MINIMALLY INVASIVE TREATMENT OF LATERAL STENOSES OF THE LUMBAR SPINE
About the author:
Radchenko V. O., Piontkovskyi V. K., Zlatіv V. P., Myronyk B. M., Kasianchuk V. M.
METHODS AND METHODOLOGIES
Type of article:
This research analyses 150 clinical cases of surgical treatment of lumbar foraminal stenosis in patients who underwent endoscopic transforaminal decompression in the Department of Minimally Invasive and Instrumental Spine Surgery of the State Institution “Professor Sitenko Centre for Spinal and Joint Disorders of the Ukrainian Academy of Medical Science” and in the Regional Centre of Orthopaedics, Traumatology and Vertebrology of the Public Healthcare Institution “Rivne Regional Clinical Hospital” from April 2016 to December 2019. Following this technique, under local anaesthesia and with the help of the optoelectronic converter a spinal needle was placed on the top of the lateral facet and with the help of the needle a guide wire was inserted through which a TOM Shidi needle was introduced. Then, into the lumen of the TOM Shidi needle a guide wire was again inserted and the TOM Shidi needle was removed. After that, a foraminotomy was performed through the guide wire by the alternate introduction of blunt end bone drills from the MaxMore set of instruments, and then the working cannula with the endoscope were inserted to allow the visual control of the performed foraminotomy. The remains of the hypertrophied capsule and the ligamentum flavum were removed using a Trigger-flex radiofrequency electrode. In the end, the herniated content and nerve root were visualized and hernia was removed by a mini-clipper and a radiofrequency electrode. However, this technique is not universal and cannot be applied to all patients. Considerable practical experience has shown that surgeons may encounter certain technical difficulties with foraminal stenosis in the first zone and in some cases the access at L5-S1 level may be difficult due to the high standing of the iliac wing, the instability of functional spinal units (FSU) at the operated level, severe central stenosis of the spinal canal and distant cranial or caudal migration of free sequesters. However, if there are correct indications, this minimally invasive technique allows solving the problem of radicular compression syndrome in foraminal stenosis in a short time with minimal soft tissue damage and minimal contact with nerve structures.
foraminal stenosis, intervertebral disc hernia, endoscopic decompression.
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Publication of the article:
«Bulletin of problems biology and medicine» Issue 1 (155), 2020 year, 255-259 pages, index UDK 616.711-003.8-089.2(06)