POSTERIOR SURGICAL APPROACHES FOR CONGENITAL AND DEGENERATIVE DISEASES OF THE LUMBAR SPINE

Abstract

Objective. To analyze results of surgical treatment of patients with various diseases of the lumbar spine, to specify indications and contraindications for surgery, to substantiate the choice of optimal approach modification depending on the form and nature of compression.

Material and Methods. Results of surgical treatment of 680 patients with osteochondrosis complicated by disc-radicular conflict (n = 330), with spinal canal stenosis (n = 270), and with spondylolisthesis (n = 80) were analyzed. Patient examination included clinical evaluation, full-scale neurological study, and radiological diagnostic methods (spondylography, MRI, CT, and in some cases saccoradiculography). Surgical treatment was performed through posterior abdominal approaches of various modifications.

Results. Good and excellent results were reported in 95.2 % and satisfactory ones – in 4.8 % of patients with osteochondrosis. Stenosis patients showed good and excellent results in the early postoperative period in 84.9 % of cases, and in the late period (1–4 years) – in 94.6 %. Sixty five patients (89.8 %) with spondylolisthesis had good and excellent results, and 7 cases (10.2 %) were estimated as satisfactory.

Conclusion. Posterior surgical approaches provide optimum conditions for spinal canal decompression. Modified laminectomy technique is an operation of choice for treatment of spinal canal stenosis, large intervertebral disc hernia, and spondylolisthesis with spinal cord compression.