Neurosurgery

doi: 10.25005/2074-0581-2019-21-3-395-399
THE IMPORTANCE OF USING EPIDURAL FAT IN THE PREVENTION OF OPERATED SPINE SYNDROME

Kh.D. Rakhmonov, R.N. Berdiev, F.G. Khozhanazarov

Department of Neurosurgery and Polytrauma, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan

Objective: Improving the results of microsurgical treatment of recurrences of a herniated inter-vertebral disc (HIVD) in operated spine syndrome.

Methods: The results of surgical treatment of 70 patients with lumboishialgia and disco-radicular conflict due to the HIVD were studied. Among the total number of sick women were 26 (37.1%), men – 44 (62.9%). A comprehensive examination of patients included X-ray, tomography and/or MRI of the lumbosacral section of the spinal column, as well as the electromyography study of lower limbs. Dynamic examination of patients was carried out before and after surgery, and the time frame through 3, 6 and 12 months after surgery.

Results: In the studying the levels of lesions of the spine divisions, it was found that the most common HIVD was observed at the level of L5 -S1 – in 36 (51.4%); L4 -L5 HIVD was found at 29 (41.4%); and L3 -L4 - at 5 (7.1%) cases. In 40 (57.1%) patients out of 70 had microsurgical discectomy in the traditional way and in 30 (42.9%) cases performed a microsurgical discectomy with the laying of free fat in the interstitial space. The results of the comparative analysis showed that patients in both groups had a decrease in the intensity of pain syndrome compared to the condition before operation. At the same time, in the patients of the main group, this parameter was better though the 6 and 12 months than in the control group (p<0.01).

Conclusions: Proposed microsurgical discectomy with the laying of free fat in the interstitial space during re-operation on the recurrence of HIVD, along with its simplicity in performance has shown great efficiency without requiring additional costs. A decrease in the number of unsatisfactory outcomes by 2-3 times was noted with a simultaneous increase in the number of satisfactory and good results of surgical treatment of this disease.

Keywords: Operated spine syndrome, epidural fat, osteochondrosis, pain syndrome.

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References
  1. Pavlov SA Shpagin MV, Yastrebov DN. Kompleksnaya terapiya ostatochnogo bolevogo sindroma posle diskektomii na poyasnichnom urovne [Combined therapy of residual pain after discectomy at the lumbar level]. Meditsinskiy al’manakh. 2011;1:143-5.
  2. Vorobyova OV. Kak predupredit’ khronizatsiyu boli v oblasti spiny [How to prevent chronic pain in the back]. Trudnyy patsient. 2011;4:36-40.
  3. Rakhmonov KhD, Berdiev RN, Ali-Zade SG. Novoe v udalenii gryzh mezhpozvonkovykh diskov [New approach in the spinal disc herniation treatment]. Vestnik Avitsenny [Avicenna Bulletin]. 2019;21(1):55-9. Available from: https://doi.org/10.25005/2074-0581-2019-21-1-55-59.
  4. Razumov DV, Podchufarova EV. Rol’ bolevogo povedeniya v formirovanii invalidizatsii u patsientov s khronicheskoy bol’yu v spine [The role of pain in the formation of disability in patients with chronic back pain]. Rossiyskiy meditsinskiy zhurnal. 2010;3:11-8.
  5. Aslanukov MN, Vasilyev SA, Zagorulko OI, Levin RS, Pesnya-Prasolov SB, Fisenko EP. Ul’trazvukovoe issledovanie v khirurgii degenerativnykh zabolevaniy poyasnichnogo otdela pozvonochnika [Ultrasound examination in surgery of degenerative diseases of the lumbar spine]. Klinicheskaya i eksperimental’naya khirurgiya. 2016;3:28-35.
  6. Volkov IV. Vliyanie drenirovaniya i plastiki epidural’nogo prostranstva na rezul’taty poyasnichnykh diskektomiy [Effect of drainage and plastics of the epidural space on the results of lumbar diskectomy]. Vestnik khirurgii. 2008;2:61-4.
  7. Barinov AN. Nevropaticheskiy bolevoy sindrom pri bolyakh v spine [Neuropathic pain syndrome in back pain]. Trudnyy patsient. 2011;1:17-23.
  8. Krupatkin AI, Kuleshov AA, Sokolova TV, Gospod AO. Patopsikhologicheskie aspekty bolevykh sindromov v nizhney chasti spiny [Pathopsychological aspects of pain in the lower back]. Zhurnal nevrologii i psikhiatrii. 2017;4:102-6.
  9. Khizhnyak MV, Pedachenko YuE, Tanaseychuk AF, Kramarenko VA. Mikrodiskektomiya v sochetanii s sistemoy mezhostistoy stabilizatsii pri mul’tifaktornoy kompressii poyasnichnogo otdela pozvonochnika [Microdiscectomy in combination with the system of interspinous stabilization in multifactorial compression of the lumbar spine]. Ukrainskiy neyrokhirurgicheskiy zhurnal. 2012;3:27-30.
  10. Belova AN. Shkaly, testy i oprosniki v nevrologii i neyrokhirurgii. 3-ye izd. [Scales, tests and questionnaires in neurology and neurosurgery. 3d ed.]. Moscow, RF: Prakticheskaya meditsina; 2018. 696 p.
  11. Bulgakov IO, Poverenova IE. Sravnitel’naya kharakteristika metodov operativnogo lecheniya gryzh mezhpozvonkovykh diskov na urovne poyasnichno-kresttsovogo otdela pozvonochnika [Comparative characteristics of surgical treatment of herniated intervertebral discs at the level of the lumbosacral spine]. Saratovskiy nauchno-meditsinskiy zhurnal. 2010;6(1):144-6.
  12. Bokov AE, Perlmutter OA, Mlyavykh SG, Simonov AE. Analiz prichin sokhranyayushchegosya bolevogo sindroma posle khirurgicheskogo lecheniya kompressionnogo koreshkovogo sindroma, obuslovlennogo gryzhey diska na poyasnichnom urovne [Analysis of the causes of persistent pain after surgical treatment of compression root syndrome caused by disc herniation at the lumbar level]. Rossiyskiy neyrokhirurgicheskiy zhurnal im. Polenova. 2012;12(1):10-5.
  13. Kamilova GI, Ashurova NS, Chudinov AV, Gaibova MG. Osnovnye faktory, obuslovlivayushchie pervichnuyu invalidnost’ naseleniya Respubliki Tadzhikistan [The main factors contributing to the primary disability of the population of the Republic of Tajikistan]. Vestnik Avitsenny [Avicenna Bulletin]. 2015;3:102-5.
  14. Arestov SO, Gushcha AO, Kashcheev AA. Osobennosti tekhniki i otdalyonnye rezul’taty portal’nykh endoskopicheskikh vmeshatel’stv pri gryzhakh mezhpozvonkovykh diskov poyasnichno-kresttsovogo otdela pozvonochnika [Features of equipment and long-term results of portal endoscopic interventions for hernias of intervertebral discs of the lumbosacral spine]. Voprosy neyrokhirurgii. 2011;1:27-33.
  15. Rambaransingh B, Stanford G, Burnham R. The effect of repeated zygapophysial joint radiofrequency neurotomy on pain, disability, and improvement duration. Pain Med. 2010;11(9):1343-7. Available from: https://doi. org/10.1111/j.1526-4637.2010.00923.x.
  16. Tu Z, Wang B, Li L, Li Y. Early experience of full-endoscopic interlaminar discectomy for adolescent lumbar disc herniation with sciatic scoliosis. Pain Physician. 2018;21(1):E63-E70.
  17. Wang H, Cheng J, Xiao H, Zhou Y. Adolescent lumbar disc herniation: experience from a large minimally invasive treatment centre for lumbar degenerative disease in Chongqing, China. Clinical Neurology and Neurosurgery. 2013;115(8):1415-9.
  18. Bouma G, Barth M, Ledic D, Vilendecic M. The high-risk discectomy patient: prevention of reherniation in patients with large anular defects using an anular closure device. European Spine Journal. 2013;22(5):1030-6. Available from: https://doi.org/10.1007/s00586-013-2656-1.
  19. Gulati S, Madsbu MA, Solberg TK, Sorlie A, Giannadakis C, Skram MK, et al. Lumbar microdiscectomy for sciatica in adolescents: a multicentre observational registry-based study. Acta Neurochirurgica (Wien). 2017;159(3):509- 16.

Authors informations:

Rakhmonov Khurshed Dzhamshedovich Candidate of Medical Sciences, Associate Professor of the Department of Neurosurgery and Polytrauma, Avicenna Tajik State Medical University ORCID ID: 0000-0002-6782-2979

Berdiev Rustam Namozovich Doctor of Medical Sciences, Head of the Department of Neurosurgery and Polytrauma, Avicenna Tajik State Medical University ORCID ID: 0000-0002-4804-1931

Khozhanazarov Fakhriddin Garovboevich Postgraduate Student, Department of Neurosurgery and Polytrauma, Avicenna Tajik State Medical University ORCID ID: 0000-0003-0377-6253

Address for correspondence:

Berdiev Rustam Namozovich
Doctor of Medical Sciences, Head of the Department of Neurosurgery and Polytrauma, Avicenna Tajik State Medical University

734003, Republic of Tajikistan, Dushanbe, Rudaki Ave., 139

Tel.: +992 (918) 813282

E-mail: rnamozzoda@mail.ru

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