Unbearable pain syndrome, intermittent claudication, rough walking, increasing paresis of hands, feet, joining pelvic disorders indicate a pronounced lesion, compression of the spinal cord, roots of the horse’s tail. In case of ineffectiveness of adequate conservative treatment within 6 months and more patients are shown surgical intervention.
Planning of the type and volume of the operation is based on the analysis of the neurological syndrome and its compliance with x-ray and myelographic data. The presence of a complete blockade of the subarachnoid space or obliteration of the root sleeve at one level allows us to count on a good result of the operation. In patients with unilateral neurological manifestations, gentle decompression with mandatory resection of the medial portion of the arc process joints can be performed. The principle of minimum sufficiency is the main one, which allows to achieve the maximum release of the root or dural SAC in the place of compression with the least traumatization.
A large variety of types of spinal stenosis, including common combined with the existence of a herniated or bulging disc, polysegmental or intermittent stenosis, combined stenosis and radicular channels, the combination of a fixed stenosis at the same level with dynamic on the other, forcing you to avoid cliches to the extent of surgery. In elderly people with multilevel combined stenosis of the lumbar vertebral canal, having a rigid spine due to severe osteophytosis, it is necessary to conduct a broad decompressive laminectomy at three or more levels. In this case, a good clinical result is achieved, the risk of instability is minimal. In the case of pronounced spondylolisthesis, disc herniation may additionally require discectomy, spondylodesis, facetectomy with complete release of the root.
Surgery on the cervical spine in segmental degenerative stenosis is to remove the disc or posterior osteophyte of the vertebral body through the anterior access, in the thoracic spine for the same purpose, an extrapleural posterior-lateral approach with resection of the vertebral leg is used. If there is significant thickening of the pedicles, facet joints and yellow ligaments additionally performed back extended decompressive laminectomy with medial facetectomies. MRI better detects changes in the disc, posterior longitudinal ligament, CT-osteophytes, joint pathology, calcification of the yellow ligament, MG-blockade of radicular pockets, radicular cysts. The combined use of these methods helps to properly plan the operation in a particular patient.
The use of microsurgical techniques, good anesthetic support allow to achieve a positive result in more than 2/3 of operated patients with spinal canal stenosis.