Differentiated tactics of surgical treatment of intervertebral disc herniation complicated by spinal canal stenosis

Abstract

Objective: to conduct a retrospective analysis and evaluate the results of various methods of surgical treatment of patients with intervertebral disc herniation (IDH), which is complicated by spinal canal stenosis (SCS) of the lumbar spine.Materials and methods: 80 patients (36 (45%) men and 44 (55%) women) with a diagnosis of IDH complicated by SCS took part in the study. The average age of patients is under 50 years. All patients were operated on in the neurosurgery department of Zaporizhzhya Regional Clinical Hospital between 2016 and 2020. Patients were divided into two groups depending on the area of ​​the spinal canal and the method of surgical treatment. Group A (n=20) – relative SCS, area of the spinal canal – 75‒100 mm2, the presence of IDH >6 mm (according to magnetic resonance imaging). These patients underwent a standard microdiscectomy. Group B (n=60) ‒ absolute SCS, spinal canal area 0.05). In both groups, a significant decrease in the Oswestry index was registered immediately after surgery and its further decrease until the end of the follow-up period. When comparing the groups at the end of the first day after the operation, after 3 and 6 months, no statistically significant differences were found (p>0.05), but preoperative Oswestry index was significantly higher in group B, (р=0.04 according to the Mann‒Whitney test).Conclusions. In group A, the treatment effectiveness of patients reached 80‒85%, in the observation period on the 3 and 6 months. In group B, the treatment effectiveness of patients was also high and amounted to 75‒80%, in the observation period on the 3 and 6 months. Thus, taking into account the high variability of clinical and morphological changes in patients with IDH complicated by SCS, it is optimal to use differentiated surgical treatment tactics.