MORPHOLOGICAL STRUCTURAL CHANGES OF FAT AUTOGRAFT USED FOR PREVENTION OF SCAR-ADHESIONS EPIDURITIS IN PATIENTS WITH HERNIATED DISCS OF THE LUMBAR SPINE
The frequency of recurrence of pain after the removal of herniation of intervertebral discs of the lumbar spine, continues to be high, reaching 20-40%. We have already developed a method of surgical treatment of lumbar spine hernias with simultaneous prevention of scar and adhesive epiduritis by wrapping the spine with an injectable depomedrol fragment of autologous subcutaneous fat. Given the proven effectiveness of our proposed method for the prevention of scaradhesive epidurit after microdiscectomy of the lumbar spine on the basis of follow-up data, we conducted histological structure of autotransplanted adipose tissue, implanted in the epidural space to prevent the development of scar adhesions epidurit in the early and late postoperative period in patients after removal of herniated disc of the lumbar spine. Four of the 215 patients we observed, operated from 2005 to the present time as a result of excessive physical activity, despite our recommendations, had relapses of disc herniation, subject to repeated surgical treatment, which made it possible to perform histological examination of fat autotransplant. Histological examination proved the presence of vascularization fat autotransplanted as early as two weeks after implantation - marked neoangiogenesis in fibrous tissue, focal proliferation of endothelial cells of newly formed capillaries. A few months later revealed numerous newly formed blood vessels surrounded by loose connective tissue,with layers of fibrous tissue at the periphery, which confirms the viability of the fat graft is already two weeks after implantation demonstrated the effectiveness of the proposed method as a method of prevention of scar-adhesive epidurit as the main causes of recurrent radicular pain syndrome in the postoperative period.