D. Klyuchnikov, E. Filatov, I. V. Tyumin, O. Tyumina
Objective. To study the associations of single-nucleotide polymorphisms: rs6570507 in GPR126 gene, rs1800795 in IL-6 gene, rs1800469 in TGFB1 gene, rs731236 in VDR gene, rs625039 and rs11598564 polymorphisms in LBX1 gene, and rs12946942 in SOX9 gene with congenital scoliosis.Material and Methods. The study included 90 patients with verified congenital anomalies of the spine (single and multiple malformations of the spine, ICD-10 Code: Q76.3) and 157 clinically healthy volunteers without diagnosed spinal deformity and without family history of spinal malformations or osteoarticular system diseases. Molecular genetic testing was performed by PCR with real-time registration of a signal from the developed oligonucleotides used to determine rs6570507, rs1800795, rs1800469, rs625039, rs11598564, rs12946942, and rs731236 polymorphisms. Reference sequences were selected from the dbSNP database, and sequence design was performed on the BLAST platform. Data analysis was performed using the R free software computing environment. Data were compared using Pearson’s c2 test, and 95 % confidence interval limits were calculated to assess the significance of OR.Results. Statistically significant association of the G allele and GG genotype of the rs1800795 polymorphism in the interleukin-6 gene with congenital scoliosis was found in group of Russian patients (p < 0.001). No significant association of alleles and genotypes of polymorphic variants of rs6570507, rs1800469, rs625039, rs11598564, rs12946942, and rs731236 with congenital scoliosis was found.Conclusion. The rs1800795 polymorphism can be considered as a promising marker for molecular genetic diagnostics of congenital scoliosis.
{"title":"Analysis of associations of genetic markers with the development of congenital scoliosis","authors":"D. Klyuchnikov, E. Filatov, I. V. Tyumin, O. Tyumina","doi":"10.14531/ss2022.2.33-39","DOIUrl":"https://doi.org/10.14531/ss2022.2.33-39","url":null,"abstract":"Objective. To study the associations of single-nucleotide polymorphisms: rs6570507 in GPR126 gene, rs1800795 in IL-6 gene, rs1800469 in TGFB1 gene, rs731236 in VDR gene, rs625039 and rs11598564 polymorphisms in LBX1 gene, and rs12946942 in SOX9 gene with congenital scoliosis.Material and Methods. The study included 90 patients with verified congenital anomalies of the spine (single and multiple malformations of the spine, ICD-10 Code: Q76.3) and 157 clinically healthy volunteers without diagnosed spinal deformity and without family history of spinal malformations or osteoarticular system diseases. Molecular genetic testing was performed by PCR with real-time registration of a signal from the developed oligonucleotides used to determine rs6570507, rs1800795, rs1800469, rs625039, rs11598564, rs12946942, and rs731236 polymorphisms. Reference sequences were selected from the dbSNP database, and sequence design was performed on the BLAST platform. Data analysis was performed using the R free software computing environment. Data were compared using Pearson’s c2 test, and 95 % confidence interval limits were calculated to assess the significance of OR.Results. Statistically significant association of the G allele and GG genotype of the rs1800795 polymorphism in the interleukin-6 gene with congenital scoliosis was found in group of Russian patients (p < 0.001). No significant association of alleles and genotypes of polymorphic variants of rs6570507, rs1800469, rs625039, rs11598564, rs12946942, and rs731236 with congenital scoliosis was found.Conclusion. The rs1800795 polymorphism can be considered as a promising marker for molecular genetic diagnostics of congenital scoliosis.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122635578","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 role of the functional state of the diaphragm in patients with cervical spinal cord injury at the stages of respiratory support and to substantiate additional criteria for their readiness to transfer to spontaneous breathing.Material and Methods. The state of the diaphragm was assessed by ultrasound in 24 patients with spinal cord injury. The excursion of the diaphragm during quiet breathing, the excursion and thickness of the diaphragm during forced breathing, and the change in forced expiratory volume from the moment of admission till the end of mechanical ventilation were analyzed.Results. On the first day, on the background of mechanical ventilation, there was a significant decrease in the excursion and thickness of the diaphragm during forced breathing (p = 0.002; p = 0.008) which persisted up to 3 days (p < 0.001; p < 0.001); by the fifth day of mechanical ventilation, the indicators increased to the initial levels (p = 0.112; p = 0.433); and by the 10th day they exceeded the initial values (p < 0.001). When comparing the excursion and thickness of the diaphragm during the transfer of patients to spontaneous breathing with the data on their admission, a significant difference was obtained (p < 0.001; p < 0.001). The dynamics of forced expiratory volume indicators was similar to those of diaphragm excursion during forced breathing.Conclusion. A peculiarity of the functional state of the diaphragm in patients with cervical spinal cord injury in the acute period was a significant decrease in diaphragm excursion and the development of ventilator-induced diaphragm dysfunction (VIDD) associated with mechanical ventilation in replacement modes. The tactics of early tracheostomy and the use of auxiliary ventilation modes determined the absence of progression of VIDD during prolonged mechanical ventilation. The presence of a strong correlation between the diaphragm excursion during forced breathing and the forced expiratory volume allows concluding that these indicators can be additional objective criteria for the readiness of patients with cervical SC injury to transfer to spontaneous breathing, since they reflect not only the functional state of the diaphragm, but also the state of the lung tissue.
{"title":"Functional state of the diaphragm in patients with cervical spinal cord injury at the stages of respiratory support","authors":"I. Statsenko, M. Lebedeva, A. V. Palmash","doi":"10.14531/ss2022.2.40-46","DOIUrl":"https://doi.org/10.14531/ss2022.2.40-46","url":null,"abstract":"Objective. To analyze the role of the functional state of the diaphragm in patients with cervical spinal cord injury at the stages of respiratory support and to substantiate additional criteria for their readiness to transfer to spontaneous breathing.Material and Methods. The state of the diaphragm was assessed by ultrasound in 24 patients with spinal cord injury. The excursion of the diaphragm during quiet breathing, the excursion and thickness of the diaphragm during forced breathing, and the change in forced expiratory volume from the moment of admission till the end of mechanical ventilation were analyzed.Results. On the first day, on the background of mechanical ventilation, there was a significant decrease in the excursion and thickness of the diaphragm during forced breathing (p = 0.002; p = 0.008) which persisted up to 3 days (p < 0.001; p < 0.001); by the fifth day of mechanical ventilation, the indicators increased to the initial levels (p = 0.112; p = 0.433); and by the 10th day they exceeded the initial values (p < 0.001). When comparing the excursion and thickness of the diaphragm during the transfer of patients to spontaneous breathing with the data on their admission, a significant difference was obtained (p < 0.001; p < 0.001). The dynamics of forced expiratory volume indicators was similar to those of diaphragm excursion during forced breathing.Conclusion. A peculiarity of the functional state of the diaphragm in patients with cervical spinal cord injury in the acute period was a significant decrease in diaphragm excursion and the development of ventilator-induced diaphragm dysfunction (VIDD) associated with mechanical ventilation in replacement modes. The tactics of early tracheostomy and the use of auxiliary ventilation modes determined the absence of progression of VIDD during prolonged mechanical ventilation. The presence of a strong correlation between the diaphragm excursion during forced breathing and the forced expiratory volume allows concluding that these indicators can be additional objective criteria for the readiness of patients with cervical SC injury to transfer to spontaneous breathing, since they reflect not only the functional state of the diaphragm, but also the state of the lung tissue.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131898495","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 current literature dedicated to the etiopathogenesis and development of idiopathic scoliosis.Material and Methods. The analysis includes studies on the etiological factors of idiopathic scoliosis. The search was carried out on eLibrary, PubMed and Google Scholar databases. The review includes research and experimental studies, as well as systematic reviews and meta-analyses. The exclusion criterion is a theoretical work without practical research/experiment to confirm the theory. The depth of analysis is 30 years.Results. Out of 456 papers on the research topic, 153 were selected as meeting the inclusion/exclusion criteria. The main theories of the occurrence of idiopathic scoliosis are identified: genetic, neurogenic, theory of bone and muscle tissue defects, biomechanical, hormonal, evolutionary, and the theory of environmental and lifestyle influences.Conclusions. The term “idiopathic scoliosis” combines a number of diseases with different etiopathogenetic mechanisms of development. Idiopathic scoliosis has a polygenic inheritance. Different genes are responsible for its occurrence in different populations, and the progression mechanisms are triggered by various epigenetic factors. Bone and muscle tissue defects, pathology of the central nervous system, biomechanical disturbances, hormonal and biochemical abnormalities may play a dominant role in some cases of idiopathic scoliosis.
{"title":"Idiopathic scoliosis as a multifactorial disease: systematic review of current literature","authors":"A. P. Gorbach, O. M. Sergeenko, E. N. Shchurova","doi":"10.14531/ss2022.2.19-32","DOIUrl":"https://doi.org/10.14531/ss2022.2.19-32","url":null,"abstract":"Objective. To analyze the current literature dedicated to the etiopathogenesis and development of idiopathic scoliosis.Material and Methods. The analysis includes studies on the etiological factors of idiopathic scoliosis. The search was carried out on eLibrary, PubMed and Google Scholar databases. The review includes research and experimental studies, as well as systematic reviews and meta-analyses. The exclusion criterion is a theoretical work without practical research/experiment to confirm the theory. The depth of analysis is 30 years.Results. Out of 456 papers on the research topic, 153 were selected as meeting the inclusion/exclusion criteria. The main theories of the occurrence of idiopathic scoliosis are identified: genetic, neurogenic, theory of bone and muscle tissue defects, biomechanical, hormonal, evolutionary, and the theory of environmental and lifestyle influences.Conclusions. The term “idiopathic scoliosis” combines a number of diseases with different etiopathogenetic mechanisms of development. Idiopathic scoliosis has a polygenic inheritance. Different genes are responsible for its occurrence in different populations, and the progression mechanisms are triggered by various epigenetic factors. Bone and muscle tissue defects, pathology of the central nervous system, biomechanical disturbances, hormonal and biochemical abnormalities may play a dominant role in some cases of idiopathic scoliosis.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"99 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128383664","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 known classifications of infectious and inflammatory lesions of the cervical spine using the example of the author’s clinical material.Material and Methods. Data on the results of treatment of 24 patients with lesions of the cervical spine were analyzed. Classifications proposed by groups of authors led by L. Homagk (2016) E. Pola (2017), M. Akbar (2012) and H. Almansour (2020) were used for comparison.Results. Out of 24 patients with osteomyelitis of the cervical spine, monosegmental lesions were observed in 15, polysegmental – in 5, multilevel – in 2, and multilevel polysegmental lesions – in 2 cases. The C5–C6 segment was affected in 70.8 % of cases. Sepsis was diagnosed in 2 (8.3 %) patients. One case was not classified, as there was a lesion of the C1–C2 segment. The total number of neurological deficit was 16 (66.7 %). Twenty (83.3 %) patients were admitted with the acute form of the disease, and 4 (16.7 %) patients with the chronic form. Surgery was performed in 20 (83.3 %) patients. Hospital mortality was 8.3 % (n = 2), 91.7 % (n = 22) of patients recovered. The analysis of the classifications presented above was carried out, and proposals for their use were outlined.Conclusion. «New Classification of Pyogenic Spondylodiscitis» by Pola et al., a modified classification with specification of instability criteria and adaptation of surgical methods of treatment for the cervical spine allows applying it as the main treatment and diagnostic algorithm.
{"title":"Actual tactical classifications of the infectious inflammatory lesions of the cervical spine and their use on the example of a series of 24 cases","authors":"A. Bazarov","doi":"10.14531/ss2022.2.57-66","DOIUrl":"https://doi.org/10.14531/ss2022.2.57-66","url":null,"abstract":"Objective. To analyze the known classifications of infectious and inflammatory lesions of the cervical spine using the example of the author’s clinical material.Material and Methods. Data on the results of treatment of 24 patients with lesions of the cervical spine were analyzed. Classifications proposed by groups of authors led by L. Homagk (2016) E. Pola (2017), M. Akbar (2012) and H. Almansour (2020) were used for comparison.Results. Out of 24 patients with osteomyelitis of the cervical spine, monosegmental lesions were observed in 15, polysegmental – in 5, multilevel – in 2, and multilevel polysegmental lesions – in 2 cases. The C5–C6 segment was affected in 70.8 % of cases. Sepsis was diagnosed in 2 (8.3 %) patients. One case was not classified, as there was a lesion of the C1–C2 segment. The total number of neurological deficit was 16 (66.7 %). Twenty (83.3 %) patients were admitted with the acute form of the disease, and 4 (16.7 %) patients with the chronic form. Surgery was performed in 20 (83.3 %) patients. Hospital mortality was 8.3 % (n = 2), 91.7 % (n = 22) of patients recovered. The analysis of the classifications presented above was carried out, and proposals for their use were outlined.Conclusion. «New Classification of Pyogenic Spondylodiscitis» by Pola et al., a modified classification with specification of instability criteria and adaptation of surgical methods of treatment for the cervical spine allows applying it as the main treatment and diagnostic algorithm.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"52 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125960011","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. V. Kosulin, I. N. Usenko, G. О. Bagaturiya, A. A. Lesovaya, A. O. Egorova
Objective. To analyze immediate results of meningomyelocele closure with simultaneous kyphectomy in newborns.Material and Methods. In two newborns, correction of kyphosis by vertebrectomy and decancellation of the apical vertebral body was performed simultaneously during surgery for meningomyeloceleResults. In both cases, extensive mobilization of soft tissues to close the skin defect was not required, while a significant correction of kyphoticdeformity was noted. The postoperative wound healed by primary intention on days 9–11. The follow-up period was 11 and 8 months.Only 34 such operations in newborns were reported in the literature. All the authors noted the absence of postoperative wound complications typical for meningomyelocele repair without an orthopedic stage. In small series with a long follow-up period there was a gradual loss of correction after such operations, but without the formation of angular kyphosis requiring repeated kyphectomy.Conclusion. Kyphectomy in newborns with meningomyelocele provided the possibility of effective closure of the skin defect and uncomplicated healing of the postoperative wound.
{"title":"Kyphosis correction as an option for surgical treatment of meningomyelocele in a newborn: immediate results of two clinical cases and literature review","authors":"A. V. Kosulin, I. N. Usenko, G. О. Bagaturiya, A. A. Lesovaya, A. O. Egorova","doi":"10.14531/ss2022.2.6-11","DOIUrl":"https://doi.org/10.14531/ss2022.2.6-11","url":null,"abstract":"Objective. To analyze immediate results of meningomyelocele closure with simultaneous kyphectomy in newborns.Material and Methods. In two newborns, correction of kyphosis by vertebrectomy and decancellation of the apical vertebral body was performed simultaneously during surgery for meningomyeloceleResults. In both cases, extensive mobilization of soft tissues to close the skin defect was not required, while a significant correction of kyphoticdeformity was noted. The postoperative wound healed by primary intention on days 9–11. The follow-up period was 11 and 8 months.Only 34 such operations in newborns were reported in the literature. All the authors noted the absence of postoperative wound complications typical for meningomyelocele repair without an orthopedic stage. In small series with a long follow-up period there was a gradual loss of correction after such operations, but without the formation of angular kyphosis requiring repeated kyphectomy.Conclusion. Kyphectomy in newborns with meningomyelocele provided the possibility of effective closure of the skin defect and uncomplicated healing of the postoperative wound.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129487656","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. V. Peleganchuk, E. N. Turgunov, E. A. Mushkachev, A. Sanginov, A. E. Simonovich, V. V. Pavlov
Objective. To analyze the influence of sagittal balance parameters on the risk of dislocations of the head of the femoral component of the hip joint endoprosthesis.Material and Methods. A retrospective analysis of medical records of 113 patients with idiopathic coxarthrosis who underwent unilateral total hip arthroplasty was performed. The study assessed the parameters characterizing the sagittal balance in patients without prosthetic femoral head dislocation in the postoperative period (Group 1; n = 60) and in patients treated for prosthetic femoral head dislocation (Group 2; n = 53). Comparison of indicators was carried out by non-parametric Mann – Whitney U-test, and identification of dislocation predictors – by building single- and multi-factor logistic regression models. Differences were considered statistically significant at the achieved significance level p < 0.05.Results. In Group 1, the type 3 sagittal balance according to Roussouly prevailed (48 %), in Group 2 – types 1, 2 and 4 (75 %). In patients with types 1 and 2 sagittal balance, the dislocations of the prosthetic femoral head occured 1.84 times more often than in patients with type 3, and that in patients with type 4 – 1.66 times more often.Conclusion. Patients with Roussouly type 3 sagittal balance have significantly lower risks of postoperative dislocation of the prosthetic femoral head, as compared with those with types 1, 2 and 4.
{"title":"The influence of spinopelvic relationships on late dislocation of the prosthetic femoral head after total hip arthroplasty","authors":"A. V. Peleganchuk, E. N. Turgunov, E. A. Mushkachev, A. Sanginov, A. E. Simonovich, V. V. Pavlov","doi":"10.14531/ss2022.1.63-70","DOIUrl":"https://doi.org/10.14531/ss2022.1.63-70","url":null,"abstract":"Objective. To analyze the influence of sagittal balance parameters on the risk of dislocations of the head of the femoral component of the hip joint endoprosthesis.Material and Methods. A retrospective analysis of medical records of 113 patients with idiopathic coxarthrosis who underwent unilateral total hip arthroplasty was performed. The study assessed the parameters characterizing the sagittal balance in patients without prosthetic femoral head dislocation in the postoperative period (Group 1; n = 60) and in patients treated for prosthetic femoral head dislocation (Group 2; n = 53). Comparison of indicators was carried out by non-parametric Mann – Whitney U-test, and identification of dislocation predictors – by building single- and multi-factor logistic regression models. Differences were considered statistically significant at the achieved significance level p < 0.05.Results. In Group 1, the type 3 sagittal balance according to Roussouly prevailed (48 %), in Group 2 – types 1, 2 and 4 (75 %). In patients with types 1 and 2 sagittal balance, the dislocations of the prosthetic femoral head occured 1.84 times more often than in patients with type 3, and that in patients with type 4 – 1.66 times more often.Conclusion. Patients with Roussouly type 3 sagittal balance have significantly lower risks of postoperative dislocation of the prosthetic femoral head, as compared with those with types 1, 2 and 4.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121920865","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. A. Chernyadjeva, A. Vasyura, V. Lukinov, V. Novikov
Objective. To conduct a comparative analysis of surgical treatment results for idiopathic thoracic scoliosis in patients during active bone growth and to identify the most effective methods of scoliosis correction for the considered age group.Material and Methods. The results of surgical treatment of 343 patients aged 10–14 years with continued active growth and progressive idiopathic thoracic scoliosis were analyzed. The patients were operated on in 1998–2018 using five surgical techniques: hybrid fixation with and without anterior stage, transpedicular fixation, and laminar fixation with and without anterior stage.Results. Statistically significant deformity progression was observed in patients operated on using laminar (Group IV) and hybrid (Group I) fixation. An additional anterior stage (discectomy and interbody fusion) in combination with laminar fixation (Group V) does not prevent deformity progression after surgery. In patients who underwent hybrid fixation in combination with the anterior stage (Group II) or total transpedicular fixation (Group III), no statistically significant progression of scoliotic deformity was observed in the postoperative period. Patients operated on with total transpedicular fixation (Group III) show improvement in all domains of the SRS-24 questionnaire: no increase in pain throughout the entire follow-up period, higher assessment of appearance after surgery and satisfaction with the treatment result. In groups II and III, there was no negative dynamics of topographic parameters in the long-term period after treatment; the initial correction of the deformity was maintained throughout the entire postoperative follow-up.Conclusion. Total transpedicular fixation provides the best correction of scoliosis in the absence of progression in the long-term postoperative follow-up in children during the period of active bone growth (age 10–14 years). According to the survey data, patients operated on with total transpedicular fixation demonstrate improvement in the following domains: the absence of pain syndrome throughout the entire postoperative follow-up period, the highest assessment of appearance after surgery and satisfaction with the result of surgical treatment. Hybrid fixation in combination with the anterior stage and total transpedicular fixation ensure the absence of negative dynamics of topographic parameters in the long term after surgery with maintenance of the initial surgical correction of spinal deformity.
{"title":"Comparative analysis of the results of surgical correction of idiopathic thoracic scoliosis in patients with active bone growth","authors":"M. A. Chernyadjeva, A. Vasyura, V. Lukinov, V. Novikov","doi":"10.14531/ss2022.1.22-30","DOIUrl":"https://doi.org/10.14531/ss2022.1.22-30","url":null,"abstract":"Objective. To conduct a comparative analysis of surgical treatment results for idiopathic thoracic scoliosis in patients during active bone growth and to identify the most effective methods of scoliosis correction for the considered age group.Material and Methods. The results of surgical treatment of 343 patients aged 10–14 years with continued active growth and progressive idiopathic thoracic scoliosis were analyzed. The patients were operated on in 1998–2018 using five surgical techniques: hybrid fixation with and without anterior stage, transpedicular fixation, and laminar fixation with and without anterior stage.Results. Statistically significant deformity progression was observed in patients operated on using laminar (Group IV) and hybrid (Group I) fixation. An additional anterior stage (discectomy and interbody fusion) in combination with laminar fixation (Group V) does not prevent deformity progression after surgery. In patients who underwent hybrid fixation in combination with the anterior stage (Group II) or total transpedicular fixation (Group III), no statistically significant progression of scoliotic deformity was observed in the postoperative period. Patients operated on with total transpedicular fixation (Group III) show improvement in all domains of the SRS-24 questionnaire: no increase in pain throughout the entire follow-up period, higher assessment of appearance after surgery and satisfaction with the treatment result. In groups II and III, there was no negative dynamics of topographic parameters in the long-term period after treatment; the initial correction of the deformity was maintained throughout the entire postoperative follow-up.Conclusion. Total transpedicular fixation provides the best correction of scoliosis in the absence of progression in the long-term postoperative follow-up in children during the period of active bone growth (age 10–14 years). According to the survey data, patients operated on with total transpedicular fixation demonstrate improvement in the following domains: the absence of pain syndrome throughout the entire postoperative follow-up period, the highest assessment of appearance after surgery and satisfaction with the result of surgical treatment. Hybrid fixation in combination with the anterior stage and total transpedicular fixation ensure the absence of negative dynamics of topographic parameters in the long term after surgery with maintenance of the initial surgical correction of spinal deformity.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128322559","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 clarify a significance of the risk factors for damage to the dura mater (DM) in fractures of the thoracic and lumbar spine.Material and Methods. The study is based on the analysis of examination data and surgical treatment results of 350 patients with spinal cord injury (SCI). Fractures of the thoracic spine were observed in 124 patients, and those of the lumbar spine in 226. The study included 167 operated patients who underwent posterior decompression at the fracture level using laminectomy and transpedicular fixation of the injured spinal motion segment. There were two groups of patients: study group included 55 patients with DM rupture and control one – 112 patients without damage to the DM.Results. Damage to the DM was found in 32.9 % of patients, the rupture was localized on the posterior surface of the dural sac. In patients with rupture of the dura mater, ASIA type A and B neurological disorders were significantly more common (p = 0.00065). The DM damage occurs significantly more often in patients with type C fracture according to the AOSpine classification, with multilevel spinal injuries and combined SCI (Injury Severity Score more than 27.58 ± 9.46 points). The most significant risk factors for the development of DM ruptures are narrowing of the spinal canal at the fracture level by more than 50 %, a fracture of the vertebral arch, an increase in the relative interpedicular distance of more than 20 %, and diastasis between the fragments of the arches by more than 2.5 mm.Conclusion. The damage to the dura mater is a common complication of vertebral fracture. The prediction of dura mater rupture will allow optimizing surgical approach and improving the treatment outcome.
{"title":"Risk factors for damage to the dura mater in thoracic and lumbar spine injury","authors":"A. Martikyan, A. Grin, A. Talypov, S. Arakelyan","doi":"10.14531/ss2022.1.31-38","DOIUrl":"https://doi.org/10.14531/ss2022.1.31-38","url":null,"abstract":"Objective. To clarify a significance of the risk factors for damage to the dura mater (DM) in fractures of the thoracic and lumbar spine.Material and Methods. The study is based on the analysis of examination data and surgical treatment results of 350 patients with spinal cord injury (SCI). Fractures of the thoracic spine were observed in 124 patients, and those of the lumbar spine in 226. The study included 167 operated patients who underwent posterior decompression at the fracture level using laminectomy and transpedicular fixation of the injured spinal motion segment. There were two groups of patients: study group included 55 patients with DM rupture and control one – 112 patients without damage to the DM.Results. Damage to the DM was found in 32.9 % of patients, the rupture was localized on the posterior surface of the dural sac. In patients with rupture of the dura mater, ASIA type A and B neurological disorders were significantly more common (p = 0.00065). The DM damage occurs significantly more often in patients with type C fracture according to the AOSpine classification, with multilevel spinal injuries and combined SCI (Injury Severity Score more than 27.58 ± 9.46 points). The most significant risk factors for the development of DM ruptures are narrowing of the spinal canal at the fracture level by more than 50 %, a fracture of the vertebral arch, an increase in the relative interpedicular distance of more than 20 %, and diastasis between the fragments of the arches by more than 2.5 mm.Conclusion. The damage to the dura mater is a common complication of vertebral fracture. The prediction of dura mater rupture will allow optimizing surgical approach and improving the treatment outcome.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"62 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128950179","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}
S. Gizatullin, A. S. Kristosturov, D. Davydov, A. V. Stanishevsky, A. A. Povetkin
Objective. To analyze clinical outcomes and complication rates of transforaminal and interlaminar endoscopic decompression and open microsurgical operations performed for lumbosacral spinal canal stenosis.Material and Methods. The data of 60 literature sources selected in accordance with the inclusion and exclusion criteria in the PubMed, Science Direct, Google Scholar and Cochrane Library databases were systematized by evaluating diagnostic methods, clinical pictures and surgical treatment of the lumbar spinal canal stenosis. Original studies, case series and reviews containing information on surgical methods for the treatment of spinal stenosis at the lumbar level were analyzed.Results. The complication rate after transforaminal endoscopic decompression (relapses, infectious complications, damage to the dural membrane and spinal roots) does not exceed 2.7 %, which is significantly lower than that in open microsurgical operation (4.8–8.8 %). Endoscopic decompression and reconstruction of the spinal canal demonstrate good clinical outcomes, lower number of bed-days, readmissions, and good economic benefits. When stenosis is combined with instability of the spinal motion segment, performing only a decompressive operation in any volume does not give a significant clinical result, and stabilization surgery is required.Conclusion. The introduction of endoscopic reconstructive surgery for spinal canal stenosis in the lumbosacral spine is associated not only with technical progress and improvement of endoscopic optics, but also with the search for the causes of unsatisfactory results of open operations. Endoscopic interventions showed good clinical outcomes and a decrease in the complication rate. However, the evidence base needs to be expanded due to the lack of randomized trials to compare open decompression and stabilization, and endoscopic reconstructive surgeries in patients with various manifestations of spinal stenosis.
{"title":"Comparison of endoscopic and open methods of surgical treatment for lumbosacral spinal canal stenosis: a systematic literature review","authors":"S. Gizatullin, A. S. Kristosturov, D. Davydov, A. V. Stanishevsky, A. A. Povetkin","doi":"10.14531/ss2022.1.46-55","DOIUrl":"https://doi.org/10.14531/ss2022.1.46-55","url":null,"abstract":"Objective. To analyze clinical outcomes and complication rates of transforaminal and interlaminar endoscopic decompression and open microsurgical operations performed for lumbosacral spinal canal stenosis.Material and Methods. The data of 60 literature sources selected in accordance with the inclusion and exclusion criteria in the PubMed, Science Direct, Google Scholar and Cochrane Library databases were systematized by evaluating diagnostic methods, clinical pictures and surgical treatment of the lumbar spinal canal stenosis. Original studies, case series and reviews containing information on surgical methods for the treatment of spinal stenosis at the lumbar level were analyzed.Results. The complication rate after transforaminal endoscopic decompression (relapses, infectious complications, damage to the dural membrane and spinal roots) does not exceed 2.7 %, which is significantly lower than that in open microsurgical operation (4.8–8.8 %). Endoscopic decompression and reconstruction of the spinal canal demonstrate good clinical outcomes, lower number of bed-days, readmissions, and good economic benefits. When stenosis is combined with instability of the spinal motion segment, performing only a decompressive operation in any volume does not give a significant clinical result, and stabilization surgery is required.Conclusion. The introduction of endoscopic reconstructive surgery for spinal canal stenosis in the lumbosacral spine is associated not only with technical progress and improvement of endoscopic optics, but also with the search for the causes of unsatisfactory results of open operations. Endoscopic interventions showed good clinical outcomes and a decrease in the complication rate. However, the evidence base needs to be expanded due to the lack of randomized trials to compare open decompression and stabilization, and endoscopic reconstructive surgeries in patients with various manifestations of spinal stenosis.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"73 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127358657","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. Basankin, D. Ptashnikov, S. Masevnin, A. Afaunov, A. A. Giulzatyan, K. Takhmazyan
Objective. To conduct a comparative analysis of the effectiveness of various options for the prevention of proximal junctional kyphosis (PJK) in the surgical treatment of adult patients with deformities of the lumbar spine, including taking into account the degree of correction of the lumbar lordosis.Material and Methods. The results of instrumental fixation of the spine performed in 140 adult patients with severe frontal spinal deformity and/or sagittal imbalance corresponding to types III and IV according to Berjano and Lamartina were studied. The patients were divided into 4 clinical groups depending on the methods of surgical treatment: in 36 cases, correction of lumbar lordosis of no more than 30° was performed without the use of PJK prevention methods (Group I); in 24 – the same correction was supplemented with laminar fixation of the vertebra above the fusion zone (Group II); 20 patients underwent complete restoration of the sagittal and frontal balance with prophylactic vertebroplasty of the superjacent vertebra above the zone of instrumental fixation (Group III); and in 60 – the same intervention was performed without the use of the PJK prevention methods (Group IV).Results. Statistically significant differences in lumbar lordosis, difference in the pelvic angle and lumbar lordosis, and displacement of the sagittal vertical axis were found between the pairs of groups I and II, and III and IV. Postoperative values of the index of the proximal junctional angle (PJA) in patients of Group II differed significantly from the corresponding indicators of other groups. A statistically significant increase in the PJA after surgery was found in patients of groups III and IV. There was a statistically significant decrease in PJK cases in Group II in comparison with other groups (p = 0.001), as well as more pronounced trend to decrease in pain intensity and ODI score. Laminar fixation of the superjacent vertebra leads to a decrease in local kyphosis over the area of instrumental fixation and reduces the load on the ventral parts of the vertebra. Prophylactic vertebroplasty (Group III) provides better results compared to a comparable cohort (Group IV).Conclusion. Partial correction of lumbar lordosis (no more than 30°) and preventive laminar fixation of the superjacent vertebra showed significantly better clinical results (by more than 50 %; p = 0.001) compared with the other three clinical groups in terms of reducing the level of pain and improving the quality of life, as well as of decrease in number of cases of PJK development – by 16–28 % (p = 0.001).
{"title":"Efficiency of various options for surgical treatment and prevention of proximal junctional kyphosis in patients with lumbar spine deformities and concomitant osteoporosis","authors":"I. Basankin, D. Ptashnikov, S. Masevnin, A. Afaunov, A. A. Giulzatyan, K. Takhmazyan","doi":"10.14531/ss2022.1.6-14","DOIUrl":"https://doi.org/10.14531/ss2022.1.6-14","url":null,"abstract":"Objective. To conduct a comparative analysis of the effectiveness of various options for the prevention of proximal junctional kyphosis (PJK) in the surgical treatment of adult patients with deformities of the lumbar spine, including taking into account the degree of correction of the lumbar lordosis.Material and Methods. The results of instrumental fixation of the spine performed in 140 adult patients with severe frontal spinal deformity and/or sagittal imbalance corresponding to types III and IV according to Berjano and Lamartina were studied. The patients were divided into 4 clinical groups depending on the methods of surgical treatment: in 36 cases, correction of lumbar lordosis of no more than 30° was performed without the use of PJK prevention methods (Group I); in 24 – the same correction was supplemented with laminar fixation of the vertebra above the fusion zone (Group II); 20 patients underwent complete restoration of the sagittal and frontal balance with prophylactic vertebroplasty of the superjacent vertebra above the zone of instrumental fixation (Group III); and in 60 – the same intervention was performed without the use of the PJK prevention methods (Group IV).Results. Statistically significant differences in lumbar lordosis, difference in the pelvic angle and lumbar lordosis, and displacement of the sagittal vertical axis were found between the pairs of groups I and II, and III and IV. Postoperative values of the index of the proximal junctional angle (PJA) in patients of Group II differed significantly from the corresponding indicators of other groups. A statistically significant increase in the PJA after surgery was found in patients of groups III and IV. There was a statistically significant decrease in PJK cases in Group II in comparison with other groups (p = 0.001), as well as more pronounced trend to decrease in pain intensity and ODI score. Laminar fixation of the superjacent vertebra leads to a decrease in local kyphosis over the area of instrumental fixation and reduces the load on the ventral parts of the vertebra. Prophylactic vertebroplasty (Group III) provides better results compared to a comparable cohort (Group IV).Conclusion. Partial correction of lumbar lordosis (no more than 30°) and preventive laminar fixation of the superjacent vertebra showed significantly better clinical results (by more than 50 %; p = 0.001) compared with the other three clinical groups in terms of reducing the level of pain and improving the quality of life, as well as of decrease in number of cases of PJK development – by 16–28 % (p = 0.001).","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125165377","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：