Novosti
Khirurgii

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Year 2018 Vol. 26 No 6

NEUROSURGERY

P.S. REMOV 1, 2, M.V. ALIZAROVICH 1, 2

FEATURES OF X-RAY DIAGNOSTICS OF CENTRAL DISTROPHIC STENOSIS OF THE SPINAL CANAL

Gomel State Medical University 1,
Gomel Regional Clinical Hospital 2, Gomel,
The Republic of Belarus

Objective. To assess the x-ray anatomic parameters of the spinal canal at the lumbosacral level and to suggest the method for their application in the diagnosis and surgical treatment of central dystrophic stenosis.
Methods. 64 patients operated on because of the degenerative-dystrophic pathology of the lumbosacral spine were included in the study. The main group consisted of patients with the combination of herniated intervertebral disc and central dystrophic stenosis of the spinal canal. The control group included patients with herniated discs without stenosis. The anteroposterior, interarticular ligamentous parameters, the area of the dural sac, and thickness of the ligamentum flavum were investigated. The method of determining of the surgical decompression dimension for cases of central stenosis of the spinal canal has been developed.
Results. The study revealed a statistically significant difference between the groups in the anteroposterior, interarticular ligamentous distance and dural sac area. Isolated hypertrophy of the ligamentum flavum with anteroposterior size value of 12 mm and more was the most common cause of dystrophic stenosis (38.2%). There was a strong correlation between interarticular ligamentous distance and area of the dural sac (in the main group – rs=0.72 at p<0.00001; in the group of control – rs=0.70 at p<0.00001). Cases of thickening of the ligamentum flavum more than 4 mm are noted both in the stenotic segments, and in the segments with herniated discs without stenosis.
Conclusions. Interarticular ligamentous distance has confirmed its diagnostic significance and the possibility of using as a criterion for a deficiency of free space in the spinal canal in cases of hypertrophy of the ligamentum flavum and/or articular processes. The fact of thickening of the ligamentum flavum does not in all cases indicate the presence of its compressive effect on the dural sac and is not sufficient to establish the diagnosis of dystrophic stenosis. The developed measurement procedure according to the 7 specified plans allows performing a reasonable, selective resection of the elements of the posterior support complex in cases of combination of herniated disc and central dystrophic stenosis.

Keywords: central dystrophic stenosis, interarticular ligamentous distance, ligamentum flavum, articular processes, area of dural sac, intervertebral fissure
p. 715-725 of the original issue
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Address for correspondence:
246000, The Republic of Belarus,
Gomel, Lange Str., 5,
Gomel State Medical University,
Department of Neurology and Neurosurgery
With the Course of Medical Rehabilitation,
Mob. tel. :+375 44 597 04 76,
E-mail: neuro_ugokb2013@mail.ru,
Pavel S. Remov
Information about the authors:
Remov Pavel S., Assistant of the Department of Neurology and Neurosurgery with the Course of Medical Rehabilitation, Gomel State Medical University, Gomel, Republic of Belarus.
https://orcid.org/0000-0003-2194-5233
Alizarovich Mikhail V., PhD, Associate Professor of the Department of Neurology and Neurosurgery with the Course of Medical Rehabilitation, Gomel State Medical University, Gomel, Republic of Belarus.
https://orcid.org/0000-0001-6060-5720
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