Minimally Invasive Surgical Accesses to the Lumbar Spine

Abstract

Objective of the study. Analysis of the volume of bone resections performed during surgical access on the lumbosacral spine according to the data of preoperative computer calculation. Materials and methods. The study group included 100 patients operated on for degenerative-dystrophic pathology of the spine at the lumbosacral level. An analysis of the resection volume above and the underlying arches of the vertebra, the upper and lower articular processes, and the yellow ligament was carried out. Results. In segments of the L_III-L_IV level a wider resection of the upper and lower articular processes was require compared with L_IV-L_V L and L_V-S_I (p < 0.05). The smallest volume of medial facetectomy was performed at the L_V-S_I level in segments with herniated disc without stenosis - in this case, the lower articular process was kept intact in 53.9 % of cases, the upper - in 64.1 % of cases. At the two most frequently operated L_IV-L_V L and L_V-S_I levels, surgical approaches prevailed, at which the overlying arch remained intact or resected in the volume of less than ½ of the total length. Significant differences in the volume of resection of the arcs between stenotic segments and segments with herniated disc without stenosis was not detected (p > 0.05). Conclusion. Computer calculation of surgical access with localization of the lateral border of the bone window 5 mm from the edge of the dural sac and / or spinal nerve is aimed at maintaining stability in the segment, achieving sufficient visualization of the herniated disc and proper decompression in cases of dystrophic stenosis. The identified statistical differences (p < 0.05) in the volume of resection of the structures of the posterior support complex between the studied levels underscore the importance of taking into account individual anatomical features of the vertebral segment during planning surgical access.