Microsurgical reconstructive decompression of neurovascular formations in diskal pathology of the lumbar spine

Kholodov S.A.

(Hospital of War Veterans N 2, Moscow, Russia)

The analysis of 436 microsurgical operations, performed by the author in patients with compression forms of diskal pathology of the lumbar spine in 1993-2001, is given. Compression radiculopathy was watched in 389 patients (89.2%); radiculoischemia, myeloischemia and radiculomyeloischemia were present in 30 (6.9%), 10 (2.3%) and 7 (1.6%) cases respectively. The operations (436 patients) were made at 739 levels of the vertebrolocomotive segment. Diskal hernias were removed at 655 out of 739 levels (88.6%); they were not diagnosed at 84 levels (11.4%). Interventions at these levels were made in case of presence of subarticular or foraminal stenosis, adhesive radiculopathy, spinal canal stenosis or necessity of the level revision.

Diskal pathology was diagnosed most frequently at the levels of L4-L5 and L5-S1 (581 levels or 88.7%). Operations were performed at two and more levels in the majority of cases (258 out of 436 patients or 59.2%). They were made at one and two levels in 178 (40.8%) and 215 (49.3%) cases respectively. A number of patients with three and four levels was equal to 41 (9.4%) and 2 (0.5%) respectively.

A conception of surgical treatment was worked out. It was done on the basis of such methods, as use of a microsurgical approach, preserving the spine supporting function, reconstruction of the spinal canal and neural tunics, surgical prevention of epidural fibrosis and its sequelae. Implantation of silicone microneuroprotectors and Gore-tex spinal membranes was used. Peculiarities of microsurgical treatment of multi-level diskal pathology, foraminal hernias, hernias of the upper lumbar spine, spinal canal stenosis and stenosis of the lateral zone were considered.

Results of surgical treatment were as follows: excellent - 40%, good - 52%, satisfactory - 7%, bad - 1%. As for a remote period (a follow-up of 1-8 years), excellent, good, satisfactory and bad results were watched in 66%, 27%, 5% and 2% of cases respectively.