Две тактики лечения поясничных грыж межпозвонковых дисков с миграцией в зону второго, третьего окна по  Маккаллоку: транспедикулярная и трансламинарная секвестрэктомия (ридит-анализ)

Гизатуллин, Ш.Х.; Кристостуров, А.С.; Давыдов, Д.В.; Станишевский, А.В.; Колобаева, Е.Г.; Дубинин, И.П.; Ивахин, А.В.; Давыдов, А.Н.

Авторы: Гизатуллин Ш.Х., Кристостуров А.С., Давыдов Д.В., Станишевский А.В., Колобаева Е.Г., Дубинин И.П., Ивахин А.В., Давыдов А.Н.
Журнал: Вопросы нейрохирургии имени Н.Н.Бурденко
Том: 85
Номер: 6
Год издания: 2021
Издательство: Общество с ограниченной ответственностью Издательство Медиа Сфера
Местоположение издательства: Москва
Первая страница: 68
Последняя страница: 75
DOI: 10.17116/neiro20218506168
Аннотация: ABSTRACTA ridit analysis of results of transpedicular endoscopic and translaminar microsurgical surgeries for sequester migration to the second and third McCulloch’s windows was carried out. The authors assessed pain syndrome, quality of life and neurological impairment.Objective. To compare the outcomes of transpedicular and translaminar sequestrectomy for lumbar disc herniation and sequester migration to the second and third McCulloch’s windows.Material and methods. We analyzed treatment outcomes in 51 patients with lumbar disc herniation and severe sequester migration. We assessed lumbar and leg pain syndrome using then visual analogue scale, neurological impairment using the adapted Nurik scale and quality of life using the Oswestry questionnaire and the MacNab scale in early postoperative period, as well as in 2 weeks, 6 and 12 months after surgery. Ridit analysis was used for statistical processing of data.Results. Transpedicular sequestrectomy was performed in 24 patients, translaminar sequestrectomy — in 27 cases. Groups were comparable by gender, size and location of sequestration, somatic and neurological status, as well as pain severity. There was a higher probability of back (0.39) and leg (0.364) pain regression, neurological recovery (0.446) and improvement of quality of life according to the Oswestry questionnaire (0.389) after transpedicular surgery. According to the MacNab scoring system, excellent and good results were obtained in 84.21% and 15.79% of patients in 6 months after transpedicular surgery. In the second group, excellent, good and satisfactory results were obtained in 63%, 25.9% and 11.1% of patients, respectively.Conclusion. Herniated intervertebral discs with severe sequester migration should be divided in accordance with localization of the main sequestration. Transpedicular endoscopic approach is advisable for sequester in the third and rarely the second McCulloch’s windows. Translaminar microsurgical approach is preferred for sequestration in the second and rarely the third McCulloch’s windows. Clinical outcomes after translaminar microsurgical sequestrectomy and transpedicular endoscopic surgeries are similar. However, postoperative back and leg pain regression, neurological recovery and improvement of quality of life according to the Oswestry scoring system are more common after transpedicular surgery.Keywords: minimally invasive neurosurgery, herniated intervertebral disc, lumbosacral disc herniation with severe sequester migration, McCulloch’s window, transpedicular endoscopic sequestrectomy, translaminar microsurgical sequestrectomy.https://doi.org/10.17116/neiro20218506168
Добавил в систему: Гизатуллин Шамиль Хамбалович

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