Year 2022 Vol. 30 No 6

SCIENTIFIC PUBLICATIONS

A.M. MEREDZHI 1, 2, A.Y. ORLOV 1, A.S. NAZAROV1, Y.V. BELYAKOV 1, A.V. KUDZIEV1, T.V. LALAYAN 1, S.B. SINGAEVSKIY 1, P.V. SMIRNOV 2

PERCUTANEOUS FULL-ENDOSCOPIC TRANSFORAMINAL SUBANNULAR DISCECTOMY FOR LARGE MEDIAN PROTRUSIVE TYPE LUMBAR DISC HERNIATIONS

Polenov Neurosurgical Research Institute, branch of Federal State Budgetary Institution Almazov National Medical Research Centre" of the Ministry of Health of the Russian Federation 1, Saint Petersburg,
Multidisciplinary Clinic Named after N.I. Pirogov 2, Saint Petersburg,
Russian Federation

Objective. Evaluation of clinical results and technical features of percutaneous full-endoscopic transforaminal subannular removal of large median hernias of the protrusion type of the lumbar spine.
Methods. The patients (n=27) with large median hernias of the lumbar spine have been operated (2016-2019 and the results of percutaneous full-endoscopic transforaminal discectomy for large median herniations have been analized. To evaluate the results of surgical treatment used the ODI questionnaire, VAS scale and McNab.
Results. The assessment was made before surgery, the next day, after 1, 6 12 and 24 months after surgery,The average severity of preoperative radicular axial and back pain according VAS after surgery decreased from 7,81,4 and 5,21,2 to 1,61,2 (in average 6,3, 95% CI (confidence interval) : from 5,6 to 7,0; t=19,00; p<2,2×1016) and 3,61,4 (in average 1,1, 95% CI: from 0,2 to 2,0; t=2,411; p=0,0233) the next day; to 1,81,4 (in average 5,9, 95% CI: from 5,1 to 6,8; t=15,12; p=2,2×10−14) and 3,61,4 (in average 1,2, 95% CI: from 0,5 to 1,8; t=3,677; p=0,0011) after 1 month; to 1,51,2 (in average 6,2, 95% CI: from 5,5 to 6,9; t=17,60; p=5,9×10−16) and 2,81,4 (in average 2,3, 95% CI: from 1,5 to 3,0; t=6,332; p=1,1×10−6) after 6 months; to 1,51,2 (in average 6,3, 95% CI: from 5,7 to 7,0; t=20,26; p<2,2×10−16) and 2,81,4 (in average 2,4, 95% CI: from 1,7 to 3,2; t=6,653; p=4,7×10−7) after 12 months and 1,61,2 (in average 5,7, 95% CI: from 5,0 to 6,5; t=15,87; p=6,9×10−15) and 2,01,2 (in average 3,3 , 95% CI: from 2,6 to 4,0; t=9,991; p=2,2×10−10) 24 months after surgery, respectively, According to the McNab scale, 10 (37,0%) patients rated the treatment results excellent, 15 (55,6%) good, 2 (7,4%) satisfactory. The average ODI improved from 65,26,4 to 19,22,8 (in average 47,9, 95% CI: from 44,4 to 51,4; t=28,04; p<2,2×10−16) after 1 month; to 14,62,2 (in average 50,3, 95% CI: from 46,9 to 53,6; t=30,91; p<2,2×10−16) after 6 months; to 15,42,3 (in average 50,9, 95% CI: from 47,6 to 54,1; t=32,15; p<2,2×10−16) after 12 months and to 14,42,2 (in average 51,4, 95% CI: from 48,7 to 54,2; t=38,05; p<2,2×10−16) 24 months after surgery, respectively.
Conclusion. Percutaneous full-endoscopic transforaminal subannular removal of large median herniations of the protrusive type of the lumbar spine is consided to be a safe and effective method; avoiding excessive unnecessary resection of the bone structural elements of the spine and the risks of neurological complications associated with traction of dural sac and roots of the spinal cord; reducing the recurrence risk of such herniations and avoiding spinal fusion; facilitating early postoperative activation and recovery of the patient.

Keywords: endoscopic transforaminal discectomy for large median disc herniations
p. 540-551 of the original issue
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Address for correspondence:
19101, Russian Federation, St. Petersburg,
Russian Research Neurosurgical Institute Named after prof, A. L. Polenov - a Branch of the Federal
State Budgetary Institution NMRC Named after V.A. Almazov Ministry of Health of the Russian Federation, Mayakovsky st., 12
E-mail: yv.belyakov@yahoo.com,
tel. +79967992946
Belyakov Yury V.
Information about the authors:
Mereji Amir M., Neurosurgeon, PhD, Senior Researcher, Research Laboratory of Neurosurgery of the Spine and Peripheral Nervous System, Russian Research Neurosurgical Institute Named after Proftssor A. L. Polenov a Branch of the Federal State Budgetary Institution NMRC named after V.A. Almazov Ministry of Health of the Russian Federation, St. Petersburg, Russian Federation, Multidisciplinary Clinic Named after N.I. Pirogov, Saint Petersburg, Russian Federation.
https://orcid.org/0000-0003-3282-2992
Orlov Andrey Y., Neurosurgeon. MD, Head of the Research Laboratory of Neurosurgery of the Spine and Peripheral Nervous System Russian Research Neurosurgical Institute Named after Professor A. L. Polenov a Branch of the Federal State Budgetary Institution NMRC named after V.A. Almazov Ministry of Health of the Russian Federation, Russia, St. Petersburg, Russian Federation, Multidisciplinary Clinic Named after N.I. Pirogov, Russia, St. Petersburg, Russian Federation.
https://orcid.org/0000-0001-6597-3733
Nazarov Alexander S. Neurosurgeon, PhD, Senior Researcher at the Research Laboratory of Neurosurgery of the Spine and Peripheral Nervous System, Head of the Department of Neurosurgery of the Spine and Peripheral Nervous System, Russian Research Neurosurgical Institute Named after Professor A. L. Polenov a Branch of the Federal State Budgetary Institution NMRC Named after V.A. Almazov Ministry of Health of the Russian Federation, St. Petersburg, Russian Federation.
https://orcid.org/0000-0002-5727-5991
Belyakov Yury V., Neurosurgeon, Researcher at the Research Laboratory of Neurosurgery of the Spine and Peripheral Nervous System, Russian Research Neurosurgical Institute Named after Professor, A. L. Polenov a Branch of the Federal State Budgetary Institution NMRC Named after V.A. Almazov Ministry of Health of the Russian Federation, St. Petersburg, Russian Federation.
https://orcid.org/0000-0001-8772-5781
Kudziev Andrey V., Neurosurgeon, Researcher in the Research Laboratory of Neurosurgery of the Spine and Peripheral Nervous System, Russian Research Neurosurgical Institute Named after Professor A. L. Polenov a Branch of the Federal State Budgetary Institution NMRC Named after V.A. Almazov Ministry of Health of the Russian Federation, St. Petersburg, Russian Federation.
https://orcid.org/0000-0001-9061-5014
Lalayan Tigran V., Neurologist, PhD, Associate Professor of the Department of Neurology and Manual Medicine, Faculty of Postgraduate Education of the First SSMU Named after Academician I.P. Pavlov, St. Petersburg, Russian Federation.
https://orcid.org/0000-0001-7946-0517
Singaevskiy Sergey B., Surgeon, MD, Chief Physician of the Multidisciplinary Clinic Named after N.I. Pirogov, St. Petersburg, Russian Federation.
https://orcid.org/0000-0003-3426-2431
Smirnov Pavel V., Neurologist of the Multidisciplinary Clinic Named after N.I.Pirogov. St. Petersburg, Russian Federation.
https://orcid.org/0000-0001-5225-5329
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