[Two treatment approaches for lumbar disc herniation and sequester migration to the second and third McCulloch's windows: transpedicular and translaminar sequestrectomy (ridit analysis)]

A 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.

Degenerative scoliosis of the spine: diagnosis, classification and surgical approach in older patients

Adult scoliosis is a deformity of the spine with an angle of more than 10 (according to Cobb) in people with a fully formed bone system. Due to the aging of the population, improvement of surgical techniques, creation of new implants and progress in anesthetic aids, the problem of degenerative scoliosis has been more and more frequently considered from the viewpoint of a surgical approach. There are many theories about the factors that contribute to the formation of degenerative scoliosis. The conservative therapy of degenerative scoliosis includes non-steroidal anti-inflammatory drugs, bracing, epidural and paravertebral injections with glucocorticosteroids and physical therapy. In case the conservative therapy is ineffective and there is a significant decrease in the quality of life, the issue of the surgical intervention is raised individually for each patient. Currently, the role and the volume of the surgical intervention in individuals with this pathology remains debatable. The choice of a surgical technique depends on a thorough assessment of clinical symptoms, neurological status, data of instrumental methods and a mandatory estimation of the parameters of the global vertebral-pelvic balance. Therefore, in this article, we pay special attention to the surgical algorithms based on the choice of the decompression type and the fusion length. We describe the generally accepted criteria for selecting the level of spondylosynthesis. Special attention is paid to the risk factors of the surgical treatment, as well as associated complications.