International Medical Journal, Vol. 23., Iss. 4, 2017, P. 38−42.
SIGNIFICANCE OF NEUROVISUALIZING METHODS FOR OPTIMIZING SURGICAL TACTICS IN PATIENTS WITH MULTIPLE CERVICAL SPINE HERNIAS
The State Institution Romodanov Neurosurgery Institute National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
The diagnosis and subsequent differential surgical treatment of neurological manifestations resulting from the lesions of the cervical spine in osteochondrosis is an extremely difficult task. The wide introduction of neuroimaging diagnostic techniques (digital spondylography, computed tomography, magnetic resonance imaging) has significantly expanded understanding of the mechanism of neurological disorders in spine pathology. To evaluate the capabilities of neuroimaging methods of diagnosis in optimizing the choice of surgical tactics for the treatment of patients with multiple hernias of the cervical spine we investigated 157. In addition to evaluating the neurological symptoms, the history of the disease, the age of the patient, digital spondylography (including functional tests) CT, MRI were mandatory, which allowed to measure the Tchaikovsky's index, assess the degree of the intervertebral disk degeneration and dehydration according to C. W. Phirmann et al., 2001. Based on evaluation of the results of neuroimaging findings, 79 patients underwent puncture laser microdiscectomy; open microdiscectomy with subsequent installation of the cage was carried out by 78 patients. The patients were activated in the first 24 hours after the surgery. The term of hospital stay after puncture laser microdiscectomy was 1 day, that of open microdiscectomy with subsequent cage installation was 3−4 days. Postoperative complications were not observed. According to the results of our study, no cases of pain syndrome or progress of neurological symptoms in the early postoperative period were noted. Thus, the diagnostic information obtained with digital spondylography, CT, MRI allows to substantiate the choice of surgical tactics in patients with multiple hernias of the cervical spine. Puncture laser microdiscectomy can be performed in patients with Tchaikovsky's index over 0,8. Tchaikovsky's index < 0,7, as well as the degree of V degeneration of the intervertebral disc according to W. Phirrmann are contraindications to its use. In such cases, preference should be given to open discectomy followed by spinal fusion.
Key words: digital spondylography, computerized tomography, magnetic resonance imaging, multiple cervical spine hernias.