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CNAA / Theses / 2009 / May /

Microneurosurgery of lumbar disc herniation


Author: Eftodiev Eduard
Degree:doctor of medicine
Speciality: 14.00.28 - Neurosurgery
Year:2009
Scientific adviser: Grigore Zapuhlih
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Scientific consultant: Diomid Gherman (decedat)
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:

Status

The thesis was presented on the 20 May, 2009
Approved by NCAA on the 18 June, 2009

Abstract

Adobe PDF document0.93 Mb / in romanian

Thesis

CZU 616.711.6 – 007.43+616.8 - 089

Adobe PDF document 1.48 Mb / in romanian
136 pages


Keywords

Lumbar disc herniation, microsurgical discectomy, outcome, quality of life, MacNab criteria, nucleotomy, interlaminar discectomy, cauda equina syndrome

Summary

Low back pain is a very common disorder. Many international surveys of low back pain report a point prevalence of 15% to 30%, a 1-month prevalence between 19% and 43%, and a lifetime prevalence of about 60% to 80%. Population surveys suggest that the patients with low back problems became younger and they show a high grade of functional disability.

The present study is based on the 325 patients with lumbar disc herniation, operated at the Institute of Neurology and Neurosurgery during the period 1998 – 2008. The goal of the research was to improve the results of surgical treatment in patients with all types of lumbar disc herniation by developing of microneurosurgical technique. Among these patients 160 (49,2%) were male and 165 (50,8%) – female, the patient’s age varied from 18 to 75 years, mean age – 43,4±0,86 years.

Corresponding to the surgical approach to the medal lumbar disc herniation patients were divided in two groups: 1st group – 62 patients - the microsurgical discectomy via laminectomy was performed. In the patients of the second group – 56 patients – the microsurgical discectomy via interlaminar – interapophyseal approach was performed.

Mean rate of complication was 15,3%. The incidence of Failed back surgery syndrome was 13,5%. The efficiency of surgical treatment was appreciated by using MacNab criteria. Using this questionnaire overall good outcome in 81,8% cases was registered, mediocre – in 7,4% and 6,5% - poor outcome.

Conclusion: Microneurosurgical approach is safe and effective for lumbar microdiscectomy. Careful attention to surgical technique will ensure that complications are minimized and will optimize patient outcomes. The benefits of microsurgical technique spinal surgery were the reduced occurrence of complications, the lower rate of recurrences, shorter hospitalization and better improvement of functional disability and quality of life.