EUROMEDICA  Hanover 23-24  Mai 2011	Advanced methods of diagnosis, treatment and prophylactics
	European Academy of Natural Sciences, Hanover European Scientific Society, Hanover

Home

Abstracts

Contact

Disclaimer

The relapse of pain after microdiscectomy at the lumbar spine level until is one of the most urgent problem of the surgical treatment the nerve root compression syndrome.

Patients and methods. Since 2007-2010 the 151 patients was admitted to our hospital at postoperative period after standard microdiscectomy, which was done without the any of instrumental technique. All patients were divided into 2 groups. At the first one we include 97 patients with reflex-pain syndrome without the clinic of the radiculopathy. And 54 patients had recidivating of the nerve root compression syndrome. All of them underwent the first operation at 1988 to 2005 years. Among all well known reasons of radiculopathy we detected these: recurrence of the herniated disc – 21 cases, with instability of operated segment – 11 cases, spondylolistesis - 5 cases, and recurrence of the herniated disc in combination with spondyloarthrosis – 17 cases. The epidural fibrosis was detected in all cases. The results were assessed by Oswestry’s Disability index and Mac Nab outcome scale. Patients were followed for an average of 1.2 years at the first group and 1.5 years at the second (minimum 6 months in both groups).

In the first group we used the sequential denervation of facet joints and intervertebral discs (of course only the upper-and lower from operated) in combination with standard complex of conservative treatment, which includes the epidural blocks. The procedure of denervation consists from the introduction the mixture of anesthetic agent and ethanol in correlation 2:1. Such introduction in the region of facet joints and(or) into the intervertebral disc provoked the reflex-pain syndrome, which patient recognize and immediately arrest the pain, because of 96% ethanol, which can “coagulate” facet joint’s nerve or fibrous ring. This fact prove for us and patient: this pain depended on facet joints and(or) intervertebral disc. We always started with facet joints and after 5-7 days (if the pain wasn’t provoked) we continue with intervertebral discs.

All patients of the second group were reoperated. In this series we prefer ventrolateral retroperitoneal approach to the lumbar vertebra. In all cases we added this approach with anterior foraminotomy. The technique of this surgery have some differ from standard anterior stabilization case. After removing residue of nucleus pulposis we drilled the slot (20-22 mm.) in the adjacent surfaces of the lumbar vertebra. From this slot it become more easier to remove disc’s hernia (because of good vision and epidural fibrosis absence) and then resect the most lateral part of posterior inferior border of the upper lumbar vertebra. It will be anterior foraminotomy. In the end of surgery the Nickel-Titan implant drive in the slot to obtain the segmental stabilization.

We prefer this method because it allows us to solve the biggest part of problems in one surgery: to remove disc’s hernia, open the upper level of the lateral recess, obtain the segmental stabilization, to allow of no more progressing of epidural fibrosis.

Results. In the first group excellent results were achieved in 34 (35%) cases, good – 51 (52.5%), satisfactory – 9 (9.5%), fair (without changes) – 3 (3%).Second group: excellent results – 11 (20.3%), good – 26 (48%), satisfactory – 9 (16.6%), fair – 6 (11.1%).

Conclusion. 1) The sequential denervation of facet joints and intervertebral discs allow provoking the reflex-pain syndrome, which patient can recognize and immediately arrest the pain. This procedure can prove the fact that chronic pain after standard microdiscectomy (failure back surgery syndrome) may be depending on the pathology of facet joints and intervertebral discs. 2) The ventrolateral retroperitoneal approach to the lumbar vertebra with anterior foraminotomy can be recommended for the surgery of the herniated disc relapse.