PUNCTURE LASER MICRODISCECTOMY IN THE TREATMENT OF SEQUESTERED HERNIATION OF LUMBAR INTERVERTEBRAL DISCS

Abstract

Objective. to improve the results of treatment of sequestered herniation of lumbar intervertebral discs by the puncture laser microdiscectomy (PLM) method. Methods. During the period from 2000 to 2023, 132 patients with sequestered lumbar disc herniations were operated on by the PLM method. There were 88 males and 34 females. The age of the patients was from 23 to 64 (42.3 ± 3.5) years. Surgeries were performed using a C-arc operating fluoroscope. The laser pulse duration — 0.3–0.5 sec, and radiation exposure — 500–600 J. Approach to the sequestrum was mainly posteromedian transdural. For laterally located sequestra, posterolateral approach was used. The efficacy of PLM was assessed by pain intensity reduction according to the VAS scale one month after surgery, and according to the McNab scale 3 months after surgery. Results. One month after PLM, the maximum reduction of radicular pain intensity was noted in patients with posteromedian hernias, to a lesser extent — with paramedian hernias, and the least pronounced — with lateral hernias. However, no statistically significant differences in pain intensity one month after surgery depending on hernia location were found (p > 0.05). As for the intensity of lumbar pain, in all groups, regardless of hernia location, it significantly decreased and did not exceed 1 point after one month. 3 months after surgery, 95 (71.9 %) patients had an excellent result according to the McNab scale, 13 (9.8 %) — good, 7 (5.3 %) — satisfactory, 17 (12.8 %) — unsatisfactory, indicating that the PLM method of sequestered hernias can be quite effective in a certain selection of patients. According to our  data, positive results can reach 81.8 % (95 % CI 74.2–87.9 %) (CI — confidence interval). Conclusions Sequestered hernias, which can be operated by the PLM method, should not exceed 9 mm in height on axial sections, should have a smooth rounded lenticular shape without signs of migration. The positive effect of PLM of sequestered hernias reached 81.7 %. The results were better with PLM of posteromedian hernias.