Эффективность декомпрессии в сочетании с транспедикулярной винтовой фиксацией при смешанном поясничном стенозе

Гайдаш М.И., Ли Ч., Башлачев М.Г., Зонов М.Г., Аакеф Х.Н.A. Эффективность декомпрессии в сочетании с транспедикулярной винтовой фиксацией при смешанном поясничном стенозе. Consilium Medicum. 2024;26(2):93–96. DOI: 10.26442/20751753.2024.2.202712

© ООО «КОНСИЛИУМ МЕДИКУМ», 2024 г.

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Gaydash MI, Lee C, Bashlachev MG, Zonov MG, Akif HN. Efficacy of decompression combined with transpedicular screw fixation in mixed lumbar stenosis. Case report. Consilium Medicum. 2024;26(2):93–96.
DOI: 10.26442/20751753.2024.2.202712

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Аннотация

Дегенеративный стеноз является распространенной патологией поясничного отдела позвоночника, однако в настоящее время отсутствует единое мнение о клинической значимости данных нейровизуализации и тактике ведения пациентов c таким заболеванием. Соответственно, вопросы диагностики и лечения в течение многих лет вызывают дискуссии среди врачей как терапевтического, так и хирургического профилей. Представлено наблюдение пациентки 65 лет со смешанным поясничным стенозом, у которой хирургическое вмешательство в виде декомпрессии и транспедикулярной винтовой фиксации привело к полному регрессу боли и двигательных нарушений, способствовало существенному улучшению функционального состояния. Рассмотрены вопросы диагностики, консервативного и хирургического лечения смешанного поясничного стеноза.

Ключевые слова: смешанный поясничный стеноз, транспедикулярная винтовая фиксация, нейрогенная перемежающаяся хромота

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Degenerative stenosis is a common pathology of the lumbar spine, however, there is currently no consensus on the clinical significance of neuroimaging findings and management tactics for such patients. In this regard, the issues of diagnosis and treatment have been causing discussions among doctors of both therapeutic and surgical profiles for many years. The article presents an observation of a 65-year-old patient with mixed lumbar stenosis, in whom surgical intervention in the form of decompression and transpedicular screw fixation led to a complete regression of pain, motor disorders and a significant improvement in functional condition. The issues of diagnosis, conservative and surgical treatment of mixed lumbar stenosis are discussed.

Keywords: mixed lumbar stenosis, transpedicular screw fixation, neurogenic intermittent claudication

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19. Strube P, Putzier M, Siewe J, et al. To fuse or not to fuse: a survey among members of the German Spine Society (DWG) regarding lumbar degenerative spondylolisthesis and spinal stenosis. Arch Orthop Trauma Surg. 2019;139(5):613-21. DOI:10.1007/s00402-018-3096-5
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21. Demir Ö, Öksüz E, Deniz FE, Demir O. Assessing the effects of lumbar posterior stabilization and fusion to vertebral bone density in stabilized and adjacent segments by using Hounsfield unit. J Spine Surg. 2017;3(4):548-53. DOI:10.21037/jss.2017.09.05
22. Jung JM, Hyun SJ, Kim KJ, et al. A prospective study of non-surgical versus surgical treatment for lumbar spinal stenosis without instability. J Clin Neurosci. 2020;80:100-7. DOI:10.1016/j.jocn.2020.07.062

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1. Verbiest H. A radicular syndrome from developmental narrowing of the lumbar vertebral canal. J Bone Joint Surg Br. 1954;36-B(2):230-7. DOI:10.1302/0301-620X.36B2.230
2. Khalepa RV, Klimov VS. Lumbar spinal stenosis in elderly and senile patients: problem state and features of surgical treatment. Russian Journal of Neurosurgery. 2017;(1):100-8 (in Russian).
3. Yarikov AV, Smirnov II, Perl’mutter OA, et al. Spinal canal stenosis of the lumbar spine. Klinicheskaya Praktika. 2020;11(3):50-60 (in Russian). DOI:10.17816/clinpract34032
4. Manchikanti L, Knezevic NN, Navani A, et al. Epidural Interventions in the Management of Chronic Spinal Pain: American Society of Interventional Pain Physicians (ASIPP) Comprehensive Evidence-Based Guidelines. Pain Physician. 2021;24(S1):S27-S208.
5. Abbas J, Peled N, Hershkovitz I, Hamoud K. The Role of Vertebral Morphometry in the Pathogenesis of Degenerative Lumbar Spinal Stenosis. Biomed Res Int. 2021;2021:7093745. DOI:10.1155/2021/7093745
6. Wu L, Munakomi S, Cruz R. Lumbar Spinal Stenosis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2024.
7. Nikitin AS. Degenerative lateral stenosis of lumbar vertebral canal. Russian Journal of Neurosurgery. 2016;(1):85-92 (in Russian).
8. Seo J, Lee JW. Magnetic Resonance Imaging Grading Systems for Central Canal and Neural Foraminal Stenoses of the Lumbar and Cervical Spines With a Focus on the Lee Grading System. Korean J Radiol. 2023;24(3):224-34. DOI:10.3348/kjr.2022.0351
9. Isaykin AI, Chernenko OA, Rosen AI. Lumbar spinal stenosis. RMJ. 2019;9:40-3 (in Russian).
10. Sekiguchi M. The Essence of Clinical Practice Guidelines for Lumbar Spinal Stenosis, 2021: 1. Definition, Epidemiology, and Natural History. Spine Surg Relat Res. 2023;7(4):298-9. DOI:10.22603/ssrr.2022-0079
11. Takahashi K, Kagechika K, Takino T, et al. Changes in epidural pressure during walking in patients with lumbar spinal stenosis. Spine (Phila Pa 1976).
1995;20(24):2746-9. DOI:10.1097/00007632-199512150-00017
12. Gandhi J, Shah J, Joshi G, et al. Neuro-urological sequelae of lumbar spinal stenosis. Int J Neurosci. 2018;128(6):554-62. DOI:10.1080/00207454.2017.1400973
13. Kobayashi S. Pathophysiology, diagnosis and treatment of intermittent claudication in patients with lumbar canal stenosis. World J Orthop. 2014;5(2):134-45. DOI:10.5312/wjo.v5.i2.134
14. Ammendolia C, Hofkirchner C, Plener J, et al. Non-operative treatment for lumbar spinal stenosis with neurogenic claudication: an updated systematic review. BMJ Open. 2022;12(1):e057724. DOI:10.1136/bmjopen-2021-057724
15. Kawakami M, Takeshita K, Inoue G, et al. Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of lumbar spinal stenosis, 2021 – Secondary publication. J Orthop Sci. 2023;28(1):46-91. DOI:10.1016/j.jos.2022.03.013
16. Bochicchio M, Aicale R, Romeo R, et al. Mini-invasive bilateral transfacet screw fixation with reconstruction of the neural arch for lumbar stenosis: A two centre case series. Surgeon. 2022;20(4):e122-8. DOI:10.1016/j.surge.2021.05.006
17. Deer T, Sayed D, Michels J, et al. A Review of Lumbar Spinal Stenosis with Intermittent Neurogenic Claudication: Disease and Diagnosis. Pain Med. 2019;20(Suppl. 2):S32-44. DOI:10.1093/pm/pnz161
18. Dickman CA, Fessler RG, MacMillan M, Haid RW. Transpedicular screw-rod fixation of the lumbar spine: operative technique and outcome in 104 cases. J Neurosurg.
1992;77(6):860-70. DOI:10.3171/jns.1992.77.6.0860
19. Strube P, Putzier M, Siewe J, et al. To fuse or not to fuse: a survey among members of the German Spine Society (DWG) regarding lumbar degenerative spondylolisthesis and spinal stenosis. Arch Orthop Trauma Surg. 2019;139(5):613-21. DOI:10.1007/s00402-018-3096-5
20. Nayak MT, Sannegowda RB. Clinical and Radiological Outcome in Cases of Posterolateral Fusion with Instrumentation for Lumbar Spondylolisthesis. J Clin Diagn Res. 2015;9(6):PC17-21. DOI:10.7860/JCDR/2015/11530.6077
21. Demir Ö, Öksüz E, Deniz FE, Demir O. Assessing the effects of lumbar posterior stabilization and fusion to vertebral bone density in stabilized and adjacent segments by using Hounsfield unit. J Spine Surg. 2017;3(4):548-53. DOI:10.21037/jss.2017.09.05
22. Jung JM, Hyun SJ, Kim KJ, et al. A prospective study of non-surgical versus surgical treatment for lumbar spinal stenosis without instability. J Clin Neurosci. 2020;80:100-7. DOI:10.1016/j.jocn.2020.07.062

Авторы

М.И. Гайдаш*, Ч. Ли, М.Г. Башлачев, М.Г. Зонов, Х.Н.A. Аакеф

ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*gaydash_maksim@mail.ru

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Maksim I. Gaydash*, Changsu Lee, Mikhail G. Bashlachev, Mikhail G. Zonov, Hayder N. Akif

Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*gaydash_maksim@mail.ru

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