Minimally Invasive Spinal Canal Reconstruction for Degenerative Lumbar Spinal Stenosis

Abstract

Objective. To analyze early results of surgical treatment in patients with lumbar spinal stenosis using minimally invasive techniques for reconstruction of the spinal canal and fixation of the spine. Material and Methods. A total of 168 patients were treated with minimally invasive unilateral microsurgical decompression for spinal stenosis at the lumbar level. Results. The average length of post-operative inpatient care was 5.8 ± 2.8 days. When assessing the pain intensity in the legs and lumbar spine, as well as in daily activity, positive dynamics was noted after 1 and 6 months. Of the installed 732 screws, 18 (2.4 %) screws were displaced into the spinal canal by less than 2 mm and 4 (0.5 %)-by less than 4 mm. Signs of persistent subcompensated spinal stenosis at the operated level were detected in 5 (2.9 %) patients. The average intraoperative blood loss was 121.1 ± 22.0 ml. All patients were activated at the first day after surgery. Conclusion. Minimally invasive unilateral decompression, if necessary in combination with correction and fixation with percutaneous pedicle screw system and TLIF, eliminates factors causing compression of neural structures, reduces intraoperative blood loss, allows early activation of patients and shortens the length of hospital stay.

Efficacy of the Clinical-Instrumental Algorithm in the Treatment of Spinal Tandem Stenosis

“…The surgical techniques used in the study group patients are standard and have been widely used by various groups of authors in the surgical treatment of patients with isolated stenoses of the spinal canal at the cervical and lumbar levels. 14,15 However, approaches to the step-by-step implementation of surgical interventions and the timing of their implementation, the personified use of ventral and dorsal surgical techniques, as well as the priority of applying decompressive techniques before decompressive-stabilizing techniques in patients with tandem stenosis, were absent.…”

“…13,14 A comprehensive clinical evaluation of neurological symptoms directly arising from the degree of narrowing of the vertebral canal and intervertebral foramen combined with tandem stenoses is used to determine the dominant role in the surgical tactics, and the effectiveness of the intervention. 4,10,15 Neuroimaging techniques have significantly expanded the diagnostic capabilities for early verification of degenerative spinal diseases, which in turn, has led to an increase in the number of surgical interventions for spinal stenosis. 16,17 However, certain difficulties still remain in diagnosing the disease and choosing objective indications for surgery.…”

Multicenter Analysis of Surgical Treatment Effectiveness for Patients With Symptomatic Tandem Stenosis of the Cervical and Lumbar Spine Based on Differentiated Clinical-Instrumental Algorithm

“…Хирургические технологии, используемые при лечении пациентов исследуемой группы, являются стандартными и широко применяются различными авторами при хирургическом лечении пациентов с изолированными стенозами позвоночного канала [14,15]. но подходы к этапному выполнению оперативных вмешательств и срокам их проведения, персонифицированному использованию вентральных и дорзальных хирургических технологий, а также приоритетность применения декомпрессивных методик перед и декомпрессивно-стабилизирующими у пациентов с тандемстенозом отсутствовали.…”

“…клиническая комплексная оценка неврологической симптоматики, непосредственно зависящей от степени сужения позвоночного канала и межпозвонкового отверстия при сочетанных тандем-стенозах, определяет выбор оперативного вмешательства [4,10,15]. нейровизуализационные методы исследования значительно расширили диагностические возможности ранней верификации дегенеративных заболеваний позвоночника, что определило тенденцию к увеличению числа хирургических вмешательств по поводу стенозов позвоночного канала [16,17].…”