The Results of Surgical Treatment of Intervertebral Disc Herniation in Lumbar Spine Depending on Localization According to MSU

Summary. Background. The dependence between the results of surgical treatment and the localization of a hernia is understudied. Understanding this interrelation may help us determine the adequacy of the surgical technique applied depending on the localization of an intervertebral disc protrusion. Objective. The objective of our study was to compare the results of surgical treatment of intervertebral disc protrusions depending on their location according to the Michigan State University (MSU) classification, using different methods. Material and Methods. We applied different methods for surgical treatment of patients with intervertebral disc protrusions in the lumbar spine: 93 patients underwent interlaminar microdiscectomy (mean age of the patients was 41.9±11.6 years), 92 underwent unilateral biportal endoscopy via interlaminar approach, and 13 had transforaminal monoportal discectomy. The mean age of the patients surgically treated using endoscopic methods was 43.1±13.1 years. Based on the MRI visualization, disc protrusions were assessed using the MSU classification according to their location by size in the axial plane. To analyze the results, we used standardized VAS and Oswestry scales on the first day, one month, and six months after the surgery. Results. At all stages of the research, foraminal protrusions type C according to the MSU classification demonstrated the worst results. This fact may be associated with the use of the interlaminar approach, while the transforaminal approach allowed us to obtain good results in this category of patients. The quality of life according to the Oswestry scale within six months after the surgery appeared twice as bad for both methods compared to the non-foraminal location of protrusions (10.5±0.7 compared to 5.2±4.4). Patients with large 2C protrusions had significant worsening of their quality of life but less pain syndrome compared to the patients with 1C protrusions. Conclusions. Clinical results of both methods demonstrate their comparative efficiency. The obtained data about the higher effectiveness of endoscopic discectomy compared to the microsurgical technique appear convincing in the early postoperative period but remain ambiguous at the later follow-up stages. Taking into account that this method is as good as microsurgery according to technical characteristics and possibilities, this technology may be used instead of the standard method of removing intervertebral disc protrusions.