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COMPARATIVE EVALUATION OF TREATMENT OUTCOMES AFTER REOPERATION IN PATIENTS WITH DISCOGENIC NEUROKOMPRESSIONNYM LUMBAR SPINE SYNDROME

Authors: Khyzhnjak M. V., Potapov A. A., Tanasiichuk A. F., Novakovic E. S., Priymak E. V.

Pages: 542-546

Abstract

  

Every year in the United States carried out more than 200 thousand primary microdiscectomy, the frequency of repeated interventions of up to 22% [1,2], and the relapses of hernias of intervertebral discs(ID) are between 3-15% [2]. However, despite the good results microdiscectomy, the problem of recurrence of pain syndromes are still relevant. Recurrences of pain syndromes can be caused by the formation of a hernia operated or adjacent vertebral-motor segment, segmental instability, various forms of degenerative spinal canal stenosis, epidural fibrosis [3, 4, 5]. Medical and social problems relapses of hernias of intervertebral discs caused by a decrease in the quality of life of the working population, significant economic losses and disability of patients. In Ukraine, the proportion of patients with spinal osteochondrosis of the working population in the structure of diseases of the musculoskeletal system reaches 40%.

The purpose of the study was to examine nearest, intermediate and long-term results of surgical re-treatment in patients with discogenic syndrome of lumbar spine, on the basis of differentiated application of surgical techniques.

A dynamic observation of 364 patients who were re-operated on in the department of minimally invasive spinal neurosurgery and laser State Institute of Neurosurgery. Acad. AP Romodanov Kyiv in the period from 2003 to 2012 for recurrent discogenic pain syndromes. Patients were divided into five main groups. 1) I ─ 196 patients who were operated on for ipsilateral (true relapse) hernia ID. 2) IІ ─ 22 patients who underwent microdiscectomy ID, followed by the installation of systems transpedicular fixation. 3) IIІ─ 11 patients who underwent removal of recurrent hernia ID, and the installation of a dynamic system such as fixing DIAM or COFLEX. 4) IV ─ 46 patients who underwent microsurgical removal of contralateral hernia previously operated ID. 5) V ─ 89 patients who underwent microdiscectomy on an adjacent level ID. Estimation of efficiency of surgical treatment of re-operated patients with herniated discs of the lumbar spine was performed in early (1months), intermediate (6 months) and long-term (12 months) the period of observation.

Results of surgical treatment were also evaluated on the basis of the relationship structures in the operated using PDS roentgenometer. Postoperative studies conducted during the second and third groups of observations indicated restore biomechanical relationships PDS, which was a proof of the correctness of the operation. The results of radiometric studies in patients of group III were carried out at different times after surgery.

Key words: osteochondrosis, discogenic pain syndrome, re microdiscectomy , Oswestry index , the index of the Roland -Morris.

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