RÉSUMÉ
Background: Spine disorder is the first cause of disability of workers below 45 years and economicalburden costs 20-50 billion us.dol, in European countries. Lumbar disc hernia estimates 40% of 30-50aged population in U.S and in Japan 26/10000. In last 5 years, spine surgeries increased in 4-5 timesdue intervertebral disc hernia, at Shastin State Third Central hospital of Mongolia.Goal: To populate new methods of surgical treatment for compressive lesions of spinal cord, spinalnerve root of cervix, thorax and lumbar spineMaterials and Methods: We did clinical research involving patients who had spine surgery at ourdepartment due “compressive lesion of spinal nerve root and spinal cord”. From, total 217 patients,excluded 9. Excluded cases are: declined from surgery 3, Arnold-Chiari malformation 5, and epiduralabscess 1. We collected data with permission of patient and did statistical analysis by IBM SPSS 17.Results: The surgery for intervertebral disc hernia takes 84.6% (176) of total surgery and 94.9% (167)of lumbar disease. Tumor of spinal cord estimates 9.1% (19) of total case, dominates in lumbar area(57.9%). We used posterior approach mostly, because it is frequently used in lumbar spine. The surgerycontinued 36-750 min (204.6, SD 128.5) ten patients (4.8%) had complications. In this project weused 5 surgical methods totally in solitary or combined. Spondilodesis is the most combined methodamong them. We used Oswestry disability index in Mongolia at first, to count treatment effect. Currentindex evaluated pre and post surgery period. Patient complaint and difficulty of daily life progressivelydecreased after surgery and almost disappeared at third month (p<0.00).Conclusion:1. It is possible to develop international standard surgical treatment of compressive lesions of spinalnerve root, spinal cord of cervix, thorax and lumbar spine in Mongolia.2. We used Oswestry disability index in Mongolia at first, so this questionnaire is simpler and accuratemethod for spine, spinal cord induced disability.3. Twenty seven point nine percent of patients who had surgical treatment has minimal to moderatedisability by Oswestry disability index, so it means we have to process standard of spine surgeryand increase non surgical treatment efficiency.4. Working ability recovers faster when spine surgery has been done.5. These new methods of spine surgery are cost effective than same surgery which will be doneabroad.
RÉSUMÉ
BackgroundDandy described first, about intervertebral disc hernia (1929). Mixter W.J and Barr J.S (1934) investigated that correlation of sciatica and lumbar disc hernia. Discectomy is most confirming surgery among all spine surgery. Asymptomatic lumbar disc hernia revealed in 70% of adult, by MRI. Spine disorder is first cause of disability of workers below 45 yrs, in European countries. International research for predisposing, risk factors of intervertebral disc hernia is widely confirmed, but diagnostic and treatment aspects are not completed.Materials and MethodsWe did computer aided search using key words “disc degeneration, risk factor, discectomy, lumbar disc hernia, spinal instrumentation” in online library: MEDLINE, E pub, PUBMED, HINARI, Mongolmed, years 1970-2011, also domestic research works from Central library of HSUM, Mongolia. We included article, case-control study, systematic review, case study.ConclusionIncidence and disability caused by lumbar disc hernia, requiring surgical treatment is common problem in world. By anatomical region, lumbar disc hernia is the highest. Research work revealed that patients who took surgical treatment different by gender (male:female=2:1), geographical region (US 160/100000, Switzerland 62/100000). At last 20 yrs, dramatically changed theory about predisposing factor of disc hernia. It is changed from mechanical load to genetic role. Disc degeneration disease is basis of disc hernia. Nucleus pulposus, annulus fibrosus losing own structure, containing moleculs, and water under degeneration. The risk factors are frequent heavy lifting, frequent twisting and bending, vibration, sedentary work, driving and overweight. The golden standard surgery of herniated disc of cervical area is anterior cervical discectomy and fusion (ACDF). Posterior screw fixation of lumbar vertebrae is most frequently confirming surgery among the world.