Surgical tactics for multilevel displacements of lumbar intervertebral discs

Abstract

Purpose. To improve the results of surgical treatment of lumbar pain syndromes and radiculopathy caused by the multilevel displacement of the intervertebral discs in the lumbosacral spine.Materials and methods. During 2014 through 2018, we examined and treated 3,045 patients with lumbar pain and radiculopathy caused by the displacement of the lumbar intervertebral discs. Seventy-two per cent of patients with the multilevel displacement of intervertebral discs were examined and treated in I.I. Mechnikov Dnipropetrovsk Regional Clinical Hospital, 21 % of patients — in the medical centre “Endoscopic Neurosurgery” and 7% of patients were operated in the medical centre “Clinic of Family Medicine”. The mean age of the patients was 42.6 ± 5.4 years. All patients underwent a neurological examination with functional tests, a computer and magnetic resonance imaging, spondylography, electroneuromyography. The effectiveness of the selected surgical treatment method was evaluated by VAS scale, static and dynamic spine function testing before the intervention and in 2–3 weeks, 2–3 months and in 3–5 years after surgery. The days of disability were taken into account.Results. The patients underwent puncture laser microdiscectomy (PLM) and endoscopic microdiscectomy (EDE) (p<0.05) presented with the most significant relief of pain syndrome, and the microdiscectomy with instrumentation was associated with pain syndrome reduction at all stages. The indicators of static and dynamic function of the spine using the Schober test, lateroflexion, extension in the dynamics were also significantly better in patients after PLM and EDE in comparison with other methods of surgery. The lowest number of days of disability was observed in patients who underwent PLM (30.7 ± 6.3 days) and EDE (24.6 ± 5.2 days). Maximum number of days of disability was in 34 patients after microdiscectomy with instrumentation — 64.5 ± 10.7 days.Conclusions. When choosing a surgical tactic for two hernias located at non-adjacent levels, the clinical manifestations and size of the second hernia should be crucial. When comparing the effectiveness of surgical treatment of multilevel hernias of the intervertebral discs in the lumbosacral spine, the best results were obtained using the methods of EDE and PLM.