Pub Date : 2021-10-01DOI: 10.17691/stm2021.13.5.10
S. Timonin, N. Konovalov
Intramedullary hemangioblastomas (HAB) refer to very rare highly vascularized vascular spinal cord tumors associated with various neurological disorders. Effective HAB therapy to a greater extent depends on diagnostic accuracy and the absence of intra- and postoperative complications. The present study is a review of publications concerned with modern diagnostic and therapeutic techniques to control spinal HAB. The authors showed that perfusion computed tomography, computed tomographic angiography, and magnetic resonance angiography can be reasonably used for diagnosis and differentiation in a number of HAB due to their high vascularization. Preoperative embolization significantly reducing intraoperative bleeding risks is highly efficient. Some authors recommend this procedure in case of large lesions and high risks of intraoperative bleeding. The review also considered intraoperative imaging of a tumor and its feeding vessels using indocyanine green providing inspectability over the total tumor resection and clear imaging of tumor vascular architecture. The advantages and restrictions of the mentioned procedures were described.
{"title":"Surgical Treatment of Intramedullary Hemangioblastomas: Current State of Problem (Review)","authors":"S. Timonin, N. Konovalov","doi":"10.17691/stm2021.13.5.10","DOIUrl":"https://doi.org/10.17691/stm2021.13.5.10","url":null,"abstract":"Intramedullary hemangioblastomas (HAB) refer to very rare highly vascularized vascular spinal cord tumors associated with various neurological disorders. Effective HAB therapy to a greater extent depends on diagnostic accuracy and the absence of intra- and postoperative complications. The present study is a review of publications concerned with modern diagnostic and therapeutic techniques to control spinal HAB. The authors showed that perfusion computed tomography, computed tomographic angiography, and magnetic resonance angiography can be reasonably used for diagnosis and differentiation in a number of HAB due to their high vascularization. Preoperative embolization significantly reducing intraoperative bleeding risks is highly efficient. Some authors recommend this procedure in case of large lesions and high risks of intraoperative bleeding. The review also considered intraoperative imaging of a tumor and its feeding vessels using indocyanine green providing inspectability over the total tumor resection and clear imaging of tumor vascular architecture. The advantages and restrictions of the mentioned procedures were described.","PeriodicalId":18710,"journal":{"name":"Modern Technologies in Medicine","volume":"25 1","pages":"83 - 94"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88954456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-01DOI: 10.17691/stm2021.13.5.08
А.R. Syundyukov, N. S. Nikolayev, V. Kuzmina, S. Aleksandrov, P.N. Kornyakov, V. Emelyanov
The aim of the study was to assess the effectiveness of the minimally invasive technique used to reconstruct the vertebral arch with a pedicle screw hook system in grade I isthmic spondylolisthesis in comparison with the traditional technique of segment stabilization with interbody fusion. Materials and Methods The study included 26 patients aged from 11 to 17 years. The follow-up period lasted from 1 to 7 years. Two groups were formed: in group 1 (n=6), segments L5–S1 were stabilized using the traditional technique; in group 2 (n=20), the arch of the L5 vertebra was reconstructed by means of minimally invasive surgery. The pain syndrome was assessed in each study group using the visual analogue scale and Macnab criteria before and after surgery; blood loss, duration of surgery in minutes, and hospitalization in days were also measured. Results According to the Macnab scale, the two presented techniques did not show any statistically significant differences; however, when the arch synthesis technique was employed the spinal motion segment remained intact. Furthermore, in group 2, the volume of blood loss was smaller (44.0±19.6 compared to 300.0±130.4 ml, p<0.0001), the duration of the operation was 176.0±41.6 compared to 349.2±93.2 min, p<0.0001, and hospital stay was 6.9±1.6 compared to 10.0±2.1 days, p=0.0025 in the control group. Conclusion The technique of vertebral arch reconstruction by a minimally invasive access gives the possibility to stabilize the spinal motion segment and to preserve biomechanics and movements in the spine. This technique allows for shorter inpatient stays for patients as well as earlier recovery and rehabilitation due to reduced surgery time and blood loss.
{"title":"Minimally Invasive Reconstruction of Vertebral Arch in Spondylolisthesis in Children and Adolescents","authors":"А.R. Syundyukov, N. S. Nikolayev, V. Kuzmina, S. Aleksandrov, P.N. Kornyakov, V. Emelyanov","doi":"10.17691/stm2021.13.5.08","DOIUrl":"https://doi.org/10.17691/stm2021.13.5.08","url":null,"abstract":"The aim of the study was to assess the effectiveness of the minimally invasive technique used to reconstruct the vertebral arch with a pedicle screw hook system in grade I isthmic spondylolisthesis in comparison with the traditional technique of segment stabilization with interbody fusion. Materials and Methods The study included 26 patients aged from 11 to 17 years. The follow-up period lasted from 1 to 7 years. Two groups were formed: in group 1 (n=6), segments L5–S1 were stabilized using the traditional technique; in group 2 (n=20), the arch of the L5 vertebra was reconstructed by means of minimally invasive surgery. The pain syndrome was assessed in each study group using the visual analogue scale and Macnab criteria before and after surgery; blood loss, duration of surgery in minutes, and hospitalization in days were also measured. Results According to the Macnab scale, the two presented techniques did not show any statistically significant differences; however, when the arch synthesis technique was employed the spinal motion segment remained intact. Furthermore, in group 2, the volume of blood loss was smaller (44.0±19.6 compared to 300.0±130.4 ml, p<0.0001), the duration of the operation was 176.0±41.6 compared to 349.2±93.2 min, p<0.0001, and hospital stay was 6.9±1.6 compared to 10.0±2.1 days, p=0.0025 in the control group. Conclusion The technique of vertebral arch reconstruction by a minimally invasive access gives the possibility to stabilize the spinal motion segment and to preserve biomechanics and movements in the spine. This technique allows for shorter inpatient stays for patients as well as earlier recovery and rehabilitation due to reduced surgery time and blood loss.","PeriodicalId":18710,"journal":{"name":"Modern Technologies in Medicine","volume":"60 1","pages":"62 - 68"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79884900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-01DOI: 10.17691/stm2021.13.5.09
A. Aleinik, S. Mlyavykh, S. Qureshi
Lumbar spinal fusion is one of the most common operations in spinal surgery. For its implementation, anterolateral (pre-psoas) approach (oblique lumbar interbody fusion, OLIF) is now increasingly used due to its high efficacy and safety. However, there is still little information on the clinical and radiological results of using this technique. The aim of the study was to analyze the safety and efficacy of OLIF in the treatment of lumbar spine disorders as presented in the literature. Materials and Methods The systematic electronic search was performed using the Ovid Medline, PubMed, and eLIBRARY.RU electronic databases. The following search key words were used: Oblique Lumbar Interbody Fusion, OLIF, Anterior to Psoas Lumbar Interbody Fusion, and ATP. Results For the final analysis, 17 sources were selected; with a total of 2900 patients. Total complication rate was 13.9% (403 cases). The incidence of severe persistent complications was less than 1%. Based on the data obtained, we compared the clinical and radiological results of OLIF with other lumbar fusion methods. Conclusion OLIF is an effective, versatile, and minimally traumatic option for lumbar fusion with relatively few complications, which makes it superior to other retroperitoneal approaches. However, the OLIF technique is not completely free of complications associated with the ventral approach, and it cannot provide adequate decompression of the spinal canal in all cases. In addition, anterior approach surgery is still of limited use in cases of spinal deformities; adequate correction of deformity is achievable mainly in combination with posterior surgery.
{"title":"Lumbar Spinal Fusion Using Lateral Oblique (Pre-psoas) Approach (Review)","authors":"A. Aleinik, S. Mlyavykh, S. Qureshi","doi":"10.17691/stm2021.13.5.09","DOIUrl":"https://doi.org/10.17691/stm2021.13.5.09","url":null,"abstract":"Lumbar spinal fusion is one of the most common operations in spinal surgery. For its implementation, anterolateral (pre-psoas) approach (oblique lumbar interbody fusion, OLIF) is now increasingly used due to its high efficacy and safety. However, there is still little information on the clinical and radiological results of using this technique. The aim of the study was to analyze the safety and efficacy of OLIF in the treatment of lumbar spine disorders as presented in the literature. Materials and Methods The systematic electronic search was performed using the Ovid Medline, PubMed, and eLIBRARY.RU electronic databases. The following search key words were used: Oblique Lumbar Interbody Fusion, OLIF, Anterior to Psoas Lumbar Interbody Fusion, and ATP. Results For the final analysis, 17 sources were selected; with a total of 2900 patients. Total complication rate was 13.9% (403 cases). The incidence of severe persistent complications was less than 1%. Based on the data obtained, we compared the clinical and radiological results of OLIF with other lumbar fusion methods. Conclusion OLIF is an effective, versatile, and minimally traumatic option for lumbar fusion with relatively few complications, which makes it superior to other retroperitoneal approaches. However, the OLIF technique is not completely free of complications associated with the ventral approach, and it cannot provide adequate decompression of the spinal canal in all cases. In addition, anterior approach surgery is still of limited use in cases of spinal deformities; adequate correction of deformity is achievable mainly in combination with posterior surgery.","PeriodicalId":18710,"journal":{"name":"Modern Technologies in Medicine","volume":"44 1","pages":"70 - 81"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86825956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-01DOI: 10.17691/stm2021.13.5.06
I. Basankin, А.А. Giulzatyan, P. B. Nesterenko, А.B. Bagaudinov, D. Tayurski, М.L. Mukhanov
The aim of the study was to assess the efficacy and safety of direct posterior transpedicular osteosynthesis in traumatic spondylolisthesis of C2 vertebra. Materials and Methods The present study is an observational retrospective analysis of the results of surgical treatment of 19 patients operated on in 2014–2020 using the posterior transpedicular osteosynthesis technique with Herbert’s compression screws for a Hangman’s fracture type II according to Levine–Edwards classification. After the operation, the follow-up period lasted for 22 [10; 36] months. Results The study group of patients (n=19) made 2.48% of all patients operated on for traumatic injury of the cervical spine (n=766) in the period from 2014 to 2020. In all cases, the surgical treatment was successful; there were no intraoperative complications in the form of damage to the vascular and nerve structures. The average duration of surgery was 70.8±24.5 min, and intraoperative blood loss was 92.9±41.8 ml. The length of hospitalization stay was 7 [5; 17] days. On the postoperative CT scans, no significant screw malposition (>2 mm) was found. Conclusion Transpedicular osteosynthesis with compression screws in C2 traumatic spondylolisthesis is a safe and sparing operation with a short duration and insignificant blood loss. Thorough preoperative planning and knowledge of the anatomic landmarks make it possible to perform this operation effectively under the C-arm X-ray system control without any navigation system.
{"title":"Experience of Using Transpedicular Osteosynthesis in Traumatic Spondylolisthesis of the Axis","authors":"I. Basankin, А.А. Giulzatyan, P. B. Nesterenko, А.B. Bagaudinov, D. Tayurski, М.L. Mukhanov","doi":"10.17691/stm2021.13.5.06","DOIUrl":"https://doi.org/10.17691/stm2021.13.5.06","url":null,"abstract":"The aim of the study was to assess the efficacy and safety of direct posterior transpedicular osteosynthesis in traumatic spondylolisthesis of C2 vertebra. Materials and Methods The present study is an observational retrospective analysis of the results of surgical treatment of 19 patients operated on in 2014–2020 using the posterior transpedicular osteosynthesis technique with Herbert’s compression screws for a Hangman’s fracture type II according to Levine–Edwards classification. After the operation, the follow-up period lasted for 22 [10; 36] months. Results The study group of patients (n=19) made 2.48% of all patients operated on for traumatic injury of the cervical spine (n=766) in the period from 2014 to 2020. In all cases, the surgical treatment was successful; there were no intraoperative complications in the form of damage to the vascular and nerve structures. The average duration of surgery was 70.8±24.5 min, and intraoperative blood loss was 92.9±41.8 ml. The length of hospitalization stay was 7 [5; 17] days. On the postoperative CT scans, no significant screw malposition (>2 mm) was found. Conclusion Transpedicular osteosynthesis with compression screws in C2 traumatic spondylolisthesis is a safe and sparing operation with a short duration and insignificant blood loss. Thorough preoperative planning and knowledge of the anatomic landmarks make it possible to perform this operation effectively under the C-arm X-ray system control without any navigation system.","PeriodicalId":18710,"journal":{"name":"Modern Technologies in Medicine","volume":"76 1","pages":"47 - 53"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74182845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-01DOI: 10.17691/stm2021.13.5.04
S. Likhachev, V. Zaretskov, V. B. Arsenievich, V. Ostrovskij, I. Shchanitsyn, A. Shulga, S. Bazhanov
The major management technique for lumbar burst fractures is transpedicular fixation (TPF). However, in relation to fractures of the L5 vertebra, this tactic often has no advantages over conservative treatment, and, therefore, it is expected to be supplemented with anterior decompression and reconstruction of the anterior column of the L5 vertebra. The aim of the study was to determine the most optimal treatment tactics for patients with isolated burst fractures of the fifth lumbar vertebra. Materials and Methods We performed a retrospective study of 58 patients treated for isolated burst L5 fractures. 12 patients refused to undergo surgery and received conservative outpatient treatment. TPF was performed in 27 patients; circular spondylosynthesis (TPF + anterior column support with a Mesh implant) — in 19 patients. The effectiveness of the treatment was assessed by clinical and introscopic research methods. Results The radiological and functional outcomes of surgery with conventional TPF for isolated L5 burst fractures are generally comparable with the outcomes of conservative treatment. In 26% of the patients, the instability of the metal construction developed within 12 months after surgical intervention. Supplementing the transpedicular system with wedging anterior column support with a Mesh implant ensures preservation in 21%, and improves the parameters of the sagittal profile of the lumbosacral transition in 79% of cases.
{"title":"Treatment Tactics for Patients with Isolated Injuries of the Fifth Lumbar Vertebra","authors":"S. Likhachev, V. Zaretskov, V. B. Arsenievich, V. Ostrovskij, I. Shchanitsyn, A. Shulga, S. Bazhanov","doi":"10.17691/stm2021.13.5.04","DOIUrl":"https://doi.org/10.17691/stm2021.13.5.04","url":null,"abstract":"The major management technique for lumbar burst fractures is transpedicular fixation (TPF). However, in relation to fractures of the L5 vertebra, this tactic often has no advantages over conservative treatment, and, therefore, it is expected to be supplemented with anterior decompression and reconstruction of the anterior column of the L5 vertebra. The aim of the study was to determine the most optimal treatment tactics for patients with isolated burst fractures of the fifth lumbar vertebra. Materials and Methods We performed a retrospective study of 58 patients treated for isolated burst L5 fractures. 12 patients refused to undergo surgery and received conservative outpatient treatment. TPF was performed in 27 patients; circular spondylosynthesis (TPF + anterior column support with a Mesh implant) — in 19 patients. The effectiveness of the treatment was assessed by clinical and introscopic research methods. Results The radiological and functional outcomes of surgery with conventional TPF for isolated L5 burst fractures are generally comparable with the outcomes of conservative treatment. In 26% of the patients, the instability of the metal construction developed within 12 months after surgical intervention. Supplementing the transpedicular system with wedging anterior column support with a Mesh implant ensures preservation in 21%, and improves the parameters of the sagittal profile of the lumbosacral transition in 79% of cases.","PeriodicalId":18710,"journal":{"name":"Modern Technologies in Medicine","volume":"27 1","pages":"31 - 39"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84564057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-01DOI: 10.17691/stm2021.13.5.05
R. A. Kovalenko, V. A. Kashin, V. Cherebillo
Subcortical screw placement is currently performed using frontal view fluoroscopy or intraoperative O-arm navigation system. The emergence of a novel technique for spinal navigation based on individual navigation templates created using 3D printing technology determines the need to study their safety and effectiveness in subcortical implantation. The aim of the study was to evaluate and compare the efficacy of subcortical implantation of pedicle screws in the lumbar spine using individual navigation templates versus intraoperative fluoroscopy. Materials and Methods The study was based on the analysis of treatment results in 39 patients who underwent surgery with subcortical implantation of 130 screws using the MidLIF technique. In group 1, navigation templates were used, in group 2 — intraoperative fluoroscopic control. Comparative analysis of implantation correctness and time, the total operation time, and radiation load was performed. Results The mean distance between the screw and the cortical plate recorded in the groups ranged within 1.20–3.97 mm, without statistically significant difference (p>0.05). The mean time of pedicle screw implantation was 137.0 [115.25; 161.50] s in group 1 and 314.0 [183.50; 403.25] s in group 2. The total operation time was reduced from 173.0 [155.0; 192.25] min in group 2 to 119.0 [108.0; 128.75] min in group 1. The average of 1.0 [1.0; 2.0] X-ray image was performed to place one screw in group 1, while it was 12.0 [10.0; 13.25] in group 2. The differences between the groups in terms of implantation time and radiation load were statistically significant (p<0.05). Conclusion Compared with intraoperative fluoroscopy, the use of individual navigation templates for subcortical implantation of pedicle screws provides their correct positioning with a significant reduction in both operation time and radiation load at similar safety.
{"title":"Individual Navigation Templates for Subcortical Screw Placement in Lumbar Spine","authors":"R. A. Kovalenko, V. A. Kashin, V. Cherebillo","doi":"10.17691/stm2021.13.5.05","DOIUrl":"https://doi.org/10.17691/stm2021.13.5.05","url":null,"abstract":"Subcortical screw placement is currently performed using frontal view fluoroscopy or intraoperative O-arm navigation system. The emergence of a novel technique for spinal navigation based on individual navigation templates created using 3D printing technology determines the need to study their safety and effectiveness in subcortical implantation. The aim of the study was to evaluate and compare the efficacy of subcortical implantation of pedicle screws in the lumbar spine using individual navigation templates versus intraoperative fluoroscopy. Materials and Methods The study was based on the analysis of treatment results in 39 patients who underwent surgery with subcortical implantation of 130 screws using the MidLIF technique. In group 1, navigation templates were used, in group 2 — intraoperative fluoroscopic control. Comparative analysis of implantation correctness and time, the total operation time, and radiation load was performed. Results The mean distance between the screw and the cortical plate recorded in the groups ranged within 1.20–3.97 mm, without statistically significant difference (p>0.05). The mean time of pedicle screw implantation was 137.0 [115.25; 161.50] s in group 1 and 314.0 [183.50; 403.25] s in group 2. The total operation time was reduced from 173.0 [155.0; 192.25] min in group 2 to 119.0 [108.0; 128.75] min in group 1. The average of 1.0 [1.0; 2.0] X-ray image was performed to place one screw in group 1, while it was 12.0 [10.0; 13.25] in group 2. The differences between the groups in terms of implantation time and radiation load were statistically significant (p<0.05). Conclusion Compared with intraoperative fluoroscopy, the use of individual navigation templates for subcortical implantation of pedicle screws provides their correct positioning with a significant reduction in both operation time and radiation load at similar safety.","PeriodicalId":18710,"journal":{"name":"Modern Technologies in Medicine","volume":"72 1","pages":"41 - 46"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86287703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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