Year 2016 Vol. 24 No 5




ME "Gomel Regional Clinical Hospital"
The Republic of Belarus

Objectives. To study the application efficiency of frameless Brainlab neuronavigation in the surgical treatment of lumbar herniated intervertebral disc.
Methods. The study included patients (n=24) with osteochondrosis stage III. According to the level of destruction the degenerative disc changes were diagnosed at L4-L5 and L5-S1 (16 (66,7%) and 8 (33,3%), respectively. The caudal displacement of sequestration in 9 (37,5%) patients and 2 (8,3%) cranial displacement of sequestration was noted according to the computed tomography (CT) or magnetic resonance imaging (MRI) of the lumbar region. In all cases the interlaminar removing of the fragments of the fallen pulposus nucleus was performed with the revision of intervertebral gap in 18 (75%) patients and in 6 (25%) with the puncture laser nucleoplasty (PLN) by the holmium laser. Planning and intraoperative monitoring during the surgery stages carried out by neuronavigation station BrainLab (Germany).
Results. Dynamic control of intervention by means of intraoperative navigation provided validity of decompression of the spinal root, radical removal of nucleus pulposus sequesters, and also permitted to prevent the damage of the vertebral end-plates and ventral portions of the fibrous ring due to the possibility of a clear positioning of the optical fiber in the disc cavity at PLN. Using PLN provides intradiscal decompression and fibrotization of the nucleus pulposus residues. A statistically significant positive dynamics of pain syndrome intensity according to visual analog scale (VAS) in patients (Z=4,28; p<0,001) as well as a significant improvement in life quality (Oswestry questionnaire) (Z=4,28; p<0,001) in the incisional period had been established.
Conclusion. High efficiency (91,7%) of the navigation system application in the preoperative planning and intraoperative monitoring during the surgical treatment of sequestered hernias has been established. Combination of the controlled navigation microsurgical discectomy and PLN appears promising method of surgical exposure aimed at eliminating direct causes of compression of the spine root and the prevention of postoperative complications.

Keywords: neuronavigation, microsurgical discectomy, intervertebral disc hernia, laser nucleoplasty, lumbar osteochondrosis, prevention, postoperative complications
p. 482-488 of the original issue
  1. Akshulakov SK, Kerimbaev TT, Aleinikov VG, Urunbaev EA, Kisaev EV, Sansyzbaev AB, i dr. Sovremennye problemy khirurgicheskogo lecheniia degenerativno-distroficheskikh zabolevanii pozvonochnika [Current problems in the surgical treatment of degenerative diseases of the spine]. Neirokhirurgiia i Nevrologiia Kazakhstana. 2013; 1 (30): 7-16.
  2. Azizov MZh, Simonovich AE, Nuraliev KhA. Rezul'taty analiza diskektomii u bol'nykh s poiasnichnym osteokhondrozom [The results of the analysis of discectomy in patients with lumbar osteochondrosis]. Genii Ortopedii. 2010;(1):59-63.
  3. Chan C, Peng P. Failed back surgery syndrome. Pain Medicine. 2011;12: 577-606.
  4. Shevelev IN, Gushcha AO, Konovalov NA, Arestov SO. Ispol'zovanie endoskopicheskoi diskektomii po Destando pri lechenii gryzh mezhpozvonkovykh diskov poiasnichnogo otdela pozvonochnika [Using endoscopic discectomy by Destandau method in treatment of hernia intervertebral discs of the lumbar spine]. Khirurgiia Pozvonochnika. 2008;(1):51-57.
  5. Maslov LB, Saboneev NA. Razrabotka realistichnykh modelei uprugikh elementov oporno-dvigatel'nogo apparata cheloveka [Development of realistic models of the elastic elements of the locomotor apparatus of man]. Vestnik IGEU. 2008;(3): 1-6.
  6. Gladkov AV, Sivets IuV, Avdeeva KIu. Novyi podkhod v ispol'zovanii matematicheskogo apparata v postroenii trekhmernoi modeli pozvonochnika [A new approach of mathematical apparatus use in the construction of three-dimensional model of the spine]. Khirurgiia Pozvonochnika. 2005;(1):100-104.
  7. Dreischarf M, Zander T, Shirazi-Adl A, Puttlitz CM, Adam CJ, Chen CS, et al. Comparison of eight published static finite element models of the intact lumbar spine: predictive power of models improves when combined together. J Biomech. 2014 Jun 3;47(8):1757-66. doi: 10.1016/j.jbiomech.2014.04.002.
  8. Ben-Hatira F, Saidane K, Mrabet A. A finite element modeling of the human lumbar unit including the spinal cord. J Biomed Sci Eng. 2012;5(3):146-52. doi: 10.4236/jbise.2012.53019.
  9. Dreischarf M, Schmidt H, Putzier M, Zander T. Biomechanics of the L5-S1 motion segment after total disc replacement - Influence of iatrogenic distraction, implant positioning and preoperative disc height on the range of motion and loading of facet joints. J Biomech. 2015 Sep 18;48(12):3283-91. doi: 10.1016/j.jbiomech.2015.06.023.
  10. Usikov VD, Ptashnikov DA, Mikhailov DA. The use of low-invasive surgery in treatment of degenerative dystrophic spine diseases. Travmatologiia i Ortopediia Rossii. 2009;(3):78-84.
  11. Borshchenko IA, Migachev SL, Dreval' ON, Baskov AV. Opyt chreskozhnoi endoskopicheskoi poiasnichnoi diskektomii [Experience of percutaneous endoscopic lumbar discectomy. Results and prospects]. Rezul'taty i perspektivy. Neirokhirurgiia. 2009;(4):25-34.
  12. Ruetten S, Komp M, Merk H, Godolias G. Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine (Phila Pa 1976). 2008 Apr 20;33(9):931-9. doi: 10.1097/BRS.0b013e31816c8af7.
Address for correspondence:
246012, Republic of Belarus,
Gomel, Brothers Lizyukova st., 5,
Gomel Regional Clinical Hospital.
neurosurgical department N1.
Tel: +375 232 48-55-66
Evgeny Leonidovich Tsitko
Information about the authors:
Tsitko E.L. PhD, Neurosurgeon, ME "Gomel Regional Clinical Hospital".
Govrushko O.S. Head of neurosurgical department N1, ME "Gomel Regional Clinical Hospital".
Litvin A.A. PhD, Ass. Professor, Deputy Chief Physician (Surgery), ME "Gomel Regional Clinical Hospital".
Tsitko E.V. PhD, Deputy Chief Physician (Polyclinic work), ME "Gomel Regional Clinical Hospital".
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