V. Parfenov, V. Manukovsky, D. Kandyba
(Clinic and Faculty of Neurosurgery, Medicomilitary Academy, Saint Petersburg)
The last decade is characterized by a marked tendency to using little-invasive methods in removal of intervertebral disc hernias. There have appeared various surgical methods, reducing a traumatizing effect of an operation, its duration and a period of stay in hospital. Development of little-invasive interventions has led to decrease of a number of complications and recurrences of the disease. According to D. Stolke (1989), the rate of different complications in removal of intervertebral disc hernias with applying conventional wide approaches is as high as 13.4%. Introduction of operative microscopy and videoendoscopy into clinical practice has reduced this rate up to 5-7% (P. Kambin, 2000). It is no higher than 3%, when microendoscopic removal of intervertebral disc hernias is used (K. Foley, 1997).
Today there is no precise tactics of surgical treatment of cases with such hernias. Neurosurgical establishments are prone to perform conventional surgical interventions. It is conditioned by insufficient training of personnel and absence of necessary material and technical resources. Besides, there is no algorithm of an intervention choice, dependent on a hernia size, and, as a result, of subsequent treatment. Almost every patient with monoradicular syndrome and a verified intervertebral disc hernia is a candidate for conventional neurosurgical intervention.
Specialists of the Clinic of Neurosurgery of the Medicomilitary Academy perform all types of interventions, aimed at removal of the above hernias. Little-invasive transcutaneous pulp decompression was introduced in it six months ago. This method was developed several years ago and is widely used in the USA and Western Europe. Interventions are performed under conditions of an X-ray operating room and with applying the Stryker transcutaneous pulp decompressor.
We operated 36 cases. Good results were achieved in 35 of them, There was regression of radicular syndrome. We did not watch any complications, caused by intervention. Repeated conventional operation was performed in one case with preserved radicular syndrome.
Transcutaneous pulp decompression is a rather safe and simple method, which does not demand use of complex medical instruments and equipment. Interventions are made under conditions of local anesthesia. They are characterized by a minimum number of contraindications. This method ensures considerable reduction of stay in hospital.