Treatment of a herniated intervertebral disc and stenosed openings - Causes, symptoms and treatment. MF.
Osteochondrosis of the spine , degenerative-dystrophic spine pathology, herniated disc, stenosis of the spinal canal are very common diagnoses at the present time. The development of diagnostic methods makes it possible to establish the cause of pain in the spine.
Stenosis of the spinal canal - narrowing of the lumen - often develops as a degenerative-dystrophic process - deforming spondylosis, spondyloarthrosis, hypertrophy and sclerosis of the ligamentous apparatus, disc herniation. Possible congenital stenosis - anatomical features of a person and acquired - post-traumatic, against the backdrop of Bekhterev's disease, tuberculosis of the spine. Herniated discs are a manifestation of degenerative changes in the vertebral-motor segment of the spine. In the development of the clinical picture of the disease, it is not the mere presence of a hernia that matters, but its size, location - that is, its role in the compression of roots, spinal cord and the development of radiculopathy, radiculomyelopathy. Stenosis of the spinal canal and foramenal orifices can be the cause of the pain syndrome only if there is compression of the contents - the neurovascular structures.
For diagnostic purposes, X-ray examination, computer and magnetic resonance imaging, electroneurography, and elimination of somatic pathology as a possible cause of pain syndrome at this level are performed.
Conservative treatment of vertebrogenic pathology is a medical treatment - nonsteroidal anti-inflammatory drugs, muscle relaxants, vascular drugs, B group vitamins, pyrimidine nucleotides, gabapentins. .. physiotherapy, manual therapy, stretching, sanatorium treatment.
The need for neurosurgical treatment is determined by the doctor. Prolonged persistent pain syndrome, radicular syndrome in the presence of a disc herniation squeezing this nerve root, stenosis of the foramenal opening in the presence of the clinic of radiculopathy. .., no effect of conservative treatment.
Spinoscope
The use of minimally invasive methods of treatment of spine diseases, the presence of ultra-compact microcams, perfect catheters, lasers, endoscopes and many other high-tech instruments allow minimizing surgical intervention and making the operation safer, less traumatic, less prolonged. Modern methods are percutaneous endoscopic nucleotomy, microscopic nucleotomy, microscopic laminectomy, intervertebral disc prosthesis, percutaneous thermocoagulation, intervertebral cryotherapy, minimally invasive spinal segment stabilization, microscopic decompression of the spinal canal with stenosis.
The method and volume of the operation will depend on the method of anesthesia, the length of stay in the hospital, and the subsequent rehabilitation, and the period of incapacity for work.
The volume of surgical treatment is determined by the neurosurgeon: decompression laminectomy, discectomy - removal( resection) of the structures that squeezed the nerve root, decompression laminectomy in conjunction with stabilizing operations, interstitial dynamic fixation, the use of stabilizing systems, laser microdiscectomy, endoscopic surgery. ..
For minimally invasive neurosurgical treatment of herniasintervertebral disc and stenosed apertures at all levels of the spine is used a spinoscope.
Endoscopic operation provides control of tool movement in all directions, provides a bend angle of 90 degrees, provides access to the L5-S1 disk, inside and out-of-disk control, removal of disc herniation with laser or mechanical forceps, decompression with the opening of a stenosed opening - foramenoplasty.
Microdiscectomy( usually L4-L5, L5-S1) is performed in the supine position, under intravenous anesthesia. Skin and aponeurosis incision is made over the spinous processes of L4-L5, separation of the invertebral muscles from the arches and spinous processes, opening of the yellow ligament, detection of the hernia, separation and displacement of the root medially, dissection of the fibrous ring, removal of the hernial protrusion, hemostasis, layered suturing of soft tissues,aseptic bandage. The duration of the intervention is 20 to 60 minutes. Stay in the hospital for up to 7 days. Further rehabilitation is carried out by neurologists.
Percutaneous laser decompression is performed under local anesthesia, the operation is short, the damage to tissues and nerve is practically eliminated, the scar practically does not form. The energy of the laser "evaporates" parts of the pulpous nucleus of the intervertebral disc, leads to their reduction and the removal of compression on surrounding tissues. Stay in the hospital 1-3 days.
Spiral nucleotomy is performed under local anesthesia and x-ray control, without incision of the skin. A thin hollow needle is inserted into the hernia of the disc, a spiral needle is inserted inside. Rotating it captures the particles of the "dropped out" disc and takes them out, the necessary decompression takes place. The duration of the procedure is 15 - 30 minutes. The surrounding tissues are not damaged. Possible outpatient procedure.
Of course, the exact diagnosis, the specialization of the clinic, its equipping with modern equipment and the qualification of specialists - neurosurgeons, is important for choosing a method of treatment.
Endoscopic discectomy using laser