CURRENT TRENDS OF SURGICAL TREATMENT INTERVERTEBRAL HERNIAS AND LUMBAR STENOSIS THE SPINE
DOI:
https://doi.org/10.15674/0030-598720244105-113Keywords:
Spine, intervertebral hernia, discectomy, open discectomy, microdiscectomy, transforaminal discectomy, endoscopic discectomy, monoportal discectomy, biportal discectomy, decompressia, complicationAbstract
Objective. On the basis of a study of scientific literature on the treatment of patients with intercho-ribbus hernias and stenosis of the spinal canal of the lumbar spine to determine the tendencies of development of methods of performing surgical treatment of these diseases and the conditions of their appointment. Methods. The literature search was performed in the PubMed database. The inclusion criteria were original clinical studies in English. Results. We selected and studied 47 studies. Conclusions. The advantages of modern endoscopic spine surgery include less tissue damage, lower blood loss, less damage to the epidural blood supply with less fibrosis, shorter hospital stay, and early cosmetic recovery. Percutaneous endoscopic partial discectomy (PEPD) allows to avoid significant damage to the skin, muscles, plates and synapses, excessive load on the dura mater, it is performed under local anesthesia. This type of discectomy is more suitable for the treatment of foraminal and extraforaminal hernias, when the transforaminal approach facilitates visualization of the lesion. In the middle type hernias, the limitations of the intervertebral opening and the interference of the solid meninge when performing this technique leads to the worst clinical results. In general, after PEPD, the results are better than after microdiscectomy. Surgical treatment of lumbar spinal stenosis is mainly performed using single-channel endoscopic surgery, which allows for complete preservation of the physiological structure of the lumbar spine with minor surgical trauma and rapid postoperative recovery. The disadvantages are a small field, as well as the difficulty of expanding the boundaries of decompression. One of the most recent developments in the treatment of intervertebral hernias is unilateral biportal endoscopic discectomy (UBED). The effectiveness of discectomy and release of nerve roots in the spinal canal is higher than that of percutaneous endoscopic interlaminar partial discectomy, but UBED is longer, with greater actual blood loss during surgery
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