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Khirurgii

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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 7,8±1,4 and 5,2±1,2 to 1,6±1,2 (in average 6,3, 95% CI (confidence interval) : from 5,6 to 7,0; t=19,00; p<2,2×1016) and 3,6±1,4 (in average 1,1, 95% CI: from 0,2 to 2,0; t=2,411; p=0,0233) the next day; to 1,8±1,4 (in average 5,9, 95% CI: from 5,1 to 6,8; t=15,12; p=2,2×10−14) and 3,6±1,4 (in average 1,2, 95% CI: from 0,5 to 1,8; t=3,677; p=0,0011) after 1 month; to 1,5±1,2 (in average 6,2, 95% CI: from 5,5 to 6,9; t=17,60; p=5,9×10−16) and 2,8±1,4 (in average 2,3, 95% CI: from 1,5 to 3,0; t=6,332; p=1,1×10−6) after 6 months; to 1,5±1,2 (in average 6,3, 95% CI: from 5,7 to 7,0; t=20,26; p<2,2×10−16) and 2,8±1,4 (in average 2,4, 95% CI: from 1,7 to 3,2; t=6,653; p=4,7×10−7) after 12 months and 1,6±1,2 (in average 5,7, 95% CI: from 5,0 to 6,5; t=15,87; p=6,9×10−15) and 2,0±1,2 (in average 3,3 áàëëà, 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 65,2±6,4 to 19,2±2,8 (in average 47,9, 95% CI: from 44,4 to 51,4; t=28,04; p<2,2×10−16) after 1 month; to 14,6±2,2 (in average 50,3, 95% CI: from 46,9 to 53,6; t=30,91; p<2,2×10−16) after 6 months; to 15,4±2,3 (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 14,4±2,2 (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
References
  1. Akhaddar A, Belfquih H, Salami M, Boucetta M. Surgical management of giant lumbar disc herniation: analysis of 154 patients over a decade. Neurochirurgie. 2014 Oct;60(5):244-48. doi: 10.1016/j.neuchi.2014.02.012
  2. Barth M, Diepers M, Weiss C, Thomé C. Two-year outcome after lumbar microdiscectomy versus microscopic sequestrectomy: part 2: radiographic evaluation and correlation with clinical outcome. Spine (Phila Pa 1976). 2008 Feb 1;33(3):273-79. doi: 10.1097/BRS.0b013e31816201a6
  3. Barth M, Weiss C, Thomé C. Two-year outcome after lumbar microdiscectomy versus microscopic sequestrectomy: part 1: evaluation of clinical outcome. Spine (Phila Pa 1976). 2008 Feb 1;33(3):265-72.
  4. Black HA. Massive Herniation of the intervertebral disc producing compression of the cauda equina. Calif Med. 1948;69:271-74.
  5. Carragee EJ, Spinnickie AO, Alamin TF, Paragioudakis S. A prospective controlled study of limited versus subtotal posterior discectomy: short-term outcomes in patients with herniated lumbar intervertebral discs and large posterior anular defect. Spine (Phila Pa 1976). 2006 Mar 15;31(6):653-57. doi: 10.1097/01.brs.0000203714.76250.68
  6. Carragee EJ, Han MY, Suen PW, Kim D. Clinical outcomes after lumbar discectomy for sciatica: the effects of fragment type and anular competence. J Bone Joint Surg Am. 2003 Jan;85(1):102-8. doi: 10.2106/00004623-200301000-00016
  7. Choi KC, Lee JH, Kim JS, Sabal LA, Lee S, Kim H, Lee SH. Unsuccessful percutaneous endoscopic lumbar discectomy: a single-center experience of 10,228 cases. Neurosurgery. 2015 Apr;76(4):372-80; discussion 380-1; quiz 381. doi: 10.1227/NEU.0000000000000628
  8. Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976). 2001 Sep 1;26(17):1873-78. doi: 10.1097/00007632-200109010-00011
  9. Cribb GL, Jaffray DC, Cassar-Pullicino VN. Observations on the natural history of massive lumbar disc herniation. J Bone Joint Surg Br. 2007 Jun;89(6):782-84. doi: 10.1302/0301-620X.89B6.18712
  10. Belykh E, Krutko AV, Baykov ES, Giers MB, Preul MC, Byvaltsev VA. Preoperative estimation of disc herniation recurrence after microdiscectomy: predictive value of a multivariate model based on radiographic parameters. Spine J. 2017 Mar;17(3):390-400. doi: 10.1016/j.spinee.2016.10.011
  11. Fardon DF, Milette PC; Combined Task Forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology. Nomenclature and classification of lumbar disc pathology. Recommendations of the Combined task Forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology. Spine (Phila Pa 1976). 2001 Mar 1;26(5):E93-E113. doi: 10.1097/00007632-200103010-00006
  12. Faulhauer K, Manicke C. Fragment excision versus conventional disc removal in the microsurgical treatment of herniated lumbar disc. Acta Neurochir (Wien). 1995;133(3-4):107-11. doi: 10.1007/BF01420059
  13. Goel VK, Nishiyama K, Weinstein JN, Liu YK. Mechanical properties of lumbar spinal motion segments as affected by partial disc removal. Spine (Phila Pa 1976). 1986 Dec;11(10):1008-12. doi: 10.1097/00007632-198612000-00007
  14. Choi G, Lee SH, Lokhande P, Kong BJ, Shim CS, Jung B, Kim JS. Percutaneous endoscopic approach for highly migrated intracanal disc herniations by foraminoplastic technique using rigid working channel endoscope. Spine (Phila Pa 1976). 2008 Jul 1;33(15):E508-15. doi: 10.1097/BRS.0b013e31817bfa1a
  15. Jeon CH, Chung NS, Son KH, Lee HS. Massive lumbar disc herniation with complete dural sac stenosis. Indian J Orthop. 2013 May;47(3):244-49. doi: 10.4103/0019-5413.111505
  16. Kim KT, Park SW, Kim YB. Disc height and segmental motion as risk factors for recurrent lumbar disc herniation. Spine (Phila Pa 1976). 2009 Nov 15;34(24):2674-78. doi: 10.1097/BRS.0b013e3181b4aaac
  17. Lee DY, Shim CS, Ahn Y, Choi YG, Kim HJ, Lee SH. Comparison of percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy for recurrent disc herniation. J Korean Neurosurg Soc. 2009 Dec;46(6):515-21. doi: 10.3340/jkns.2009.46.6.515
  18. Louison R, Barber JB. Massive herniation of lumbar discs with compression of the cauda equine – a surgical emergency; report of two cases. J Natl Med Assoc. 1968 May;60(3):188-90. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2611474/
  19. McGirt MJ, Eustacchio S, Varga P, Vilendecic M, Trummer M, Gorensek M, Ledic D, Carragee EJ. A Prospective Cohort Study of Close Interval Computed Tomography and Magnetic Resonance Imaging After Primary Lumbar Discectomy: Factors Associated With Recurrent Disc Herniation and Disc Height Loss. Spine. 2009;34(19):2044-51. doi: 10.1097/brs.0b013e3181b34a9a
  20. Kondo M, Oshima Y, Inoue H, Takano Y, Inanami H, Koga H. Significance and pitfalls of percutaneous endoscopic lumbar discectomy for large central lumbar disc herniation. J Spine Surg. 2018 Mar;4(1):79-85. doi: 10.21037/jss.2018.03.06
  21. Mochida J, Nishimura K, Nomura T, Toh E, Chiba M. The importance of preserving disc structure in surgical approach to lumbar disc herniation. Spine. 1996 Jul 1;21(13):1556-63; discussion 1563-4. doi: 10.1097/00007632-199607010-00014
  22. 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):931-39. doi: 10.1097/BRS.0b013e31816c8af7
  23. Lee SH, Choi KC, Baek OK, Kim HJ, Yoo SH. Percutaneous endoscopic intra-annular subligamentous herniotomy for large central disc herniation: a technical case report. Spine (Phila Pa 1976). 2014 Apr 1;39(7):E473-9. doi: 10.1097/BRS.0000000000000239
  24. Benson RT, Tavares SP, Robertson SC, Sharp R, Marshall RW. Conservatively treated massive prolapsed discs: a 7-year follow-up. Ann R Coll Surg Engl. 2010 Mar;92(2):147-53. doi: 10.1308/003588410X12518836438840
  25. Shen M, Razi A, Lurie JD, Hanscom B, Weinstein J. Retrolisthesis and lumbar disc herniation: a preoperative assessment of patient function. Spine J. 2007 Jul-Aug;7(4):406-13. doi: 10.1016/j.spinee.2006.08.011
  26. Meredzi AM, Gulyaev DA, Singaevskiy SB, Prishvin AP. Percutaneous transforaminal endoscopic discectomy for the upper lumbar disc herniation. Ros Neirokhirurg Zhurn im prof. AL Polenova. 2017;9(4):22-29. https://polenovjournal.ru/2017_4 (In Russ.)
  27. Merzhoev AM, Guliaev DA, Davydov EA. Perkutannaia endoskopicheskaia poiasnichnaia diskektomiia – interlaminarnyi dostup. Ros Neirokhirurg Zhurn im prof AL Polenova. 2017;9(1):49-56. https://polenovjournal.ru/2017_ (In Russ.)
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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