Ivanenko À., Kokin G., Orlov À., Korotkevich Ì.
Polenov Research Neurosurgical Institute, Saint Petersburg, Russia
Puncture laser vaporization (PLV) was used in 55 cases. Operations on lumbar and cervical spine were performed in 47 and 8 patients respectively. A mean age was 45.7±5.9 years. The disease duration varied from 9 months up to 20 years. PLV was made under local anesthesia and intraoperative fluoroscopic control. The LS-0.97 IRE-Polus laser scalpel and a needle with an inner diameter of 0.9 mm were used. Lumbar and cervical discs were punctured, using posterolateral and anterolateral approaches. A procedure was carried out in a pulse mode (5 - an impact of 15 s, 5 - a break of 10 s, total duration of 200-250 s; power - 2.5-4 W). Patients were allowed to walk in a semi-rigid jacket 3-4 hours after operation. Dehydrating (4 mg of I/V dexason 2 times a day) and desensitizing (tavegil, pipolfen, etc.) therapy was carried out in all the cases during 3 days. Remedial gymnastics started on the second day. It was aimed at restoring tolerance to static loads, a volume of movements in the spine and strengthening the back muscles.
Results. The analysis showed, that there were reduction or disappearance of pain syndrome and regression of sensitive disorders in 93% of cases, watched immediately after the procedure or during the first day. Control MRI-examination of lumbar spine, carried out 3-4 months after vaporization, demonstrated, that hernia protrusion was 50% smaller in comparison with its initial size in 16 out of 55 cases (the rest cases were not subjected to examination due to some reasons of a personal character).
Conclusion. PLV can be one of the effective little-invasive and almost atraumatic methods of treatment of cervical and lumbar osteochondrosis. Its use results in smaller expenditures on treatment and a shorter period of rehabilitation.