Brinyuk E SN. N. Burdenko National Medical Research Center of Neurosurgery, Russia
Title: Experience in the use of minimally invasive microsurgical decompression (MMD) in spinal degenerative monosegmental stenosis of the spinal canal of the lumbosacral spine
Degenerative changes in the spine are a polyetiological process in which genetic predisposition is one of the important factors. In elderly and senile people, degenerative changes in the spine are a natural involutive process that occurs in 95–98% of cases and, in some cases, lead to the formation of stenosis of the spinal canal. By the age of 65, signs of lumbar degenerative spinal stenosis, according to neuroimaging data, are found in 20% of the population and in 80% of people aged 70 and older. In the modern world, there is a tendency towards an increase in the proportion of people over 65, which is directly related to an increase in the life expectancy of the population and leads to an inevitable increase in the incidence of degenerative lesions of the spinal column in the population.
Treatment of spinal stenosis includes both non-surgical and surgical methods. Conservative therapy is usually prescribed to patients in the initial stages of the disease, in the absence of severe neurological disorders and includes symptomatic pharmacotherapy, paravertebral and other blockade, physiotherapy and physiotherapy exercises. Despite the variety of nonsurgical treatments, a number of high-level studies have demonstrated that surgical decompression of the spinal canal in degenerative stenosis is more effective and superior to conservative therapy in selected patients.
In the arsenal of a modern neurosurgeon, there are many ways to eliminate degenerative stenosis of the spinal canal, however, there is currently no single consensus on the choice of the optimal method of surgical treatment. In connection with the development of microsurgical techniques, navigation systems, endoscopic devices, minimally invasive methods of surgical correction of spinal stenosis are becoming increasingly common, among which the dominant positions are occupied by unilateral laminotomy with bilateral decompression (ULBD), minimally invasive transforaminal interbody fusion (MI-TLIF) and intralaminar / transforaminal endoscopic decompression of the spinal canal.
All of the above methods of surgical treatment of degenerative spinal stenosis have their advantages and disadvantages, and the aim of our study is to compare the effectiveness of minimally invasive microsurgical decompression and traditional decompression with stabilization.
Objective: analysis of minimal invasive bilateral microsurgical decompression (MIBMD) of degenerative lumbar stenosis.
Methods: Analysis of effectiveness of MMD in degenerative lumbar stenosis surgical treatment was performed. Research included 96 patients with symptomatic stenosis of lumbar spine. Visual analogue scale (VAS) and index Osversti were used for pain objectivization. During surgical procedure computer tomography and 3D modeling were used for intraoperative control of spinal decompression. In post-operative period using special questionnaire we checked patient’s statements and collect data with followed statistical processing.
Results: We found statistically significant decreasing of pain after operation. CT is an effective method of intraoperative control of spinal decompression.
Conclusions: The suggested method of stenosis treatment is effective. Combination of minimal invasive surgical approach and highly precise intraoperative control of spinal decompression leads to significant decreasing of paravertebral muscles, ligaments and joints surgical trauma, and, also allows to visualize spinal segment as a 3D model in operation room that has a pivotal role in understanding of decompression suff
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