This journal is
indexed in Scopus
Year 2016 Vol. 24 No 5
E.L. TSITKO, O.S. GOVRUSHKO, A.A. LITVIN, E.V. TSITKO
POSSIBILITY OF FRAMELESS NEURONAVIGATION IN PLANNING AND MONITORING DURING A SURGICAL INTERVENTION OF LUMBAR HERNIATED INTERVERTEBRAL DISC
ME "Gomel Regional Clinical Hospital"
The Republic of Belarus
Objectives. To study the application efficiency of frameless Brainlab neuronavigation in the surgical treatment of lumbar herniated intervertebral disc.
Methods. The study included patients (n=24) with osteochondrosis stage III. According to the level of destruction the degenerative disc changes were diagnosed at L4-L5 and L5-S1 (16 (66,7%) and 8 (33,3%), respectively. The caudal displacement of sequestration in 9 (37,5%) patients and 2 (8,3%) cranial displacement of sequestration was noted according to the computed tomography (CT) or magnetic resonance imaging (MRI) of the lumbar region. In all cases the interlaminar removing of the fragments of the fallen pulposus nucleus was performed with the revision of intervertebral gap in 18 (75%) patients and in 6 (25%) – with the puncture laser nucleoplasty (PLN) by the holmium laser. Planning and intraoperative monitoring during the surgery stages carried out by neuronavigation station BrainLab (Germany).
Results. Dynamic control of intervention by means of intraoperative navigation provided validity of decompression of the spinal root, radical removal of nucleus pulposus sequesters, and also permitted to prevent the damage of the vertebral end-plates and ventral portions of the fibrous ring due to the possibility of a clear positioning of the optical fiber in the disc cavity at PLN. Using PLN provides «intradiscal decompression» and fibrotization of the nucleus pulposus residues. A statistically significant positive dynamics of pain syndrome intensity according to visual analog scale (VAS) in patients (Z=4,28; p<0,001) as well as a significant improvement in life quality (Oswestry questionnaire) (Z=4,28; p<0,001) in the incisional period had been established.
Conclusion. High efficiency (91,7%) of the navigation system application in the preoperative planning and intraoperative monitoring during the surgical treatment of sequestered hernias has been established. Combination of the controlled navigation microsurgical discectomy and PLN appears promising method of surgical exposure aimed at eliminating direct causes of compression of the spine root and the prevention of postoperative complications.
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246012, Republic of Belarus,
Gomel, Brothers Lizyukova st., 5,
Gomel Regional Clinical Hospital.
neurosurgical department N1.
Tel: +375 232 48-55-66
Evgeny Leonidovich Tsitko
Tsitko E.L. PhD, Neurosurgeon, ME "Gomel Regional Clinical Hospital".
Govrushko O.S. Head of neurosurgical department N1, ME "Gomel Regional Clinical Hospital".
Litvin A.A. PhD, Ass. Professor, Deputy Chief Physician (Surgery), ME "Gomel Regional Clinical Hospital".
Tsitko E.V. PhD, Deputy Chief Physician (Polyclinic work), ME "Gomel Regional Clinical Hospital".