Konovalov N., Shevelev I., Tissen Ò., Guscha À., Nazarenko À., Arestov S.
Burdenko Research Institute of Neurosurgery, Moscow, Russia
A number of cases, operated at the Research Institute of Neurosurgery for disc hernias during 1995-2006, was 1400. More than 200 operations were performed in patients with stenosis of the vertebral canal. Beginning with 2000, we made transpedicular stabilization in more than 200 cases. During the last two years there were 51 interventions, performed with applying a posterior approach and self-expanding interbody implants. Total prosthetics of discs was made in 14 cases. The analysis of the above clinical material allowed to arrive at the following conclusion. Primary hernias without instability signs demanded standard removal, using an intralaminar access and sometimes an endoscope. In case of gross instability and spondylolisthesis, it was expedient to perform transpedicular stabilization, combined with interbody implants. If disc hernia was not characterized by marked instability, but still demanded surgical correction, self-expanding interbody implants were placed after its removal. We gave up applying transpedicular fixation in such cases. Self-expanding interbody implants were placed after performing a bilateral intralaminar approach (it is much more less traumatic than in transpedicular stabilization). Being located directly within an interbody space, they permitted to restore lumbar lordosis and ensured rather reliable fixation. An alternative method was total prosthetics of an intervertebral disc, using an anterior minimum-invasive retroperitoneal approach. The advantages of this method lied in preserving anatomic integrity of posterior spinal segments and soft tissues, preventing instability development in adjacent segments and no necessity to wait for formation of a bony block.