies.

Interventional surgery effectiveness in treatment of the cervical spine and shoulder joint chronic pain

Relevance. Degenerative diseases of the spine are among the most common pathologies that cause significant medical, social and economic losses. Thus, a retrospective analysis of the Humana database from 2008 to 2014 indicates a sharp increase in discogenic neurocompression lesions of the cervical spine, which is 42 %. Degenerative processes are characterized by metabolic and structural changes in the intervertebral discs (IVD), which lead to the loss of its properties. The aim of the study was to analyze the results of intervertebral disc nucleoplasty and radiofrequency denervation of the facet joints in patients with cervical joint hernias. Materials and Methods . Intervertebral disc nucleoplasty and radiofrequency denervation of the facet joints in patients with hernias of the cervical spine was performed in 55 patients aged 18 to 74 years (mean age 36.28 ± 2.19 years), of which 56.36 % (31 patients) were men and 43.64 % (24 people) were women. Results and Discussion. The results demonstrate a significant improvement (p0.001) in VAS and ODI in patients after treatment. The majority of patients (45.45 %) rated their health status as “good”, 41.82 % of respondents believe that after the intervention, their health status can be assessed as “excellent”. Only 3 patients (5.45 %) indicated an unsatisfactory condition, which may be due to individual psychological characteristics, comorbidities, or a reduced sensitivity threshold. Conclusion. Nucleoplasty of the intervertebral disc and radiofrequency denervation of the facet joints is an effective and safe method for the treatment of intervertebral hernias of the cervical spine.

Personalized neurosurgical tactics in the treatment of intervertebral hernias of the lumbar spine

Objective. Analysis of literature data of modern neurosurgical techniques in the treatment of lumbar disc herniation; clarification of the features of surgical tactics and results during microsurgical, endoscopic methods and laser thermoplastic of the intervertebral disk. Methods. A retrospective analysis of the results of conventional microdiscectomy (228 cases), laser disc decompression (22 observations) and percutaneos endoscopic discectomy (4 observations) for lumbar disc herniation from 2016 to 2018. The results of surgical treatment was assessed according to the Oswestry Disability Index (ODI), Visual Analog Scale (VAS), modified MacNab criteria, and morphometric data of MRI and CT scans during the preoperative and postoperative periods, as well as 6 and 12 months after surgery. Results. The result of the study was a comparison of the literature data with those obtained in our clinic in the treatment of patients using all the indicated methods. On our material, we received confirmation of the feasibility and perspectivity of using minimally invasive methods in the treatment of lumbar disc herniation with low probability of recurrence and repeated treatment for pain. Also agree with the statement that the techniques have limited application, especially with instability in the VMS and multilevel lesion. Conclusion. Endoscopic discectomy, as well as laser disc decompression, are minimally invasive methods of treatment lumbar disc herniation, and have become an alternative to open lumbar microdiscectomy, as they allow minimizing surgical trauma, the effects of surgery, and quickly regress pain syndrome, contributing to early post-operative activation of the patient. A personalized approach in the treatment of lumbar disc herniation is based on the competent selection of patients and the clarification of a number of factors in determining.

Development of a Computational Model of the Mechanical Behavior of the L4-L5 Lumbar Spine: Application to Disc Degeneration.

Degenerative changes in the lumbar spine significantly reduce the quality of life of people. In order to fully understand the biomechanics of the affected spine, it is crucial to consider the biomechanical alterations caused by degeneration of the intervertebral disc (IVD). Therefore, this study is aimed at the development of a discrete element model of the mechanical behavior of the L4–L5 spinal motion segment, which covers all the degeneration grades from healthy IVD to its severe degeneration, and numerical study of the influence of the IVD degeneration on stress state and biomechanics of the spine. In order to analyze the effects of IVD degeneration on spine biomechanics, we simulated physiological loading conditions using compressive forces. The results of modeling showed that at the initial stages of degenerative changes, an increase in the amplitude and area of maximum compressive stresses in the disc is observed. At the late stages of disc degradation, a decrease in the value of intradiscal pressure and a shift in the maximum compressive stresses in the dorsal direction is observed. Such an influence of the degradation of the geometric and mechanical parameters of the tissues of the disc leads to the effect of bulging, which in turn leads to the formation of an intervertebral hernia.

Review of intervertebral hernia disease treatment methodologies: Key emphasis on the oxygen-ozone therapy as a method with multifactorial influence

IntroductionLow back pain is one of the most common causes of short-term, and sometimes long-term, disability in the population younger than 45 years old. Approximately 60% to 80% of the population in developed countries experience back pain in various locations (neck, mid and lower back) at least once in their lifetime. Guidelines regarding back pain treatment are undergoing constant modifications and improvements. The relevance of dorsalgia as a significant medical problem and its management is shown by the increased number of recently published papers, which has tripled in the past several years (from 22% to 65%).AimTo analyze the most critical risk factors of the degenerative intervertebral disk disease, and to review the effectiveness of invasive and noninvasive methods of treatment of the lower back pain syndrome.Material and methodsRecently published papers focusing on invasive and noninvasive treatments of low back pain syndrome.Results and discussionSurgical intervention as a single method of back pain treatment is indicated in a small number of cases. The risk of repeated surgeries for intravertebral disk herniation should be considered before any surgical intervention. A wide variety of treatment options allows to choose the most effective approach based on individual needs.ConclusionsConservative, noninvasive approach has shown to be an effective alternative for lower back pain and radiculopathy treatment. It has been determined that ozone therapy is an appropriate, relevant, and affordable treatment method for patients with vertebral degenerative changes and intravertebral disk diseases.

Частота и структура осложнений в раннем и отдаленном послеоперационном периоде у больных с грыжами межпозвоночных дисков, оперированных методом микродискэктомии

Актуальность. Удаление межпозвоночных грыж является наиболее частой плановой операцией в хирургии позвоночника. Несмотря на высокую технологичность операций по поводу грыж межпозвоночных дисков, до настоящего времени сохраняется большое количество неудовлетворительных послеоперационных результатов. Материалы и методы. Проведен анализ данных клинических наблюдений хирургического лечения 54 пациентов с грыжами межпозвоночных дисков, которые находились на стационарном лечении в клинике хирургии позвоночника со спинальным (нейрохирургическим) центром ГУ «Институт травматологии и ортопедии НАМН Украины» в период с 2019 по 2020 г. Результаты. Среди наших наблюдений ликворея из поврежденных оболочек дурального мешка отмечалась в одном случае (1,9 %). В структуре осложнений поясничной микродиск-эктомии в раннем послеоперационном периоде выраженный болевой синдром после операции наблюдался у 11,1 % больных; неврологические нарушения с парезом стопы, которые были до операции, сохраняются у 5,6 %; увеличение двигательных нарушений, обусловленных проведением микродискэктомии в раннем послеоперационном периоде, не отмечалось; вторичное заживление послеоперационной раны отмечено у 6 (11,1 %) больных, спондилодисцита не было. Выводы. Причинами повторного хирургического вмешательства у пациентов после первичной микродискэктомии в отдаленном периоде являются рецидив грыжи межпозвонкового диска — 4 случая (7,4 %) и нестабильность оперированного сегмента — 1 случай (1,9 %).

The Efficacy of the Therapeutic Exercises on Evminov Board with Use of the Glisson Loop in Patients with Degenerative Spine Diseases

Degenerative spine changes could be detected in 57% of persons in age of 20–29 years, in more then 95% – in age group of 40–49 years and in almost all persons older then 60, which determines the need in development of the effective methods for treatment and exacerbation prevention. The objective: to evaluate the efficacy of the therapeutic exercises on the Evminov board with Glisson loop use in patients with spine degenerative diseases. Materials and methods. The study included 349 patients with spine degenerative diseases. According to spine CT/MRI the protrusions of intervertebral discs of different parts of the spine were found in 166 patients (47.6%), and intervertebral hernias were described in 91 cases (26.1%). All patients were divided into 2 groups: group I included 205 people who received personalized therapeutic exercises on Evminov’s board without the use of nonsteroidal anti inflammatory drugs (NSAIDs), group II included 144 patients who took NSAIDs to redue cpain. Results. After 4–6 weeks of treatment with Evminov’s board, all patients showed positive changes: in 47% of cases there was no pain at rest and in 53% of cases the pain decreased in intensity (from 7.8 mm to 3.7 mm on VAS). Group II patients in course of NSAIDs were recommended low-amplitude exercise therapy (up to 20°) to prevent exceeding the pain threshold, while most group I patients noted pain at an movement amplitude of 60–80° and performed exercises with the appropriate amplitude. Group I patients showed improvement in the first week of treatment, while group II patients had improvement only in the third week of treatment. Conclusion. Treatment of patients with the degenerative spine diseases on Evminov board with full-amplitude movements is more effective as for pain management and temp of pain decrease compare to low-amlitude exercises and NSAID use.

Analysis of the frequency of pathologies of the cervical spine in adolescents according to computed tomography

Spinal pathologies today occupy a leading position in the rankings of diseases with a high degree of disability of patients, translating the problem into the category of medical and social. Cervical lesions are one of the most common manifestations of spinal pathology, and cervical osteochondrosis ranks second after lumbar. Literature sources indicate that today spinal pathologies have a pronounced tendency to rejuvenate. The aim of our study was to determine the frequency of pathological lesions of the cervical spine among adolescents in a randomized sample according to computed tomography. 100 series of anonymized computed tomograms of young people (18-21 years old) were processed. The examination was performed on the TSX-101A Aquilion 16. According to the analysis, only 22% of the examined young people do not have pathological changes in the study area. Changes in intervertebral discs in the form of protrusions of different localization were found in 51% of the examined persons, in 23% - intervertebral hernias. The high frequency of pathological lesions of the cervical spine indicates the need to identify the causes of their occurrence, as well as the development and application of effective preventive measures.

Neurological symptoms in Scheuermann’s disease: review of rare clinical observations

Neurological symptoms in Scheuermann’s disease are very rare, only a few dozen cases have been described. The main causes of spinal cord compression with the development of neurological symptoms in spinal deformities due to Scheuermann’s disease are compression by the anterior wall of the spinal canal, together with the dorsal leaflet of the dura mater, intervertebral hernia, and extradural bone cyst. The review provides a description of 38 clinical observations found in the literature. Compressing factors can also be spinal epidural lipomatosis and a displaced fragment of the annular apophysis. Scheuermann’s disease can be combined with syringomyelia. The magnitude of the kyphotic deformity does not correlate with the severity of neurological symptoms. Preoperative examination of a patient with Scheuermann’s disease should include methods that allow visualizing the condition of the spinal canal and its contents.

Neurological symptoms in Scheuermann’s disease: review of rare clinical observations

Neurological symptoms in Scheuermann’s disease are very rare, only a few dozen cases have been described. The main causes of spinal cord compression with the development of neurological symptoms in spinal deformities due to Scheuermann’s disease are compression by the anterior wall of the spinal canal, together with the dorsal leaflet of the dura mater, intervertebral hernia, and extradural bone cyst. The review provides a description of 38 clinical observations found in the literature. Compressing factors can also be spinal epidural lipomatosis and a displaced fragment of the annular apophysis. Scheuermann’s disease can be combined with syringomyelia. The magnitude of the kyphotic deformity does not correlate with the severity of neurological symptoms. Preoperative examination of a patient with Scheuermann’s disease should include methods that allow visualizing the condition of the spinal canal and its contents.

Neurological symptoms in Scheuermann’s disease: review of rare clinical observations

Neurological symptoms in Scheuermann’s disease are very rare, only a few dozen cases have been described. The main causes of spinal cord compression with the development of neurological symptoms in spinal deformities due to Scheuermann’s disease are compression by the anterior wall of the spinal canal, together with the dorsal leaflet of the dura mater, intervertebral hernia, and extradural bone cyst. The review provides a description of 38 clinical observations found in the literature. Compressing factors can also be spinal epidural lipomatosis and a displaced fragment of the annular apophysis. Scheuermann’s disease can be combined with syringomyelia. The magnitude of the kyphotic deformity does not correlate with the severity of neurological symptoms. Preoperative examination of a patient with Scheuermann’s disease should include methods that allow visualizing the condition of the spinal canal and its contents.

ДЕГЕНЕРАТИВНО-ДИСТРОФИЧЕСКИЕ ИЗМЕНЕНИЯ ПОЗВОНОЧНИКА: ОТ ГРЫЖИ МЕЖПОЗВОНКОВОГО ДИСКА ДО СПОНТАННОЙ РЕЗОРБЦИИ

A herniated disc is the most frequent manifestation of the degenerative-dystrophic process in the spine, which manifests itself in the most working age. Often, when a herniated disc is detected, such patients are referred for surgical treatment. Published meta-analyzes have shown that there are no significant differences in the effectiveness of surgical treatment of disc herniation and conservative tactics in a long-term comparison. The ineffectiveness of epidural blockade with glucocorticosteroid hormones and long-term use of non-steroidal anti-inflammatory drugs has been shown. All this dictates the need to study other methods of effective treatment of patients with discogenic pain syndrome. This article provides an overview of the study of the mechanisms of spontaneous resorption of intervertebral hernias, which is essentially a sanogenetic response of the body. The focus on patterns, connected to development of neurological manifestations, is vital. This direction in the study of degenerative disc disease, in our opinion, is the most promising at the present stage of development of medical science.

Clinical evaluation for the transforaminal endoscopic hernia of the intervertebral disc of the lumbosacral spine with puncture nucleoplasty

Transforaminal endoscopic hernia removal is currently one of the most effective and relatively safe methods of treating an intervertebral hernia of the lumbosacral spine. In the current study we aim to evaluate the effectiveness of transforaminal endoscopic discectomy in combination with puncture nucleoplasty as a surgical protocol to treat hernias of the lumbosacral spine. 87 patients (43 men and 44 women) aged 19 to 62 years were enrolled in our study and underwent proper evaluation. The duration of follow-up in the postoperative period averaged 18.7 6 months (from 7.2 to 28 months). To assess the clinical effectiveness of the performed surgical interventions, the dynamics of the pain syndrome was analyzed using a visual analogue scale (VAS). Patient status, pain and disability were assessed using Oswestry Disability Index (ODI). Postoperative complications were also analyzed to evaluate the results of the operation. Moreover, objective criteria were used to assess the level of pain and the degree of disability. All patients showed a decrease in pain intensity and an improvement in the vital signs. Long follow up for ODI within six months after the operation showed a significant decrease by two to three times. Due to the lack of similar studies (endoscopy plus nucleoplasty), the results of our work were compared with the results of endoscopic hernia removal without nucleoplasty. However, in the evaluated patients, some intra- and postoperative complications were observed. In conclusion, the use of puncture nucleoplasty as the second stage of minimally invasive hernia removal of muscle tension dysphonia (MTD) is an effective treatment method, significantly reducing the recurrence rate of the disease.

The Effectiveness of Laser Vaporization in the Treatment of Intervertebral Hernias of the Lumbar Spine

The purpose of the study : assessment of the use of laser vaporization of the disc with hernial protrusion on the lumbar spine and its effectiveness in the treatment of pain. Material and methods . We analyzed the effectiveness laser vaporization in 230 patients with degenerative-dystrophic diseases of the lumbar spine (protrusions and hernias of the intervertebral discs) treated in the neurosurgical department of the Irkutsk Scientific Centre of Surgery and Traumatology for the period from 2011 to 2018. There were 122 men and 108 women. The average age of the patients was 41 years. The duration of the disease before surgical treatment is 11 ± 3 weeks. Clinical and neurological examination revealed lumbalgia in 102 patients (44.3 %), lumbar ischalgia in 98 (42.6 %) and radiculopathy in 30 patients (13.1 %). Median hernias of the intervertebral discs were revealed in 130 patients (56.4 %), lateral hernias - in 41 (17.8 %) and protrusions - 59 (23.8 %). The leading localization of the pathological process was the L IV -L V segment (138 patients, 60 %). Assessment of the effectiveness of surgical treatment was carried out using VAS and Macnab scales. Results . In 100 % of cases were laser vaporization was applied a decrease in the intensity of the pain syndrome was achieved in terms of up to 3 months. The analysis of the long-term results of this treatment in 124 patients from 3 months to 3 years by Macnab scale revealed excellent results in 25 (20.1 %) patients, good results - in 50 (40.3 %), satisfactory - in 42 (33.8 %), and unsatisfactory results - in 7 (5.6 %) cases. Conclusion . Thus, laser vaporization of hernias of the intervertebral disc is effective in the treatment of pain, which does not stop with conservative treatment for 4-6 weeks; with a hernia of up to 6 mm; with a median localization and with no signs of sequestration.

The effectiveness of the system for predicting the results of surgical treatment of patients with lumbar disc herniation

Objective . To evaluate the effectiveness of a multivariate logistic regression model for the predicting surgical treatment results in patients with lumbar disc herniation. Materials and Methods . Study design: monocentric retrospective study. The study included patients operated on for lumbar disc herniation at levels L4–L5, L5–S1, with a 3-year follow-up. Two groups were identified: Group I included 350 patients (their data served as a basis for creation of multivariate logistic regression predicting model), and Group II – 514 patients (in this group, the effectiveness of the model was evaluated). Group II was divided into two subgroups: Subgroup IIa (recurrence probability 50 %) – 17 (3.3 %) patients. Patients in Subgroup IIa underwent microdisectomy, and in Subgroup IIb – spinal fusion. In order to obtain homogeneous pre-operative indicators of both group parameters, the PSM method was used. Statistical calculations were performed in the RStudio program. Results . In Group II, significant differences in indicators in the subgroups were noted for the following parameters (p < 0.05): smoking, disc height index, segmental volume of movement, lumbar lordosis angle, type of intervertebral hernia (except for sequestration), Modic changes, and stage of intervertebral disc degeneration according to Pfirrmann. In Subgroup IIa, 8 (1.6 %) reoperations were performed, in Subgroup IIb – 2 (0.4 %). Using the PSM method, the data of groups I and II were flattened out for significantly different indicators. The sample size was 37 patients in each group. The number of reoperations in the groups differed statistically significantly: Group I – 35 % [22 %; 51 %]; Group II – 5 % [1 %; 18 %]. The risk of reoperation in Group II is 0.13 [0.03; 0.58] times lower than in Group I (p = 0.002). Conclusions . The proposed system for predicting the results of surgical treatment of patients with intervertebral disc hernia can be used as a tool to determine the surgical tactics aimed at reducing the frequency of reoperations.

Resuscitation Following a Bupivacaine Injection for a Cervical Paravertebral Block.

BackgroundCardiac arrest related to nerve blockade using a local anaesthetic is a rare event. We report a case of bupivacaine severe cardiovascular toxicity following cervical paravertebral nerve block.Case presentationA 44-year-old female was admitted to Republican Vilnius University Hospital, with symptoms of sustained severe pain in her neck that radiated to both arms. Multiple cervical intervertebral hernias with spinal stenosis were confirmed by magnetic resonance imaging. Following infiltration of the subcutaneous tissue with a 0.5 % bupivacaine solution, an 18-gauge spinal needle was used to perform the paravertebral block at the C6 level. Bupivacaine was injected in incremental doses to a total of 10 mL. Rapid loss of consciousness and cardiovascular collapse suggested a neuraxial injection of bupivacaine. Long-lasting cardiopulmonary resuscitation, including chest compressions, defibrillation attempts for refractory ventricular fibrillation, medications, mechanical ventilation, and intravenous lipid emulsion infusion, was successful. No severe adverse outcomes other than acute kidney injury and chest pain related to prolonged chest compressions were documented.ConclusionsThis case report emphasizes the necessity of ensuring adequate safety precautions to avoid local anaesthetic systemic toxicity. Lipid emulsion preparations should be available in all hospital settings where local anaesthetics are used for regional anaesthesia or pain management.

SURGERY OF THORACIC DISC HERNIATION: A SYSTEMATIC REVIEW OF ENGLISH-LANGUAGE LITERATURE

The presented review of scientific publications from the Medline (PubMed) and Scopus databases considers modern surgical approaches used to remove intervertebral hernias in the thoracic spine. The advantages and disadvantages of anterior and posterior approaches are analyzed. It has been revealed that the anterior approaches, providing a good opportunity to remove a hernia, are associated with the risk of serious complications, including pulmonary ones, and often lead to the formation of a post-thoracotomy pain syndrome. Mini-thoracotomy and percutaneous thoracoscopy, although less invasive, do not exclude the development of complications inherent in conventional thoracotomy. Modern posterior approaches are less traumatic and allow, with minimal contact with the spinal cord, to successfully remove not only soft tissue, but also ossified disc herniation. The choice of the optimal method of discectomy remains an unsolved problem and depends on practical skills, experience and preferences of the surgeon. For an objective and reliable assessment of the efficiency of surgical technologies and the determination of optimal indications for each of them, a prospective multicenter study is necessary.