S. Gizatullin, Z. S. Aliev, A. V. Stanishevsky, A. S. Kristosturov, D. Davydov, I. Onnitsev
Objective. To assess the effectiveness of the treatment of gunshot wounds of the spine using percutaneous full-endoscopic technique.Material and Methods. Three patients with gunshot shrapnel wounds of the spine were treated using percutaneous full endoscopy.Results. The patients underwent a removal of foreign bodies (metal fragments) at the cervical, thoracic and lumbosacral levels of the spine using percutaneous full endoscopic surgery. The operations were carried out without complications, with minimal additional trauma to soft tissues and the spinal motion segment. In all three cases, there was a positive dynamics in the form of regression of the pain syndrome. There were no infectious complications.Conclusion. The successful use of percutaneous full endoscopy in the surgical treatment of blind shrapnel wounds of the spine is shown. The results indicate the expediency of further research and development of this area to address the issue of introducing the technique into the routine practice of treating gunshot wounds both in peacetime in neurosurgical hospitals and centers of spinal neurosurgery, and in wartime at the stages of specialized care.
{"title":"Treatment of gunshot wounds of the spine using full-endoscopic surgery: analysis of a small clinical series","authors":"S. Gizatullin, Z. S. Aliev, A. V. Stanishevsky, A. S. Kristosturov, D. Davydov, I. Onnitsev","doi":"10.14531/ss2022.4.77-85","DOIUrl":"https://doi.org/10.14531/ss2022.4.77-85","url":null,"abstract":"Objective. To assess the effectiveness of the treatment of gunshot wounds of the spine using percutaneous full-endoscopic technique.Material and Methods. Three patients with gunshot shrapnel wounds of the spine were treated using percutaneous full endoscopy.Results. The patients underwent a removal of foreign bodies (metal fragments) at the cervical, thoracic and lumbosacral levels of the spine using percutaneous full endoscopic surgery. The operations were carried out without complications, with minimal additional trauma to soft tissues and the spinal motion segment. In all three cases, there was a positive dynamics in the form of regression of the pain syndrome. There were no infectious complications.Conclusion. The successful use of percutaneous full endoscopy in the surgical treatment of blind shrapnel wounds of the spine is shown. The results indicate the expediency of further research and development of this area to address the issue of introducing the technique into the routine practice of treating gunshot wounds both in peacetime in neurosurgical hospitals and centers of spinal neurosurgery, and in wartime at the stages of specialized care.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"181 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125827336","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. G. Aganesov, M. Aleksanyan, S. Abugov, G. V. Mardanyan
Objective. To analyse the results of treatment of patients in whom, after fixation of the thoracic spine, contact of screws with the aorta with its wall injury was revealed.Material and Methods. Three own observations and literature data were analysed.Results. Three patients with potential (1 case) and true (2 cases) injury to the thoracic aorta by a transpedicular screw underwent simultaneous surgical intervention including thoracic endovascular aortic repair (TEVAR) followed by remounting (2 cases) or removal of the transpedicular fixation system. An analysis of publications on this topic is presented.Conclusion. Intramural hematoma caused by screw malposition is an indication for aortic repair due to the risk of its dissection or rupture.It is advisable to give preference to endovascular methods of treating vascular injuries under conditions of local anesthesia as the first stage, and then to perform the revision of transpedicular fixation system under anesthesia.
{"title":"Tactics for the treatment of potential and true thoracic aorta injuries by pedicle screws in the absence of acute bleeding: analysis of a small clinical series and literature data","authors":"A. G. Aganesov, M. Aleksanyan, S. Abugov, G. V. Mardanyan","doi":"10.14531/ss2022.4.46-51","DOIUrl":"https://doi.org/10.14531/ss2022.4.46-51","url":null,"abstract":"Objective. To analyse the results of treatment of patients in whom, after fixation of the thoracic spine, contact of screws with the aorta with its wall injury was revealed.Material and Methods. Three own observations and literature data were analysed.Results. Three patients with potential (1 case) and true (2 cases) injury to the thoracic aorta by a transpedicular screw underwent simultaneous surgical intervention including thoracic endovascular aortic repair (TEVAR) followed by remounting (2 cases) or removal of the transpedicular fixation system. An analysis of publications on this topic is presented.Conclusion. Intramural hematoma caused by screw malposition is an indication for aortic repair due to the risk of its dissection or rupture.It is advisable to give preference to endovascular methods of treating vascular injuries under conditions of local anesthesia as the first stage, and then to perform the revision of transpedicular fixation system under anesthesia.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"94 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122312598","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}
D. A. Glukhov, V. Zorin, Ya. A. Maltseva, A. Mushkin
Objective. To search for normal parameters of the sagittal balance of the cervical spine in children, to analyze their dynamics in different periods of childhood, and to compare them with the norm given for the adult population.Material and Methods. To assess the parameters of the sagittal balance of the cervical spine, radiographs were selected that were initially evaluated by radiologists as a variant of the norm. The final sample consisted of 73 radiographs of 44 girls and 29 boys aged 4 to 17 years.Digital radiographs were used to evaluate the 10 most common parameters presented in publications: the angular values of Oc–C2, C2–C7, C7S, Th1S, TIA, NT, CeT, CrT, SCA, as well as the cSVA distance measured in mm. The measurements were carried out independently by 3 specialists working with pediatric patients: an orthopedic surgeon (experience up to 5 years), an orthopedic surgeon (experience more than 15 years), and a radiologist specializing in skeletal pathology (experience more than 5 years). The obtained results weresubjected to statistical processing.Results. Using multivariate analysis of variance, the presence of a statistically significant difference in age was revealed only for cSVA, gender differences were revealed for 6 out of 10 parameters. Most of the parameters showed good and satisfactory agreement between specialists.A very strong correlation was established between the parameters C7S and Th1S, which correlates with the adjacent position of the vertebrae.The C2–C7 and SCA parameters have a strong positive correlation with each other, the CeT parameter is strongly negatively correlated with both of them. The TIA has a strong negative correlation with SCA and a moderate positive correlation with NT, CeT, C7S, and Th1S. The cSVA and CrT values strongly correlate only with each other. Comparison of the obtained parameters of the sagittal balancein children with the data in scientific publications on the adult population revealed statistically significant differences in the values of 6 out of 10 of them.Conclusion. The age norms of the main parameters of the sagittal balance for children, and their gender differences were determined. Their difference from the normal parameters of the adult population was established, which requires that these features be taken into accountin clinical practice.
{"title":"Sagittal balance of the cervical spine in children older than 4 years: what is the norm?","authors":"D. A. Glukhov, V. Zorin, Ya. A. Maltseva, A. Mushkin","doi":"10.14531/ss2022.4.19-29","DOIUrl":"https://doi.org/10.14531/ss2022.4.19-29","url":null,"abstract":"Objective. To search for normal parameters of the sagittal balance of the cervical spine in children, to analyze their dynamics in different periods of childhood, and to compare them with the norm given for the adult population.Material and Methods. To assess the parameters of the sagittal balance of the cervical spine, radiographs were selected that were initially evaluated by radiologists as a variant of the norm. The final sample consisted of 73 radiographs of 44 girls and 29 boys aged 4 to 17 years.Digital radiographs were used to evaluate the 10 most common parameters presented in publications: the angular values of Oc–C2, C2–C7, C7S, Th1S, TIA, NT, CeT, CrT, SCA, as well as the cSVA distance measured in mm. The measurements were carried out independently by 3 specialists working with pediatric patients: an orthopedic surgeon (experience up to 5 years), an orthopedic surgeon (experience more than 15 years), and a radiologist specializing in skeletal pathology (experience more than 5 years). The obtained results weresubjected to statistical processing.Results. Using multivariate analysis of variance, the presence of a statistically significant difference in age was revealed only for cSVA, gender differences were revealed for 6 out of 10 parameters. Most of the parameters showed good and satisfactory agreement between specialists.A very strong correlation was established between the parameters C7S and Th1S, which correlates with the adjacent position of the vertebrae.The C2–C7 and SCA parameters have a strong positive correlation with each other, the CeT parameter is strongly negatively correlated with both of them. The TIA has a strong negative correlation with SCA and a moderate positive correlation with NT, CeT, C7S, and Th1S. The cSVA and CrT values strongly correlate only with each other. Comparison of the obtained parameters of the sagittal balancein children with the data in scientific publications on the adult population revealed statistically significant differences in the values of 6 out of 10 of them.Conclusion. The age norms of the main parameters of the sagittal balance for children, and their gender differences were determined. Their difference from the normal parameters of the adult population was established, which requires that these features be taken into accountin clinical practice.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134031077","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 literature data and to present recommendations on the use of the minimum clinically important difference (MCID) in the practice of spinal surgeon-researcher.Material and Methods. The article is a non-systematic review of the literature. A search was performed for sources, which describe the calculation and analysis of the MCID parameter on a cohort of patients with degenerative spinal diseases in the PubMed, Scopus and Web of Science databases. Further, the analysis of the literature was carried out on the application of MCID to assess the effectiveness of surgical treatment.Results. The MCID parameter is illustrated for the most common clinical scales used to assess the effectiveness of treatment in spinal surgery, with their detailed description and discussion of their benefits and drawbacks. The specific MCID values for cervical and lumbar pathologies, first of all degenerative ones, and follow-up periods, which can be used in assessing the results of the treatment, as well as in planning prospective comparative studies are presented.Conclusion. The MCID parameter is required for sample size calculation and for the analysis of treatment outcomes. The MCID reflects not just the change in the baseline indicator, but also the clinical significance for the patient.
目标。目的:分析文献资料，并提出在脊柱外科研究人员实践中使用最小临床重要差异(MCID)的建议。材料和方法。这篇文章是非系统的文献综述。在PubMed、Scopus和Web of Science数据库中对一组退行性脊柱疾病患者的MCID参数进行了计算和分析。进一步，对应用MCID评价手术治疗效果的文献进行分析。MCID参数是用于评估脊柱外科治疗有效性的最常见的临床量表，并对其优缺点进行了详细的描述和讨论。本文介绍了颈椎和腰椎病变(首先是退行性病变)的具体MCID值和随访时间，这些值可用于评估治疗效果，以及规划前瞻性比较研究。计算样本量和分析治疗结果需要MCID参数。MCID不仅反映了基线指标的变化，也反映了对患者的临床意义。
{"title":"Minimal clinically important difference as a method for assessing the effectiveness of spinal surgery using scales and questionnaires: non-systematic literature review","authors":"O. Leonova, E. Baikov, A. Krutko","doi":"10.14531/ss2022.4.60-67","DOIUrl":"https://doi.org/10.14531/ss2022.4.60-67","url":null,"abstract":"Objective. To analyze the literature data and to present recommendations on the use of the minimum clinically important difference (MCID) in the practice of spinal surgeon-researcher.Material and Methods. The article is a non-systematic review of the literature. A search was performed for sources, which describe the calculation and analysis of the MCID parameter on a cohort of patients with degenerative spinal diseases in the PubMed, Scopus and Web of Science databases. Further, the analysis of the literature was carried out on the application of MCID to assess the effectiveness of surgical treatment.Results. The MCID parameter is illustrated for the most common clinical scales used to assess the effectiveness of treatment in spinal surgery, with their detailed description and discussion of their benefits and drawbacks. The specific MCID values for cervical and lumbar pathologies, first of all degenerative ones, and follow-up periods, which can be used in assessing the results of the treatment, as well as in planning prospective comparative studies are presented.Conclusion. The MCID parameter is required for sample size calculation and for the analysis of treatment outcomes. The MCID reflects not just the change in the baseline indicator, but also the clinical significance for the patient.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"52 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128583731","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. Vasilenko, A. Evsyukov, S. Ryabykh, E. Amelina, Yu. E. Kubetsky, I. Garipov, J. A. Rzaev
Objective. To analyze the results of the use of minimally invasive technologies in the treatment of patients with degenerative deformity of the lumbar spine.Material and Methods. Design: Single-center, non-randomized continuous retrospective cohort study. The level of evidence is 3b (UK Oxford, version 2009). A total of 57 patients (10 men and 47 women) were operated for degenerative scoliosis of the lumbar spine using minimally invasive techniques. The quality of life indicators using ODI, SF-36, VAS, as well as linear and angulometric parameters of the spine were studied.Results. The age of patients ranged from 37 to 81 years (62/62 [55; 67], hereinafter the data format is mean/median [1; 3rd quartile]). In the postoperative period, patients operated on with MIS techniques showed a statistically significant decrease in pain by 4.3/4.0 [3; 6] points in the lumbar spine, and by 4.3/4.0 [3; 6] points in the legs. Quality of life indicators according to ODI improved by 24/23 [19; 29], and the level of functional adaptation according to the SF-36 questionnaire – by 18/18 [14; 21] in terms of physical parameters and by 18/20 [16; 23] in terms of mental parameters. The deformity angle in the frontal plane according to Cobb decreased by 12.9°/13.0° [10°; 17°], lumbar lordosis changed by 3.3°/2.0° [-1°; 7°], segmental angle L4–S1 – by 1.0°/0.0° [-5°; 7°], and SVA changed by -7.5/-2.0 [-29; 15] mm. As a result of minimally invasive surgical intervention, a good clinical result was obtained in correcting the scoliotic deformity angle from 17.5°/16.0° [11°; 22°] to 4.6°/4.0° [1°; 7°].Conclusion. The study showed the effectiveness of minimally invasive surgical treatment of degenerative scoliosis of the lumbar spine with short-segment fixation, which allowed obtaining satisfactory clinical results in 93 % of cases with a minimum number of complications (7 %).
{"title":"Treatment of patients with degenerative deformities of the lumbar spine using MIS technologies: analysis of 5-year results","authors":"I. Vasilenko, A. Evsyukov, S. Ryabykh, E. Amelina, Yu. E. Kubetsky, I. Garipov, J. A. Rzaev","doi":"10.14531/ss2022.4.52-59","DOIUrl":"https://doi.org/10.14531/ss2022.4.52-59","url":null,"abstract":"Objective. To analyze the results of the use of minimally invasive technologies in the treatment of patients with degenerative deformity of the lumbar spine.Material and Methods. Design: Single-center, non-randomized continuous retrospective cohort study. The level of evidence is 3b (UK Oxford, version 2009). A total of 57 patients (10 men and 47 women) were operated for degenerative scoliosis of the lumbar spine using minimally invasive techniques. The quality of life indicators using ODI, SF-36, VAS, as well as linear and angulometric parameters of the spine were studied.Results. The age of patients ranged from 37 to 81 years (62/62 [55; 67], hereinafter the data format is mean/median [1; 3rd quartile]). In the postoperative period, patients operated on with MIS techniques showed a statistically significant decrease in pain by 4.3/4.0 [3; 6] points in the lumbar spine, and by 4.3/4.0 [3; 6] points in the legs. Quality of life indicators according to ODI improved by 24/23 [19; 29], and the level of functional adaptation according to the SF-36 questionnaire – by 18/18 [14; 21] in terms of physical parameters and by 18/20 [16; 23] in terms of mental parameters. The deformity angle in the frontal plane according to Cobb decreased by 12.9°/13.0° [10°; 17°], lumbar lordosis changed by 3.3°/2.0° [-1°; 7°], segmental angle L4–S1 – by 1.0°/0.0° [-5°; 7°], and SVA changed by -7.5/-2.0 [-29; 15] mm. As a result of minimally invasive surgical intervention, a good clinical result was obtained in correcting the scoliotic deformity angle from 17.5°/16.0° [11°; 22°] to 4.6°/4.0° [1°; 7°].Conclusion. The study showed the effectiveness of minimally invasive surgical treatment of degenerative scoliosis of the lumbar spine with short-segment fixation, which allowed obtaining satisfactory clinical results in 93 % of cases with a minimum number of complications (7 %).","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"53 53 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133863305","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. Bazarov, D. Naumov, А. Y. Mushkin, K. S. Sergeyev, S. Ryabykh, A. Vishnevsky, A. Burtsev, M. A. Mushkin
Objective. To perform validation study of the E. Pola classification (2017) and to assess expert consensus on the diagnosis and treatment of infectious lesions of the spine in the national professional community.Material and Methods. A clinical and radiological database on 15 cases of infectious spondylitis, as well as the information about original article by Pola and a Russian translation of the classification and tactical tables from this article, were distributed to 408 orthopedic traumatologists, neurosurgeons and radiologists who have experience in treating patients with spinal pathology and whose data are available in the registers of the relevant professional associations of the Russian Federation. The coincidence/difference in the responses concerning the definition of lesion types and the choice of treatment tactics, as well as proposals for the use of classification were assessed.Results. Answers were obtained from 37 respondents from 11 regions of the Russian Federation. The general interobserver agreement index (Fleiss kappa) for all types of spondylodiscitis was 0.388 (95 % CI 0.374–0.402), including for lesion types: type A – 0.480 (95 % CI 0.460–0.499, type B – 0.300 (95 % CI 0.281–0.320), and type C – 0.399 (95 % CI 0.380–0.419). Agreement levels were higher among radiologists (type A – 0.486, type B – 0.484, and type C – 0.477), orthopedic traumatologists (type A – 0.474, type B – 0.380, and type C – 0.479), and specialists with clinical experience less than 10 years (type A – 0.550, type B – 0.318, and type C – 0.437). The pooled data for all 12 lesion subtypes showed general poor agreement (k = 0.247, CI 0.240–0.253), satisfactory level was found for B3.2 type (k = 0.561, CI 0.542–0.581), good agreement (k > 0.61) was achieved between orthopedic traumatologists for type B3.2 and between radiologists for B3.1 and B3.2 lesion types. Respondents refused to use basic treatment options for type A in 15.1 %, type B in 7.5 % and type C in 3.2 % of answers, while indicating the need for interventions through anterior approach in 24.7 %, 43.0 % and 46.2 %, respectively. Limitations of the classification use depending on the localization and etiology of spondylitis were noted. Authors recommended taking into account the presence of systemic inflammatory response syndrome, mandatory CT scanning, clarification of spinal instability criteria, and the addition of anterior surgical interventions to the treatment algorithm.Conclusion. The Pola classification of spondylodiscitis is currently considered the most successful for tactical algorithms and implementation in broad clinical practice for spondylodiscitis. However, at the stages of its clinical application, there is an unsatisfactory interobserver expert consensus on the types of lesions, and there are limitations related to the etiology, localization and severity of the disease. A modified classification taking into account the identified limitations and including anterior procedures in
目标。对E. Pola分类(2017年)进行验证研究，并评估全国专业社区对脊柱感染性病变诊断和治疗的专家共识。材料和方法。关于15例感染性脊柱炎的临床和放射学数据库，以及Pola的原始文章信息和这篇文章的分类和战术表的俄文翻译，已分发给408名骨科创伤学家、神经外科医生和放射科医生，他们在治疗脊柱病理患者方面有经验，其数据可在俄罗斯联邦相关专业协会的登记册中获得。评估了在病变类型的定义、治疗策略的选择以及使用分类的建议等方面的反应的重合/差异。来自俄罗斯联邦11个地区的37名受访者给出了答案。所有类型脊椎炎的一般观察者间一致指数(Fleiss kappa)为0.388 (95% CI 0.374-0.402)，包括病变类型:A型- 0.480 (95% CI 0.460-0.499)， B型- 0.300 (95% CI 0.281-0.320)和C型- 0.399 (95% CI 0.380-0.419)。放射科医生(A型0.486,B型0.484,C型0.477)、骨科创伤科医生(A型0.474,B型0.380,C型0.479)和临床经验不足10年的专科医生(A型0.550,B型0.318,C型0.437)的认同水平更高。所有12种病变亚型的汇总数据显示，一致性总体较差(k = 0.247, CI 0.240 ~ 0.253)， B3.2类型的一致性较好(k = 0.561, CI 0.542 ~ 0.581)，骨科创伤医师对B3.2类型的一致性较好(k > 0.61)，放射科医师对B3.1和B3.2类型的一致性较好(k > 0.61)。15.1%的应答者拒绝使用A型基本治疗方案，7.5%的应答者拒绝使用B型基本治疗方案，3.2%的应答者拒绝使用C型基本治疗方案，24.7%的应答者拒绝使用B型基本治疗方案，43.0%的应答者拒绝使用C型基本治疗方案，46.2%的应答者拒绝使用前路干预方案。指出了根据脊柱炎的定位和病因分类使用的局限性。作者建议考虑全身性炎症反应综合征的存在，强制性CT扫描，澄清脊柱不稳定标准，并在治疗算法中增加前路手术干预。脊椎炎的Pola分类目前被认为是最成功的战术算法，并在脊椎炎的广泛临床实践中实施。然而，在其临床应用的各个阶段，对病变类型的观察专家之间的共识并不令人满意，并且在疾病的病因、定位和严重程度方面存在局限性。考虑到已确定的局限性并在战术选择中包括前路手术的改良分类是可取的。
{"title":"A new classification of spondylodiscitis: possibility of validation and multidisciplinary expert consensus","authors":"A. Bazarov, D. Naumov, А. Y. Mushkin, K. S. Sergeyev, S. Ryabykh, A. Vishnevsky, A. Burtsev, M. A. Mushkin","doi":"10.14531/ss2022.4.68-76","DOIUrl":"https://doi.org/10.14531/ss2022.4.68-76","url":null,"abstract":"Objective. To perform validation study of the E. Pola classification (2017) and to assess expert consensus on the diagnosis and treatment of infectious lesions of the spine in the national professional community.Material and Methods. A clinical and radiological database on 15 cases of infectious spondylitis, as well as the information about original article by Pola and a Russian translation of the classification and tactical tables from this article, were distributed to 408 orthopedic traumatologists, neurosurgeons and radiologists who have experience in treating patients with spinal pathology and whose data are available in the registers of the relevant professional associations of the Russian Federation. The coincidence/difference in the responses concerning the definition of lesion types and the choice of treatment tactics, as well as proposals for the use of classification were assessed.Results. Answers were obtained from 37 respondents from 11 regions of the Russian Federation. The general interobserver agreement index (Fleiss kappa) for all types of spondylodiscitis was 0.388 (95 % CI 0.374–0.402), including for lesion types: type A – 0.480 (95 % CI 0.460–0.499, type B – 0.300 (95 % CI 0.281–0.320), and type C – 0.399 (95 % CI 0.380–0.419). Agreement levels were higher among radiologists (type A – 0.486, type B – 0.484, and type C – 0.477), orthopedic traumatologists (type A – 0.474, type B – 0.380, and type C – 0.479), and specialists with clinical experience less than 10 years (type A – 0.550, type B – 0.318, and type C – 0.437). The pooled data for all 12 lesion subtypes showed general poor agreement (k = 0.247, CI 0.240–0.253), satisfactory level was found for B3.2 type (k = 0.561, CI 0.542–0.581), good agreement (k > 0.61) was achieved between orthopedic traumatologists for type B3.2 and between radiologists for B3.1 and B3.2 lesion types. Respondents refused to use basic treatment options for type A in 15.1 %, type B in 7.5 % and type C in 3.2 % of answers, while indicating the need for interventions through anterior approach in 24.7 %, 43.0 % and 46.2 %, respectively. Limitations of the classification use depending on the localization and etiology of spondylitis were noted. Authors recommended taking into account the presence of systemic inflammatory response syndrome, mandatory CT scanning, clarification of spinal instability criteria, and the addition of anterior surgical interventions to the treatment algorithm.Conclusion. The Pola classification of spondylodiscitis is currently considered the most successful for tactical algorithms and implementation in broad clinical practice for spondylodiscitis. However, at the stages of its clinical application, there is an unsatisfactory interobserver expert consensus on the types of lesions, and there are limitations related to the etiology, localization and severity of the disease. A modified classification taking into account the identified limitations and including anterior procedures in","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"63 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117335458","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 perform comparative analysis of posterior stabilization methods combined with cement vertebroplasty and osteoplasty with deproteinized bone allograft in the treatment of uncomplicated burst fractures of the vertebral bodies associated with osteoporosis.Material and Methods. The study was a retrospective analysis. Two groups of patients were formed, inclusion and exclusion criteria were determined. The follow-up period was 12 months. The magnitude of kyphosis correction according to the Cobb method, the magnitude of residual postoperative kyphotic deformity, its recurrence in the long term postoperative period, and the length of transpedicular fixationwere assessed. Sagittal balance parameters and subjective assessments of the patient’s condition were not evaluated.Results. With a statistically significant difference, it can be said that the main predictors of recurrence of local kyphosis, incomplete correction of deformity and increased pain syndrome are the level of injury (T12 vertebra), the degree of initial kyphotic deformity, incomplete achievement of its correction after surgery (>10°), and the value of T-criterion according to densitometry. The length of fixation does notaffect the loss of correction and recurrence of kyphosis, however it may correlate with the severity of osteoporosis.Conclusions. When comparing posterior stabilization methods in combination with cement vertebroplasty or osteoplasty, there was no statistical difference in clinical and radiological outcomes.
{"title":"Comparative analysis of hybrid stabilization methods in the treatment of burst fractures of the vertebral bodies associated with osteoporosis","authors":"V. Rerikh, V. D. Sinyavin","doi":"10.14531/ss2022.4.40-45","DOIUrl":"https://doi.org/10.14531/ss2022.4.40-45","url":null,"abstract":"Objective. To perform comparative analysis of posterior stabilization methods combined with cement vertebroplasty and osteoplasty with deproteinized bone allograft in the treatment of uncomplicated burst fractures of the vertebral bodies associated with osteoporosis.Material and Methods. The study was a retrospective analysis. Two groups of patients were formed, inclusion and exclusion criteria were determined. The follow-up period was 12 months. The magnitude of kyphosis correction according to the Cobb method, the magnitude of residual postoperative kyphotic deformity, its recurrence in the long term postoperative period, and the length of transpedicular fixationwere assessed. Sagittal balance parameters and subjective assessments of the patient’s condition were not evaluated.Results. With a statistically significant difference, it can be said that the main predictors of recurrence of local kyphosis, incomplete correction of deformity and increased pain syndrome are the level of injury (T12 vertebra), the degree of initial kyphotic deformity, incomplete achievement of its correction after surgery (>10°), and the value of T-criterion according to densitometry. The length of fixation does notaffect the loss of correction and recurrence of kyphosis, however it may correlate with the severity of osteoporosis.Conclusions. When comparing posterior stabilization methods in combination with cement vertebroplasty or osteoplasty, there was no statistical difference in clinical and radiological outcomes.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"1156 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114161194","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, E. V. Gubina, N. Aleksandrova, V. Lukinov, I. M. Mairambekov, A. Sergunin
Objective. To analyze long-term results of surgical correction of kyphosis due to Scheuermann’s disease.Material and Methods. Design: retrospective cohort study. The study group included 43 patients (m/f ratio, 34/9). The mean age was 19.1 (14–32) years; the mean postoperative follow-up was 6 ± 10 (5–20) years. Two-stage surgery including discectomy and interbody fusion followed by posterior correction and fusion was conducted in 35 cases (Group A). Eight patients (Group B) underwent only posterior correction and spinal fusion. The following parameters were determined for each patient: thoracic kyphosis (TK), lumbar lordosis (LL) (scoliotic deformity of the thoracic/thoracolumbar spine, if the curve magnitude was > 5°), sagittal vertical axis (SVA), sagittal stable vertebra (SSV), first lordotic vertebra (FLV), proximal junctional angle (PJA) and distal junctional angle (DJA). All measurements were performed immediately before surgery, one week after surgery, and at the end of the follow-up period. All patients answered the SRS-24 questionnaire after surgery and at end of the follow-up period.Results. Groups were comparable in terms of age and gender of patients, body mass index and initial Cobb angle (p < 0.05). The curve decreased from 77.8° to 40.7° in Group A and from 81.7° to 41.6° in Group B. The loss of correction was 9.1° and 6.0° in groups A and B, respectively. The parameters of lumbar lordosis remained normal during the follow-up period. At implant density less than 1.2, deformity correction and correction loss were 44.5° (54.7 %) and 3.9°, respectively (p < 0.05). Proximal junctional kyphosis (PJK) was detected in 21 out of 43 patients (48.8 %). The frequency of PJK was 45.4 % among patients whose upper end vertebra was included in the fusion and 60 % among those whose upper end vertebra was not included. PJK developed in eight (47.8 %) out of 17 patients with kyphosis correction ≥ 50 % and in 13 (50.0 %) of those with correction < 50 %. The rate of DJK development was 39.5 %. The lower instrumented vertebra (LIV) was located proximal to the sagittal stable vertebra in 16 cases, with 12 (75 %) of them being diagnosed with DJK. In 27 patients, LIV was located either at the SSV level or distal to it, the number of DJK cases was 5 (18.5 %); p < 0.05. Only two patients with complications required unplanned interventions. According to the patient questionnaires, the surgical outcome score increases between the immediate and long-term postoperative periods for all domains and from 88.4 to 91.4 in total. The same applies to answer to the question about consent to surgical treatment on the same conditions: positive answers increased from 82 to 86 %.Conclusions. Two-stage surgery, as a more difficult and prolonged one, has no advantages over one-stage operation in terms of correction magnitude and stability of the achieved effect. Surgical treatment improves the quality of life of patients with Scheuermann’s disease, and the improvement contin
{"title":"Long-term results of surgical correction of Scheuermann’s kyphosis","authors":"M. Mikhaylovskiy, E. V. Gubina, N. Aleksandrova, V. Lukinov, I. M. Mairambekov, A. Sergunin","doi":"10.14531/ss2022.4.6-18","DOIUrl":"https://doi.org/10.14531/ss2022.4.6-18","url":null,"abstract":"Objective. To analyze long-term results of surgical correction of kyphosis due to Scheuermann’s disease.Material and Methods. Design: retrospective cohort study. The study group included 43 patients (m/f ratio, 34/9). The mean age was 19.1 (14–32) years; the mean postoperative follow-up was 6 ± 10 (5–20) years. Two-stage surgery including discectomy and interbody fusion followed by posterior correction and fusion was conducted in 35 cases (Group A). Eight patients (Group B) underwent only posterior correction and spinal fusion. The following parameters were determined for each patient: thoracic kyphosis (TK), lumbar lordosis (LL) (scoliotic deformity of the thoracic/thoracolumbar spine, if the curve magnitude was > 5°), sagittal vertical axis (SVA), sagittal stable vertebra (SSV), first lordotic vertebra (FLV), proximal junctional angle (PJA) and distal junctional angle (DJA). All measurements were performed immediately before surgery, one week after surgery, and at the end of the follow-up period. All patients answered the SRS-24 questionnaire after surgery and at end of the follow-up period.Results. Groups were comparable in terms of age and gender of patients, body mass index and initial Cobb angle (p < 0.05). The curve decreased from 77.8° to 40.7° in Group A and from 81.7° to 41.6° in Group B. The loss of correction was 9.1° and 6.0° in groups A and B, respectively. The parameters of lumbar lordosis remained normal during the follow-up period. At implant density less than 1.2, deformity correction and correction loss were 44.5° (54.7 %) and 3.9°, respectively (p < 0.05). Proximal junctional kyphosis (PJK) was detected in 21 out of 43 patients (48.8 %). The frequency of PJK was 45.4 % among patients whose upper end vertebra was included in the fusion and 60 % among those whose upper end vertebra was not included. PJK developed in eight (47.8 %) out of 17 patients with kyphosis correction ≥ 50 % and in 13 (50.0 %) of those with correction < 50 %. The rate of DJK development was 39.5 %. The lower instrumented vertebra (LIV) was located proximal to the sagittal stable vertebra in 16 cases, with 12 (75 %) of them being diagnosed with DJK. In 27 patients, LIV was located either at the SSV level or distal to it, the number of DJK cases was 5 (18.5 %); p < 0.05. Only two patients with complications required unplanned interventions. According to the patient questionnaires, the surgical outcome score increases between the immediate and long-term postoperative periods for all domains and from 88.4 to 91.4 in total. The same applies to answer to the question about consent to surgical treatment on the same conditions: positive answers increased from 82 to 86 %.Conclusions. Two-stage surgery, as a more difficult and prolonged one, has no advantages over one-stage operation in terms of correction magnitude and stability of the achieved effect. Surgical treatment improves the quality of life of patients with Scheuermann’s disease, and the improvement contin","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124070736","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}
O. M. Sergeenko, D. Savin, Y.V. Molotkov, M. Saifutdinov
Objective. To analyze the frequency of hidden neuraxial pathology in idiopathic scoliosis (IS), to substantiate the need for MRI in IS and to identify promising areas for the use of MRI in the examination of patients with IS.Material and Methods. The literature review was carried out using the PubMed and Google Scholar databases. Of the 780 papers on the research topic, 65 were selected after removing duplicates and checking for inclusion/exclusion criteria. As a result, 49 original studies were included in the analysis. Level of evidence – II.Results. According to modern literature, the main direction of using MRI in idiopathic scoliosis is the search for predictors of latent pathology of the spinal cord and craniovertebral junction. The frequency of neuraxial pathology in idiopathic scoliosis is 8 % for adolescent IS and 16 % for early IS. The main predictors of neuraxial pathology are male sex, early age of deformity onset, left-sided thoracic curve and thoracic hyperkyphosis. MRI in IS may be a useful addition to radiological diagnostic methods to identify risk factors and to study degenerative changes in the spine.Conclusion. MRI of the spine should be performed in the early stages of IS to detect latent spinal cord tethering. In type I Chiari anomalies, there is a possibility that early neurosurgery can prevent the development of scoliosis. The main signs of latent neuraxial pathology in IS are early progression of spinal deformity, left-sided thoracic curve, male gender and thoracic kyphosis over 40° according to Cobb.MRI can be used as an effective non-invasive tool in research aimed at identifying risk factors for IS, including helping to track early degeneration of intervertebral discs.
目标。分析特发性脊柱侧凸(IS)中隐藏的神经轴病理学的频率，证实在IS中需要MRI，并确定MRI在IS患者检查中的应用前景。材料和方法。文献综述使用PubMed和谷歌Scholar数据库进行。在780篇关于该研究课题的论文中，65篇在剔除重复并检查纳入/排除标准后被选中。因此，49项原始研究被纳入分析。证据水平- ii .结果。根据现代文献，在特发性脊柱侧凸中使用MRI的主要方向是寻找脊髓和颅椎交界处潜在病理的预测因子。特发性脊柱侧凸中神经轴病变的发生率在青少年is中为8%，在早期is中为16%。神经轴病变的主要预测因素为男性、畸形发病年龄早、左侧胸曲度和胸后凸过大。MRI在IS中可能是放射诊断方法的有用补充，以确定危险因素和研究脊柱的退行性改变。在IS早期应进行脊柱MRI检查，以发现潜在的脊髓栓系。对于I型Chiari异常，早期神经外科手术有可能预防脊柱侧凸的发展。根据Cobb的说法，IS的潜在神经轴病理的主要迹象是脊柱畸形的早期进展，左侧胸椎弯曲，男性和胸椎后凸超过40°。MRI可以作为一种有效的非侵入性工具，用于研究IS的危险因素，包括帮助追踪椎间盘的早期退变。
{"title":"The use of MRI in the study of patients with idiopathic scoliosis: a systematic review of the literature","authors":"O. M. Sergeenko, D. Savin, Y.V. Molotkov, M. Saifutdinov","doi":"10.14531/ss2022.4.30-39","DOIUrl":"https://doi.org/10.14531/ss2022.4.30-39","url":null,"abstract":"Objective. To analyze the frequency of hidden neuraxial pathology in idiopathic scoliosis (IS), to substantiate the need for MRI in IS and to identify promising areas for the use of MRI in the examination of patients with IS.Material and Methods. The literature review was carried out using the PubMed and Google Scholar databases. Of the 780 papers on the research topic, 65 were selected after removing duplicates and checking for inclusion/exclusion criteria. As a result, 49 original studies were included in the analysis. Level of evidence – II.Results. According to modern literature, the main direction of using MRI in idiopathic scoliosis is the search for predictors of latent pathology of the spinal cord and craniovertebral junction. The frequency of neuraxial pathology in idiopathic scoliosis is 8 % for adolescent IS and 16 % for early IS. The main predictors of neuraxial pathology are male sex, early age of deformity onset, left-sided thoracic curve and thoracic hyperkyphosis. MRI in IS may be a useful addition to radiological diagnostic methods to identify risk factors and to study degenerative changes in the spine.Conclusion. MRI of the spine should be performed in the early stages of IS to detect latent spinal cord tethering. In type I Chiari anomalies, there is a possibility that early neurosurgery can prevent the development of scoliosis. The main signs of latent neuraxial pathology in IS are early progression of spinal deformity, left-sided thoracic curve, male gender and thoracic kyphosis over 40° according to Cobb.MRI can be used as an effective non-invasive tool in research aimed at identifying risk factors for IS, including helping to track early degeneration of intervertebral discs.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114676306","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. Vasilyev, I. V. Shirokikh, I. A. Eliseenko, A. Shershever, V. Stupak
Objective. To analyze clinical and morphological features of neurogenic hourglass tumors in the thoracic spine and their impact on outcomes of treatment through posterior surgical approaches.Material and Methods. The results of surgical treatment of 295 patients with tumors growing from the nerve roots of the thoracic spinal cord were studied. In 63 (21 %) of them, tumors of the spinal nerves were diagnosed. The vast majority of neoplasms were represented by Grade 1 neuromas – in 57 (90 %) patients, Grade 1 neurofibromas were found in 3 (5 %) patients, and High-grade malignant tumors – in 3 (5 %). Intracanal neoplasms were found in 42 (66.7 %) cases and intraextravertebral (hourglass) – in 21 (33.3 %).Results. Microsurgical removal of tumor was performed using two types of low-traumatic surgical approaches: 1) posterior median approach – in 56 (89.0 %) cases, of which hemilaminectomy was performed in 36 (64.4%) cases, interlaminectomy – in 15 (26.8 %) cases, and laminectomy – in 5 (8.1 %) cases; 2) paravertebral approach – in 7 (11.0 %) out of 63 cases with partial facetotomy or facetectomy and resection of part of the head and upper or lower edge of the rib at the same level. Tumors were removed totally in 56 (88.9 %) patients and subtotally – in 7 (11.1%). Intracanal tumors were removed totally in 40 (95.2 %) patients. A similar totality was achieved in removal of 16 (76.2 %) of hourglass neurinomas. Surgical interventions performed in the early postoperative period improved the functional state of patients: the Karnofsky Performance Scale (KPS) index increased from 70–80 to 90 %, the VAS pain score decreased from 5–6 to 2 points. Good clinical outcomes were achieved in 42 (66.7 %) patients, satisfactory – in 17 (27.0 %), and unsatisfactory – in 6 (6.3 %). Twenty nine patients had symptoms of myelopathy, complete regression of which occurred in 3 (10.3 %) cases, partial – in 9 (34.6 %), in 13 (50.0 %) cases they remained at the preoperative level, and in 4 (15.4 %) – worsened.Conclusion. The use of modern neurointroscopy, microsurgical techniques and low-traumatic posterior surgical approaches for resection of tumors of the spinal nerve roots in the thoracic spine provides good clinical outcomes of treatment in the early postoperative period. The existing hourglass tumor in the thoracic spine reduces the likelihood of its total removal when performing a low-traumatic posterior approach.
{"title":"Results of surgical treatment of the thoracic spinal nerve tumors: a retrospective analysis","authors":"I. Vasilyev, I. V. Shirokikh, I. A. Eliseenko, A. Shershever, V. Stupak","doi":"10.14531/ss2022.3.66-76","DOIUrl":"https://doi.org/10.14531/ss2022.3.66-76","url":null,"abstract":"Objective. To analyze clinical and morphological features of neurogenic hourglass tumors in the thoracic spine and their impact on outcomes of treatment through posterior surgical approaches.Material and Methods. The results of surgical treatment of 295 patients with tumors growing from the nerve roots of the thoracic spinal cord were studied. In 63 (21 %) of them, tumors of the spinal nerves were diagnosed. The vast majority of neoplasms were represented by Grade 1 neuromas – in 57 (90 %) patients, Grade 1 neurofibromas were found in 3 (5 %) patients, and High-grade malignant tumors – in 3 (5 %). Intracanal neoplasms were found in 42 (66.7 %) cases and intraextravertebral (hourglass) – in 21 (33.3 %).Results. Microsurgical removal of tumor was performed using two types of low-traumatic surgical approaches: 1) posterior median approach – in 56 (89.0 %) cases, of which hemilaminectomy was performed in 36 (64.4%) cases, interlaminectomy – in 15 (26.8 %) cases, and laminectomy – in 5 (8.1 %) cases; 2) paravertebral approach – in 7 (11.0 %) out of 63 cases with partial facetotomy or facetectomy and resection of part of the head and upper or lower edge of the rib at the same level. Tumors were removed totally in 56 (88.9 %) patients and subtotally – in 7 (11.1%). Intracanal tumors were removed totally in 40 (95.2 %) patients. A similar totality was achieved in removal of 16 (76.2 %) of hourglass neurinomas. Surgical interventions performed in the early postoperative period improved the functional state of patients: the Karnofsky Performance Scale (KPS) index increased from 70–80 to 90 %, the VAS pain score decreased from 5–6 to 2 points. Good clinical outcomes were achieved in 42 (66.7 %) patients, satisfactory – in 17 (27.0 %), and unsatisfactory – in 6 (6.3 %). Twenty nine patients had symptoms of myelopathy, complete regression of which occurred in 3 (10.3 %) cases, partial – in 9 (34.6 %), in 13 (50.0 %) cases they remained at the preoperative level, and in 4 (15.4 %) – worsened.Conclusion. The use of modern neurointroscopy, microsurgical techniques and low-traumatic posterior surgical approaches for resection of tumors of the spinal nerve roots in the thoracic spine provides good clinical outcomes of treatment in the early postoperative period. The existing hourglass tumor in the thoracic spine reduces the likelihood of its total removal when performing a low-traumatic posterior approach.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133779629","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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