A.I. Larin, V.M. Ezhkov, A.S. Ilyinykh. O.V. Durov, V.N. Lesnyak, E.E. Yargina
(Clinical Hospital N 83 of the Federal Medical-Biological Agency, Moscow)
Treatment of cases with pain syndrome, conditioned by hernias of intervertebral discs, is an important medical and social problem. Spinal osteochondrosis with pain syndrome is diagnosed in more than 80% of the planet population. Thus, improving methods of conservative and surgical treatment of this pathology is a goal of crucial importance. The last years are characterized by introduction of new and little-invasive technologies into surgery of hernias of intervertebral discs.
We used puncture laser nucleotomy for treatment of 140 cases with lumboischialgia, caused by small hernias or protrusion of intervertebral discs. It was performed with a neodymium YAG laser (Fibert-5100, Dornie company) according to a conventional method and under X-ray and CT control. A value of total emissive power varied from 700 up to 1500 J. Preoperative multimodality treatment was carried out in all the cases. Absence of its effect was an indication for MRI examination with the purpose of determining a level of an intervertebral disc lesion and making judgment on a degree of a spinal root compression. Lateral protrusions of intervertebral discs and their hernias (6-7 mm) were revealed in 12 and 128 cases respectively. Pain and vertebral syndromes were predominant in a clinical picture of the disease. Cases, subjected to laser nucleotomy, stayed in hospital during a week. Complete regression of pain and vertebral syndromes was watched in 71 cases. Reduced pain syndrome and absence of vertebral syndrome were typical of 60 cases. Pain syndrome resumed in 5 patients. Later they underwent surgical removal of hernias of intervertebral discs. Laser nucleotomy resulted in discitis in one case.
One can conclude, that puncture laser nucleotomy of protrusions and hernias of intervertebral discs is rather effective. This little-invasive method allows to reduce a period of stay in hospital and accelerate social adaptation of cases.