Pub Date : 2023-03-28DOI: 10.14531/ss2023.1.93-101
R. A. Kovalenko, N. V. Osipova, V. A. Mineev, L. Mitrofanova
Objective. To present a clinical case of arachnoiditis ossificans associated with syringomyelia and a brief literature review with an emphasis on its etiology, pathogenesis and methods of diagnosis and treatment.Material and Methods. A clinical case of a 68-year-old patient with symptomatic arachnoiditis ossificans is described. The diagnosis was established on the basis of the results of intraoperative biopsy, histological examination of the resected fragment and confirmed in the postoperative period using CT of the spinal cord, multislice CT myelography, etc. Analysis of the course of the pathology raised the following questions: diagnostic criteria and optimal tactics for treating this disease. A brief review of cases of arachnoiditis ossificans described in the literature for the period from 1982 to the present is given.Results. A review of cases of ossifying arachnoiditis described in the literature showed that today there is no single tactic for diagnosing and treating this disease. In most cases, the diagnosis is established intraoperatively (65 % of analyzed cases). At the preoperative stage, CT provides reliable visualization of ossification. When choosing therapy, it is necessary to be based on the severity of the clinical picture, the degree of ossification of the arachnoid membrane and the presence of concomitant pathology of the affected spinal cord department (such as syringomyelia).Conclusion. The presence of a growing neurological deficit should be considered an indication for surgical treatment of patients with arachnoiditis ossificans. The goals of surgery should include decompression of neural structures and restoration of normal cerebrospinal fluid circulation.
{"title":"Symptomatic arachnoiditis ossificans associated with syringomyelia: a clinical case and a brief literature review","authors":"R. A. Kovalenko, N. V. Osipova, V. A. Mineev, L. Mitrofanova","doi":"10.14531/ss2023.1.93-101","DOIUrl":"https://doi.org/10.14531/ss2023.1.93-101","url":null,"abstract":"Objective. To present a clinical case of arachnoiditis ossificans associated with syringomyelia and a brief literature review with an emphasis on its etiology, pathogenesis and methods of diagnosis and treatment.Material and Methods. A clinical case of a 68-year-old patient with symptomatic arachnoiditis ossificans is described. The diagnosis was established on the basis of the results of intraoperative biopsy, histological examination of the resected fragment and confirmed in the postoperative period using CT of the spinal cord, multislice CT myelography, etc. Analysis of the course of the pathology raised the following questions: diagnostic criteria and optimal tactics for treating this disease. A brief review of cases of arachnoiditis ossificans described in the literature for the period from 1982 to the present is given.Results. A review of cases of ossifying arachnoiditis described in the literature showed that today there is no single tactic for diagnosing and treating this disease. In most cases, the diagnosis is established intraoperatively (65 % of analyzed cases). At the preoperative stage, CT provides reliable visualization of ossification. When choosing therapy, it is necessary to be based on the severity of the clinical picture, the degree of ossification of the arachnoid membrane and the presence of concomitant pathology of the affected spinal cord department (such as syringomyelia).Conclusion. The presence of a growing neurological deficit should be considered an indication for surgical treatment of patients with arachnoiditis ossificans. The goals of surgery should include decompression of neural structures and restoration of normal cerebrospinal fluid circulation.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121805670","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}
Objective. To analyze the clinical features of the course of infectious spondylitis in patients with COVID-19.Material and Methods. A continuous retrospective study was performed with the analysis of medical records of 52 patients with infectious spondylitis who were treated in 2021–2022. The patients were divided into two groups: the study group (n = 24) – with a history of a new coronavirus infection; and the control group (n = 28) – without coronavirus infection.Results. The features of infectious spondylitis in patients with COVID-19 are the predominance of facultative anaerobic gram-negative flora in the focus of infection, a higher frequency of multilevel lesions, a tendency to increase the number of negative results of surgical treatment, and a chronic protracted course. At the same time, the course of infectious spondylitis associated with COVID-19 is accompanied by less destructive changes in the affected segment leading to a violation of the supporting function of the spine. Nevertheless, there is a statistically significant increase in the period of relief of the inflammatory process in the spine in these patients: 18.04 ± 3.84 weeks in the study group and 10.08 ± 2.34 weeks in the control group (Uemp < 240; p = 0.001).Conclusion. The secondary infectious lesion of the spine against the background of a new coronavirus infection is caused by gram-negative pathogens in the vast majority of cases, proceeds without severe bone destruction, with a tendency to a chronic protracted course. Surgical treatment of COVID-associated spondylitis is associated with a higher risk of postoperative complications.
{"title":"Clinical features of infectious spondylitis in patients with COVID-19","authors":"I. V. Yesin, E. O. Perecmanas, T. Tulkova","doi":"10.14531/ss2023.1.85-92","DOIUrl":"https://doi.org/10.14531/ss2023.1.85-92","url":null,"abstract":"Objective. To analyze the clinical features of the course of infectious spondylitis in patients with COVID-19.Material and Methods. A continuous retrospective study was performed with the analysis of medical records of 52 patients with infectious spondylitis who were treated in 2021–2022. The patients were divided into two groups: the study group (n = 24) – with a history of a new coronavirus infection; and the control group (n = 28) – without coronavirus infection.Results. The features of infectious spondylitis in patients with COVID-19 are the predominance of facultative anaerobic gram-negative flora in the focus of infection, a higher frequency of multilevel lesions, a tendency to increase the number of negative results of surgical treatment, and a chronic protracted course. At the same time, the course of infectious spondylitis associated with COVID-19 is accompanied by less destructive changes in the affected segment leading to a violation of the supporting function of the spine. Nevertheless, there is a statistically significant increase in the period of relief of the inflammatory process in the spine in these patients: 18.04 ± 3.84 weeks in the study group and 10.08 ± 2.34 weeks in the control group (Uemp < 240; p = 0.001).Conclusion. The secondary infectious lesion of the spine against the background of a new coronavirus infection is caused by gram-negative pathogens in the vast majority of cases, proceeds without severe bone destruction, with a tendency to a chronic protracted course. Surgical treatment of COVID-associated spondylitis is associated with a higher risk of postoperative complications.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"116 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116113080","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}
Objective. To analyze clinical and radiological results of surgical treatment of patients with isthmic spondylolisthesis of the L5 vertebra using anterior axial fusion and transpedicular stabilization with interbody fusion performed through the posterior approach.Material and Methods. The study involved 71 patients with isthmic grade I and II spondylolisthesis of the L5 vertebra. The patients were divided into two groups: the study group included 25 patients, and the control group – 46. All patients of the study group underwent presacral axial fusion. Patients in the control group underwent transpedicular stabilization combined with TLIF. The results of surgical treatment of patients were assessed using the MacNab scale, the ODI questionnaire and the VAS scale, and the severity of neurological disorders was assessed using the Francel scale.Results. The duration of surgical intervention in the study group averaged 67 ± 23 min, and in the control group – 135 ± 45 min. The length of hospital stay in the study group was 3 ± 1 days, and in the control group – 5 ± 2 days. Good results were obtained in all cases. In the postoperative period, the average indicators of pain syndrome in the study group after 14 days were 2.0 ± 1.0 points, after 1 month – 1.0 ± 0.7 points and after 1 year – 0.5 ± 0.5 points, and in the control group 2.5 ± 0.5 points, 2 ± 1 points and 0.5 ± 0.3 points, respectively. The average indicators of the general condition in the study group according to the ODI after 14 days was 32.3 ± 8.1 %, after 1 month – 8.1 ± 4.4 % and after 1 year – 4.3 ± 1.8 %, and in the control group 30.2 ± 5.2 %, 6.3 ± 2.2 % and 2.1 ± 1.9 %, respectively. When assessing the duration of the surgical intervention, it turned out that performing presacral axial fusion reduced the duration of the operation by 2 times, and the length of the hospital stay – by 1.5 times.Conclusion. The results of surgical treatment of patients with grade I and II isthmic spondylolisthesis without sagittal imbalance using transpedicular fixation combined with TLIF and those using presacral axial fusion are comparable. However, due to reducing intraoperative trauma, the method of presacral axial fusion allows to reduce the surgery duration and the length of hospital stay.
{"title":"Comparative analysis of surgical methods for the treatment of grade I and II spondylolisthesis of the L5 vertebra","authors":"A. Kiselev, A. Gushcha","doi":"10.14531/ss2023.1.66-74","DOIUrl":"https://doi.org/10.14531/ss2023.1.66-74","url":null,"abstract":"Objective. To analyze clinical and radiological results of surgical treatment of patients with isthmic spondylolisthesis of the L5 vertebra using anterior axial fusion and transpedicular stabilization with interbody fusion performed through the posterior approach.Material and Methods. The study involved 71 patients with isthmic grade I and II spondylolisthesis of the L5 vertebra. The patients were divided into two groups: the study group included 25 patients, and the control group – 46. All patients of the study group underwent presacral axial fusion. Patients in the control group underwent transpedicular stabilization combined with TLIF. The results of surgical treatment of patients were assessed using the MacNab scale, the ODI questionnaire and the VAS scale, and the severity of neurological disorders was assessed using the Francel scale.Results. The duration of surgical intervention in the study group averaged 67 ± 23 min, and in the control group – 135 ± 45 min. The length of hospital stay in the study group was 3 ± 1 days, and in the control group – 5 ± 2 days. Good results were obtained in all cases. In the postoperative period, the average indicators of pain syndrome in the study group after 14 days were 2.0 ± 1.0 points, after 1 month – 1.0 ± 0.7 points and after 1 year – 0.5 ± 0.5 points, and in the control group 2.5 ± 0.5 points, 2 ± 1 points and 0.5 ± 0.3 points, respectively. The average indicators of the general condition in the study group according to the ODI after 14 days was 32.3 ± 8.1 %, after 1 month – 8.1 ± 4.4 % and after 1 year – 4.3 ± 1.8 %, and in the control group 30.2 ± 5.2 %, 6.3 ± 2.2 % and 2.1 ± 1.9 %, respectively. When assessing the duration of the surgical intervention, it turned out that performing presacral axial fusion reduced the duration of the operation by 2 times, and the length of the hospital stay – by 1.5 times.Conclusion. The results of surgical treatment of patients with grade I and II isthmic spondylolisthesis without sagittal imbalance using transpedicular fixation combined with TLIF and those using presacral axial fusion are comparable. However, due to reducing intraoperative trauma, the method of presacral axial fusion allows to reduce the surgery duration and the length of hospital stay.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"49 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114044670","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}
Objective. To analyze the results of treatment of disseminated (polysegmental and multilevel) forms of hematogenous vertebral osteomyelitis (HVO) as compared with those of monosegmental and monovertebral lesions.Material and Methods. A retrospective analysis of a monocenter cohort of 266 patients with hematogenous osteomyelitis of the spine for 2006 to 2019 was carried out. Patients were divided into two groups: Group A (polysegmental and multilevel lesions) included 33 (12.4 %) patients and Group B (monosegmental and monovertebral lesions) – 233 (87.6 %) patients. The main examination methods were: clinical, radiological (standardized roentgenography, CT), MRI, microbiological, histological and statistical ones.Results. Comparison revealed that involvement of the cervical (p < 0.001) and thoracic (p = 0.014) spine was more typical for polysegmental and multilevel lesions. There was a tendency to the predominance of type A lesions according to the Pola classification in patients with local forms (p = 0.078) and to the increase in type C lesions in polysegmental and multilevel processes (p = 0.035). The number of neurological complications was higher in polysegmental and multilevel lesions (p = 0.003). There were no significant differences in the treatment results, the number of relapses and mortality rate between the compared groups.Conclusion. Lesions of the cervical and thoracic spine and the presence of a neurological deterioration are typical for multilevel and polysegmental HVO. The formation of a multilevel lesion in different regions of the spine with a gap of 2–4 weeks or more requires a separate implementation of the diagnostic algorithm, defining of classification criteria and differentiated treatment tactics for each focus.
{"title":"Polysegmental and multilevel lesions in hematogenous vertebral osteomyelitis: assessment of immediate and long-term results","authors":"A. Bazarov, K. S. Sergeyev, N. P. Sidoryak","doi":"10.14531/ss2023.1.75-84","DOIUrl":"https://doi.org/10.14531/ss2023.1.75-84","url":null,"abstract":"Objective. To analyze the results of treatment of disseminated (polysegmental and multilevel) forms of hematogenous vertebral osteomyelitis (HVO) as compared with those of monosegmental and monovertebral lesions.Material and Methods. A retrospective analysis of a monocenter cohort of 266 patients with hematogenous osteomyelitis of the spine for 2006 to 2019 was carried out. Patients were divided into two groups: Group A (polysegmental and multilevel lesions) included 33 (12.4 %) patients and Group B (monosegmental and monovertebral lesions) – 233 (87.6 %) patients. The main examination methods were: clinical, radiological (standardized roentgenography, CT), MRI, microbiological, histological and statistical ones.Results. Comparison revealed that involvement of the cervical (p < 0.001) and thoracic (p = 0.014) spine was more typical for polysegmental and multilevel lesions. There was a tendency to the predominance of type A lesions according to the Pola classification in patients with local forms (p = 0.078) and to the increase in type C lesions in polysegmental and multilevel processes (p = 0.035). The number of neurological complications was higher in polysegmental and multilevel lesions (p = 0.003). There were no significant differences in the treatment results, the number of relapses and mortality rate between the compared groups.Conclusion. Lesions of the cervical and thoracic spine and the presence of a neurological deterioration are typical for multilevel and polysegmental HVO. The formation of a multilevel lesion in different regions of the spine with a gap of 2–4 weeks or more requires a separate implementation of the diagnostic algorithm, defining of classification criteria and differentiated treatment tactics for each focus.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131269545","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}
M. Mikhaylovskiy, A. Sorokin, A. Sergunin, E. V. Gubina
Objective. To analyze the results of repeated corrective surgery in patients with spinal deformities of various etiologies.Material and Methods. The study group included 87 patients (mean age is 22.8 years, m : f = 10 : 77) who underwent repeated deformity correction using third-generation instrumentation (CDI and its analogues), and were selected from 144 patients previously operated on for spinal deformities of various etiologies using different types of spinal instrumentation. The magnitude of scoliotic deformity, thoracic kyphosis, lumbar lordosis, rotation of the apical vertebra, the volume of intraoperative blood loss, and the duration of the operation were assessed. All patients answered the questions of the SRS-24 questionnaire at the stages of treatment and postoperative follow-up, and were also examined by computer optical topography method.Results. Out of 87 reoperated patients, 74 had idiopathic scoliosis. In 31 patients, the results were evaluated within a period of at least 2 years (average 61.8 months). As a result of the intervention, the primary curve was corrected by 29.1° (36.5 %). Loss of correction was 4.6° (p < 0.001), derotation of the apical vertebra – from 34.9° to 22.1° (p < 0.001) and loss of correction – 0.8°. The average blood loss varied from 810 to 1138 ml, and the operation time – from 187 to 289 min. Computer optical topography data convincingly confirmed the corrective effect achieved during the repeated intervention. According to the questionnaire (SRS-24), satisfaction with the results of the operation was quite high.Conclusion. Repeated corrective interventions in patients with spinal deformities of various etiologies, even in long-term periods, can partially restore the lost primary correction and improve the quality of life of patients, which is confirmed by clinical and radiographic data, the results of computer optical topography and the SRS-24 questionnaire.
{"title":"Efficiency of repeated corrective surgery in patients with spinal deformities: analysis of the immediate results of a monocenter cohort and a brief review of the literature","authors":"M. Mikhaylovskiy, A. Sorokin, A. Sergunin, E. V. Gubina","doi":"10.14531/ss2023.1.6-15","DOIUrl":"https://doi.org/10.14531/ss2023.1.6-15","url":null,"abstract":"Objective. To analyze the results of repeated corrective surgery in patients with spinal deformities of various etiologies.Material and Methods. The study group included 87 patients (mean age is 22.8 years, m : f = 10 : 77) who underwent repeated deformity correction using third-generation instrumentation (CDI and its analogues), and were selected from 144 patients previously operated on for spinal deformities of various etiologies using different types of spinal instrumentation. The magnitude of scoliotic deformity, thoracic kyphosis, lumbar lordosis, rotation of the apical vertebra, the volume of intraoperative blood loss, and the duration of the operation were assessed. All patients answered the questions of the SRS-24 questionnaire at the stages of treatment and postoperative follow-up, and were also examined by computer optical topography method.Results. Out of 87 reoperated patients, 74 had idiopathic scoliosis. In 31 patients, the results were evaluated within a period of at least 2 years (average 61.8 months). As a result of the intervention, the primary curve was corrected by 29.1° (36.5 %). Loss of correction was 4.6° (p < 0.001), derotation of the apical vertebra – from 34.9° to 22.1° (p < 0.001) and loss of correction – 0.8°. The average blood loss varied from 810 to 1138 ml, and the operation time – from 187 to 289 min. Computer optical topography data convincingly confirmed the corrective effect achieved during the repeated intervention. According to the questionnaire (SRS-24), satisfaction with the results of the operation was quite high.Conclusion. Repeated corrective interventions in patients with spinal deformities of various etiologies, even in long-term periods, can partially restore the lost primary correction and improve the quality of life of patients, which is confirmed by clinical and radiographic data, the results of computer optical topography and the SRS-24 questionnaire.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125559366","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}
I. A. Muzyshev, S. Torchinov, A. V. Borzenkov, D. Dzukaev
The paper presents a clinical case report and non-systematic review of the literature on the problem of the manubriotomy use in the treatment of complicated injury of the cervicothoracic spine. Approach to surgical treatment of complicated compression-comminuted fracture-dislocation of the cervicothoracic spine was based on preoperative calculation of angulometric characteristics of the injury and individual characteristics of the patient’s anatomy, including the Tenga criterion. A partial resection of the manubrium of sternum in the area of the jugular notch was performed to ensure safe and stable placement of the cervical fixation plate. Complete restoration of the axis and stability of the spine, and regression of neurological deficit were achieved. The preoperative determination of the Tenga criterion in planning cervicothoracic intervention allows, taking into account the anatomical features of the patients, to assess a zone of optimal visualization, as well as to plan caudal expansion of the approach, including by limited U-shaped manubriotomy.
{"title":"The use of manubriotomy in the treatment of complicated injury of the cervicothoracic spine: clinical case report and literature review","authors":"I. A. Muzyshev, S. Torchinov, A. V. Borzenkov, D. Dzukaev","doi":"10.14531/ss2023.1.36-42","DOIUrl":"https://doi.org/10.14531/ss2023.1.36-42","url":null,"abstract":"The paper presents a clinical case report and non-systematic review of the literature on the problem of the manubriotomy use in the treatment of complicated injury of the cervicothoracic spine. Approach to surgical treatment of complicated compression-comminuted fracture-dislocation of the cervicothoracic spine was based on preoperative calculation of angulometric characteristics of the injury and individual characteristics of the patient’s anatomy, including the Tenga criterion. A partial resection of the manubrium of sternum in the area of the jugular notch was performed to ensure safe and stable placement of the cervical fixation plate. Complete restoration of the axis and stability of the spine, and regression of neurological deficit were achieved. The preoperative determination of the Tenga criterion in planning cervicothoracic intervention allows, taking into account the anatomical features of the patients, to assess a zone of optimal visualization, as well as to plan caudal expansion of the approach, including by limited U-shaped manubriotomy.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127769755","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}
M. Lebedeva, I. Statsenko, A. V. Palmash, E. Ivanova, V. Rerikh
Objective. To establish the effect of neurogenic shock (NS) on the course of acute complicated injury of the cervical spine.Material and Methods. The retrospective study included 96 patients with acute complicated injury of the cervical spine. The criteria for the presence of NS were determined as mean blood pressure (BP) < 70 mm Hg, and heart rate (HR) < 60 per minute. Two groups were distinguished: Group 1 included 13 patients with NS, and Group 2 – 83 patients without NS. The main characteristics of patients and the course of spinal cord injury were analyzed from the moment of admission to the 30th day of follow-up.Results. There were no statistically significant differences between the groups in terms of gender, age, level of spinal injury, severity of spinal cord injury and comorbidity. Admission BP and HR in patients with NS were below the reference values and had statistically significant differences in comparison with similar indicators in patients of Group 2. On the first day of treatment in the intensive care unit (ICU), hemodynamic support was required for all patients of Group 1, and for 69 patients of Group 2 (83.1 %). The duration of hemodynamic support in Group 1 was 11 days [6; 15], and in Group 2 – 7 days [4; 14]; p = 0.231. Blood lactate and pH levels were consistent with reference values at all stages, with no intergroup differences. Differences in the severity of organ dysfunctions (SOFA scale) were registered only on the seventh day of treatment in the ICU (p = 0.010); there were no significant differences in the severity of the patients’ condition (APACHE II scale). The presence of NS was accompanied by a statistically significant increase in the complication rate. The duration of treatment in the ICU was 28 days [22; 57] in Group 1, 23.5 days [11; 37] in Group 2 (p = 0.055), and that in the hospital – 58 days [44; 70] in Group 1 versus 41.5 [24; 59.5] in Group 2 (p < 0.025). Positive dynamics in the neurological status was noted at discharge in 15.0 % of Group 1 patients and in 19.3 % of Group 2 patients.Conclusion. The prevalence of NS in isolated injury of the cervical spine was 13.5 %. The development of NS significantly increases the complication rate and duration of hospital stay, but does not exclude the possibility of regression of existing neurological disorders.
目标。目的探讨神经源性休克对急性颈椎复杂损伤过程的影响。材料和方法。回顾性研究96例急性复杂颈椎损伤患者。NS存在的标准确定为平均血压(BP) < 70 mm Hg，心率(HR) < 60 /分钟。分为两组:1组有NS患者13例，2组无NS患者83例。分析患者自入院至随访第30天的主要特点及脊髓损伤的病程。两组在性别、年龄、脊髓损伤程度、脊髓损伤严重程度、合并症等方面均无统计学差异。NS患者入院时血压、HR均低于参考值，与2组类似指标比较差异有统计学意义。在重症监护病房(ICU)治疗的第一天，1组所有患者需要血流动力学支持，2组69例患者(83.1%)需要血流动力学支持。第一组血流动力学支持持续时间为11天[6;15]，第2 - 7天组[4;14);P = 0.231。各阶段血乳酸和pH值与参考值一致，组间无差异。器官功能障碍严重程度(SOFA量表)的差异仅在ICU治疗第7天记录(p = 0.010);两组患者病情严重程度(APACHE II级)无显著差异。NS的存在伴随着并发症发生率的统计学显著增加。ICU治疗时间28天[22;57]第1组，23.5天[11;[37]第二组(p = 0.055)，住院58天[44];70例，第1组为41.5例[24;59.5]， p < 0.025。在出院时，15.0%的组1患者和19.3%的组2患者的神经系统状态有积极的动态变化。孤立性颈椎损伤中NS的发生率为13.5%。NS的发展显著增加了并发症发生率和住院时间，但不排除现有神经系统疾病回归的可能性。
{"title":"The course of complicated injury of the cervical spine with the development of neurogenic shock","authors":"M. Lebedeva, I. Statsenko, A. V. Palmash, E. Ivanova, V. Rerikh","doi":"10.14531/ss2023.1.43-53","DOIUrl":"https://doi.org/10.14531/ss2023.1.43-53","url":null,"abstract":"Objective. To establish the effect of neurogenic shock (NS) on the course of acute complicated injury of the cervical spine.Material and Methods. The retrospective study included 96 patients with acute complicated injury of the cervical spine. The criteria for the presence of NS were determined as mean blood pressure (BP) < 70 mm Hg, and heart rate (HR) < 60 per minute. Two groups were distinguished: Group 1 included 13 patients with NS, and Group 2 – 83 patients without NS. The main characteristics of patients and the course of spinal cord injury were analyzed from the moment of admission to the 30th day of follow-up.Results. There were no statistically significant differences between the groups in terms of gender, age, level of spinal injury, severity of spinal cord injury and comorbidity. Admission BP and HR in patients with NS were below the reference values and had statistically significant differences in comparison with similar indicators in patients of Group 2. On the first day of treatment in the intensive care unit (ICU), hemodynamic support was required for all patients of Group 1, and for 69 patients of Group 2 (83.1 %). The duration of hemodynamic support in Group 1 was 11 days [6; 15], and in Group 2 – 7 days [4; 14]; p = 0.231. Blood lactate and pH levels were consistent with reference values at all stages, with no intergroup differences. Differences in the severity of organ dysfunctions (SOFA scale) were registered only on the seventh day of treatment in the ICU (p = 0.010); there were no significant differences in the severity of the patients’ condition (APACHE II scale). The presence of NS was accompanied by a statistically significant increase in the complication rate. The duration of treatment in the ICU was 28 days [22; 57] in Group 1, 23.5 days [11; 37] in Group 2 (p = 0.055), and that in the hospital – 58 days [44; 70] in Group 1 versus 41.5 [24; 59.5] in Group 2 (p < 0.025). Positive dynamics in the neurological status was noted at discharge in 15.0 % of Group 1 patients and in 19.3 % of Group 2 patients.Conclusion. The prevalence of NS in isolated injury of the cervical spine was 13.5 %. The development of NS significantly increases the complication rate and duration of hospital stay, but does not exclude the possibility of regression of existing neurological disorders.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"165 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114926284","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}
A. Krivoshapkin, I. D. Savitskiy, A. Gushcha, V. Klimov, G. S. Sergeyev, I. A. Savitskaya, A. S. Gaitan, O. Abdullaev
Objective. To study the efficacy and safety of transforaminal epidural block (TEB) in patients with herniated intervertebral discs, as well as to compare the results of their treatment with those achieved in patients who were treated with other methods.Material and Methods. The results of treatment of 248 patients with herniated intervertebral discs and persistent radicular pain syndrome, who had indications for surgical treatment, were studied. In 70 cases, the TEB was performed, and in case of its low efficacy (less than 50 % reduction in pain severity), surgical intervention was suggested. In 178 cases, surgical treatment was performed – microsurgical or endoscopic discectomy. The state of patients was followed-up during two years using VAS, Oswestry questionnaire and MRC scale for motor dysfunction in the limb.Results. After 1 month, a decrease in the intensity of radicular pain (by 50 % or more) was determined in the TEB group with a lower frequency (84.3 %) than in the surgical treatment group (93.8 %), without a statistically significant difference (p = 0.526). At the same time, a stable reduction in radicular pain (by 50 % or more) without the need for surgical treatment was achieved in 62.9 % of patients in the TEB group. Also, there was not significant difference in VAS score for local low back pain (p = 0.179) and ODI score (p = 0.348) between groups. After 24 months, the benefits of functional outcomes in the TEB group as compared with the surgical treatment group were confirmed by median ODI (4 [0; 8] vs 12 [4; 20], respectively) and median VAS for low back pain (0 [0; 1] vs 1 [0; 3], respectively), p < 0.001. A significant (50 % or more) decrease in VAS score for radicular pain was achieved in all patients of the TEB group, while in the surgical treatment group – in 88.8 % (p > 0.05). In the TEB group, a stable analgesic effect without subsequent surgical intervention was achieved in 42 (60.0 %) patients, and the number of repeated surgical interventions performed for various reasons was significantly lower (p = 0.001), with a comparable incidence of disc herniation recurrence among operated patients who required repeated surgical treatment (p > 0.05).Conclusion. The use of transforaminal epidural block (TEB) in the treatment of patients with herniated intervertebral discs at the lumbar level and persistent radicular pain makes it possible to avoid surgical treatment in 62.9 % of patients in the short term, and in 60.0 % during two year follow-up after the procedure, while maintaining a high quality of life.
目标。目的:探讨经椎间孔硬膜外阻滞(TEB)治疗椎间盘突出症的疗效和安全性，并将其与其他方法治疗的效果进行比较。材料和方法。对248例有手术指征的腰椎间盘突出伴持续性神经根痛综合征患者的治疗结果进行了分析。70例患者行TEB治疗，若疗效不佳(疼痛严重程度减轻不到50%)，则建议手术干预。178例手术治疗-显微手术或内镜下椎间盘切除术。采用VAS、Oswestry问卷和肢体运动功能障碍MRC量表对患者进行为期2年的随访。1个月后，TEB组神经根疼痛强度下降50%或以上，频率(84.3%)低于手术治疗组(93.8%)，差异无统计学意义(p = 0.526)。同时，在不需要手术治疗的情况下，62.9%的TEB组患者实现了神经根疼痛的稳定减少(50%或更多)。两组间局部腰痛VAS评分(p = 0.179)和ODI评分(p = 0.348)差异无统计学意义。24个月后，与手术治疗组相比，TEB组功能结局的益处得到了中位ODI (4 [0;8] vs . 12 [4;20])和中位VAS对腰痛的评价(0 [0;1] vs 1 [0;3])， p < 0.001。TEB组所有患者的神经根痛VAS评分均显著下降(50%或以上)，而手术治疗组为88.8% (p < 0.05)。在TEB组中，42例(60.0%)患者在没有后续手术干预的情况下获得了稳定的镇痛效果，并且由于各种原因进行重复手术干预的次数明显减少(p = 0.001)，需要重复手术治疗的手术患者的椎间盘突出复发发生率相当(p > 0.05)。经椎间孔硬膜外阻滞(TEB)用于治疗腰椎间盘突出和持续性神经根疼痛的患者，使62.9%的患者在短期内可以避免手术治疗，60.0%的患者在术后两年随访期间可以避免手术治疗，同时保持高质量的生活。
{"title":"The use of transforaminal epidural block in patients with herniated discs and radicular pain","authors":"A. Krivoshapkin, I. D. Savitskiy, A. Gushcha, V. Klimov, G. S. Sergeyev, I. A. Savitskaya, A. S. Gaitan, O. Abdullaev","doi":"10.14531/ss2023.1.54-65","DOIUrl":"https://doi.org/10.14531/ss2023.1.54-65","url":null,"abstract":"Objective. To study the efficacy and safety of transforaminal epidural block (TEB) in patients with herniated intervertebral discs, as well as to compare the results of their treatment with those achieved in patients who were treated with other methods.Material and Methods. The results of treatment of 248 patients with herniated intervertebral discs and persistent radicular pain syndrome, who had indications for surgical treatment, were studied. In 70 cases, the TEB was performed, and in case of its low efficacy (less than 50 % reduction in pain severity), surgical intervention was suggested. In 178 cases, surgical treatment was performed – microsurgical or endoscopic discectomy. The state of patients was followed-up during two years using VAS, Oswestry questionnaire and MRC scale for motor dysfunction in the limb.Results. After 1 month, a decrease in the intensity of radicular pain (by 50 % or more) was determined in the TEB group with a lower frequency (84.3 %) than in the surgical treatment group (93.8 %), without a statistically significant difference (p = 0.526). At the same time, a stable reduction in radicular pain (by 50 % or more) without the need for surgical treatment was achieved in 62.9 % of patients in the TEB group. Also, there was not significant difference in VAS score for local low back pain (p = 0.179) and ODI score (p = 0.348) between groups. After 24 months, the benefits of functional outcomes in the TEB group as compared with the surgical treatment group were confirmed by median ODI (4 [0; 8] vs 12 [4; 20], respectively) and median VAS for low back pain (0 [0; 1] vs 1 [0; 3], respectively), p < 0.001. A significant (50 % or more) decrease in VAS score for radicular pain was achieved in all patients of the TEB group, while in the surgical treatment group – in 88.8 % (p > 0.05). In the TEB group, a stable analgesic effect without subsequent surgical intervention was achieved in 42 (60.0 %) patients, and the number of repeated surgical interventions performed for various reasons was significantly lower (p = 0.001), with a comparable incidence of disc herniation recurrence among operated patients who required repeated surgical treatment (p > 0.05).Conclusion. The use of transforaminal epidural block (TEB) in the treatment of patients with herniated intervertebral discs at the lumbar level and persistent radicular pain makes it possible to avoid surgical treatment in 62.9 % of patients in the short term, and in 60.0 % during two year follow-up after the procedure, while maintaining a high quality of life.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"31 5","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"113983966","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}
V. N. Sarnadskiy, D. Y. Batorov, O. A. Shchuchkina
Objective. To analyze the results of scoliosis diagnostics during the examination of the same group of schoolchildren by TODP and Formetriс topographs.Material and Methods. A total of 364 schoolchildren (197 girls and 167 boys, mean age 8.92 ± 1.9 years) were examined, divided into 3 age groups: 6–8 years old (n = 135, mean age 7.22 ± 0.7 years), 8–10 years old (n = 134 children, mean age 8.95 ± 0.56 years), 10–12 years old (n = 95 children, mean age 11.35 ± 1.59 years). Schoolchildren were examined in turn by computer optical topography (TODP, released in 2021, WTOPO 5.4-2021 software) and video raster stereography (Formetric 4D released in 2015, DICAM2.6.4 software). Three standard screening poses were used for TODP, and one pose with averaging 12 frames – for Formetric.Results. The obtained statistics on the distribution of topographic analogs of the Cobb angle (the angle of lateral asymmetry for TODP and the angle of scoliosis for Formetric) showed a significant discrepancy in the percentage of detected scoliosis cases: 0–5° – 50,0 % (TODP) and 4.1 % (Formetric); 5–7° – 33.8 % and 9.3 %; 7–9° – 12.4 % and 17.9 %; 9–15° – 3.8 % and 51.6 %; 15–25° – 0,0 % and 16.2 %; 25–50° – 0,0 % and 0.8 %, respectively. Clinically significant cases of scoliosis (9° or more) in the age groups was 3.7 %, 2.2 %, 6.6 % (mean – 3.8 %) for TODP and 71.1 %, 70.1 %, 63.2 % (average – 68.7 %) for Formetric. At the same time, only 14 cases of clinically significant scoliosis (from 9° to 15°), including 9 structural and 5 compensatory scoliosis, were detected by TODP, and 250 scoliosis cases (188 – from 9° to 15°, 59 – from 15° to 25°, 3 – from 25° to 37°) – by Formetric. For 9 structural scoliosis cases (according to TODP), the Formetric diagnosis coincided completely only in 2 cases and partially in 3 (55 %), and in 5 cases of compensatory scoliosis (according to TODP) it coincided completely in 3 cases and partially in 1 (80 %).Conclusion. According to the results of topographic screening of 364 schoolchildren using the TODP topograph, 3.8 % of scoliosis cases of 9° or more was detected, which corresponds to the average screening data in a number of countries around the world. Examination of the same schoolchildren using the Formetric topograph revealed 68.7 % of cases of scoliosis of 9° or more, which allows us to judge about overdiagnosis and conclude that Formetric is poorly suited for topographic screening of scoliosis in schoolchildren.
{"title":"Comparison of scoliosis diagnostic capabilities in screening of schoolchildren by computer optical topography and video rasterstereography using TODP and Formetric topographs","authors":"V. N. Sarnadskiy, D. Y. Batorov, O. A. Shchuchkina","doi":"10.14531/ss2023.1.16-27","DOIUrl":"https://doi.org/10.14531/ss2023.1.16-27","url":null,"abstract":"Objective. To analyze the results of scoliosis diagnostics during the examination of the same group of schoolchildren by TODP and Formetriс topographs.Material and Methods. A total of 364 schoolchildren (197 girls and 167 boys, mean age 8.92 ± 1.9 years) were examined, divided into 3 age groups: 6–8 years old (n = 135, mean age 7.22 ± 0.7 years), 8–10 years old (n = 134 children, mean age 8.95 ± 0.56 years), 10–12 years old (n = 95 children, mean age 11.35 ± 1.59 years). Schoolchildren were examined in turn by computer optical topography (TODP, released in 2021, WTOPO 5.4-2021 software) and video raster stereography (Formetric 4D released in 2015, DICAM2.6.4 software). Three standard screening poses were used for TODP, and one pose with averaging 12 frames – for Formetric.Results. The obtained statistics on the distribution of topographic analogs of the Cobb angle (the angle of lateral asymmetry for TODP and the angle of scoliosis for Formetric) showed a significant discrepancy in the percentage of detected scoliosis cases: 0–5° – 50,0 % (TODP) and 4.1 % (Formetric); 5–7° – 33.8 % and 9.3 %; 7–9° – 12.4 % and 17.9 %; 9–15° – 3.8 % and 51.6 %; 15–25° – 0,0 % and 16.2 %; 25–50° – 0,0 % and 0.8 %, respectively. Clinically significant cases of scoliosis (9° or more) in the age groups was 3.7 %, 2.2 %, 6.6 % (mean – 3.8 %) for TODP and 71.1 %, 70.1 %, 63.2 % (average – 68.7 %) for Formetric. At the same time, only 14 cases of clinically significant scoliosis (from 9° to 15°), including 9 structural and 5 compensatory scoliosis, were detected by TODP, and 250 scoliosis cases (188 – from 9° to 15°, 59 – from 15° to 25°, 3 – from 25° to 37°) – by Formetric. For 9 structural scoliosis cases (according to TODP), the Formetric diagnosis coincided completely only in 2 cases and partially in 3 (55 %), and in 5 cases of compensatory scoliosis (according to TODP) it coincided completely in 3 cases and partially in 1 (80 %).Conclusion. According to the results of topographic screening of 364 schoolchildren using the TODP topograph, 3.8 % of scoliosis cases of 9° or more was detected, which corresponds to the average screening data in a number of countries around the world. Examination of the same schoolchildren using the Formetric topograph revealed 68.7 % of cases of scoliosis of 9° or more, which allows us to judge about overdiagnosis and conclude that Formetric is poorly suited for topographic screening of scoliosis in schoolchildren.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133819484","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}
A. A. Kuleshov, N. A. Aganesov, M. S. Vetrile, A. Dol, I. N. Lisyansky, S. N. Makarov
Objective. To analyze the strength of three types of spinopelvic fixation system configurations in longitudinal fracture of the sacrum by the finite element method.Material and Methods. Biomechanical analysis was carried out by the finite element method. A three-dimensional model of a segment of the spinopelvic complex (SPC), including the pelvic bones, sacrum and L4 and L5 vertebrae, was created on the basis of the CT scan results of a healthy patient. Then, a longitudinal fracture of the sacrum was simulated on the developed model of the sacrum on the left side in zone 1 according to the Denis classification. Further, a comparative assessment of three variants of spinopelvic fixation systems with the help of biomechanical computer modeling was carried out: bilateral spinopelvic system L4–S2Alar, bilateral spinopelvic system L4–S2Alar with transverse connector installation, and bilateral spinopelvic system L4–S2Alar with L-shaped rod installation. The stability of fixation, as well as the amount of loads acting on the fixation elements and bone tissues were determined.Results. As the rigidity of the structure increases by means of a transverse connector or an L-shaped rod, the load is redistributed between the screws located to the left and right of the fracture. The rigidity of the L4–S2Alar system with parallel, unconnected rods is much lower, which leads to a critical increase in loads on instrumentation and vertebrae.Conclusion. Analysis of three variants of spinopelvic fixation of longitudinal fractures of the sacrum by finite element method revealed that bilateral spinopelvic system with pedicle screws installed in the L4 and L5 vertebrae and pelvic screws installed in the iliac bones through the lateral masses of S2, two on each side (L4–S2 Alar) and connected by two parallel rods (variant 1) is the least strong in comparison with the other variants. The strength of the fixation increases when the structure is supplemented with a transverse connector between the rods (variant 2). The L4–S2 Alar design with an L-shaped rod on the side of the longitudinal fracture of the sacrum (variant 3) proved to be the most strong.
{"title":"Biomechanical analysis of variants of spinopelvic fixation of longitudinal sacral fractures by the finite element method","authors":"A. A. Kuleshov, N. A. Aganesov, M. S. Vetrile, A. Dol, I. N. Lisyansky, S. N. Makarov","doi":"10.14531/ss2023.1.28-35","DOIUrl":"https://doi.org/10.14531/ss2023.1.28-35","url":null,"abstract":"Objective. To analyze the strength of three types of spinopelvic fixation system configurations in longitudinal fracture of the sacrum by the finite element method.Material and Methods. Biomechanical analysis was carried out by the finite element method. A three-dimensional model of a segment of the spinopelvic complex (SPC), including the pelvic bones, sacrum and L4 and L5 vertebrae, was created on the basis of the CT scan results of a healthy patient. Then, a longitudinal fracture of the sacrum was simulated on the developed model of the sacrum on the left side in zone 1 according to the Denis classification. Further, a comparative assessment of three variants of spinopelvic fixation systems with the help of biomechanical computer modeling was carried out: bilateral spinopelvic system L4–S2Alar, bilateral spinopelvic system L4–S2Alar with transverse connector installation, and bilateral spinopelvic system L4–S2Alar with L-shaped rod installation. The stability of fixation, as well as the amount of loads acting on the fixation elements and bone tissues were determined.Results. As the rigidity of the structure increases by means of a transverse connector or an L-shaped rod, the load is redistributed between the screws located to the left and right of the fracture. The rigidity of the L4–S2Alar system with parallel, unconnected rods is much lower, which leads to a critical increase in loads on instrumentation and vertebrae.Conclusion. Analysis of three variants of spinopelvic fixation of longitudinal fractures of the sacrum by finite element method revealed that bilateral spinopelvic system with pedicle screws installed in the L4 and L5 vertebrae and pelvic screws installed in the iliac bones through the lateral masses of S2, two on each side (L4–S2 Alar) and connected by two parallel rods (variant 1) is the least strong in comparison with the other variants. The strength of the fixation increases when the structure is supplemented with a transverse connector between the rods (variant 2). The L4–S2 Alar design with an L-shaped rod on the side of the longitudinal fracture of the sacrum (variant 3) proved to be the most strong.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122637238","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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