Results of revision surgery for degenerative dystrophic diseases of the lumbosacral spine [Результаты ревизионных операций при дегенеративно-дистрофических заболеваниях пояснично-крестцового отдела позвоночника]

Degenerative dystrophic diseases of the lumbosacral spine present the common problem for healthcare in the whole world. The requirement for revision surgery is still high and gives variable outcomes. Objective - to conduct the comparative analysis of results of revision surgery for degenerative dystrophic diseases of the lumbosacral spine with use of transforaminal lumbar interbody fusion (TLIF) and anterior lumbar interbody fusion (ALIF). Materials and methods. The study included 50 patients with degenerative dystrophic diseases of the lumbosacral spine who had received revision surgery with ALIF and TLIF in 2017-2019. The patients were distributed into two groups, depending on surgery type. The group 1 included 26 patients, age of 31-84 (59.8 ± 14), treated with TLIF. There were 12 men (46.2 %) and 14 women (53.8 %). The group 2 included 24 patients, age of 23-67 (46.9 ± 12.3), operated with ALIF. The ratio men/women was 16 (66.7 %): 8 (33.3 %). Results. The group 2 (ALIF and TPF) showed the statistically significant results of VAS before surgery (7.3 ± 1.2; after surgery - 1.7 ± 0.4; p < 0.001), ODI before surgery (50.4 ± 11.5; after surgery - 10 ± 4.6; p < 0.001). The group 1 with decompressive stabilizing interventions with TLIF also achieved statistically significant results: presurgical VAS - 7.8 ± 0.8, postsurgical VAS - 2.7 ± 1.6, p < 0.001; presurgical ODI - 56.2 ± 10.2, postsurgical ODI - 20.6 ± 13.9, p < 0.001. However, the comparative analysis showed better values of VAS and ODI in the group 2 than in the group 1 (p < 0.001). Conclusion. ALIF in combination with TPF as technique of revision surgery theoretically allows complex discectomy for recurrent disk hernia, prevents a recurrent incision of paraspinal muscles, with lower postsurgical pain and lower intrasurgical blood loss, and less injuries to the spinal cord and roots as result of traction. Moreover, the anterior approach to the lumbar spine allows installing bigger cages with more contact surface, resulting in correction of lumbar lordosis and recovery of sagittal balance, which is also important in revision surgery for degenerative dystrophic diseases of the lumbosacral spine. However, ALIF has some risks. One of the main complications is magistral vessel damage and retrograde ejaculation. © 2020 The Charity Fund of Clinical Center of Miners' Health Protection. All rights reserved