Objective. To analyze significance of the influence of various factors on the fusion rate in patients with isthmic spondylolisthesis.Material and Methods. A retrospective monocenter study included data from 41 patients aged 18 years and older with isthmic spondylolisthesis who underwent transforaminal interbody fusion with cage using a four-screw rigid transpedicular fixation system. The influence of potential risk factors on the fusion rate was studied.Results. A univariate analysis showed that obesity (p = 0.037) and the use of non-steroidal anti-inflammatory drugs (NSAIDs) for more than three months (p = 0.007) significantly affect the formation of a bone block. When compiling a logistic regression model, it was found that a combination of obesity, smoking, and the use of NSAIDs for more than three months significantly worsens the prognosis of bone block formation (p = 0.007; R2N = 0.405; AUC = 0.850).Conclusion. The study showed that the absence of bone block formation in patients with isthmic spondylolisthesis may be associated with smoking, obesity, and the use of NSAIDs for more than three months. Keeping these factors in mind and trying to minimize their presence can help ensure better radiographic outcomes after surgery.
{"title":"Factors affecting the formation of bone block in patients with isthmic spondylolisthesis","authors":"B. R. Kinzyagulov, V. Lebedev, A. Zuev","doi":"10.14531/ss2022.1.39-45","DOIUrl":"https://doi.org/10.14531/ss2022.1.39-45","url":null,"abstract":"Objective. To analyze significance of the influence of various factors on the fusion rate in patients with isthmic spondylolisthesis.Material and Methods. A retrospective monocenter study included data from 41 patients aged 18 years and older with isthmic spondylolisthesis who underwent transforaminal interbody fusion with cage using a four-screw rigid transpedicular fixation system. The influence of potential risk factors on the fusion rate was studied.Results. A univariate analysis showed that obesity (p = 0.037) and the use of non-steroidal anti-inflammatory drugs (NSAIDs) for more than three months (p = 0.007) significantly affect the formation of a bone block. When compiling a logistic regression model, it was found that a combination of obesity, smoking, and the use of NSAIDs for more than three months significantly worsens the prognosis of bone block formation (p = 0.007; R2N = 0.405; AUC = 0.850).Conclusion. The study showed that the absence of bone block formation in patients with isthmic spondylolisthesis may be associated with smoking, obesity, and the use of NSAIDs for more than three months. Keeping these factors in mind and trying to minimize their presence can help ensure better radiographic outcomes after surgery.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"90 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":"133407599","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. Prudnikova, A. Kotelnikov, N. S. Migalkin, G. Filimonova
Objective. To present a clinical case of a patient with spinal deformity associated with myopathy, which was initially undiagnosed and assessed as secondary myopathy after performed spinal surgeries.Material and Methods. Study design: clinical observation and review of the literature. A 51-year-old female patient has been repeatedly operated on for scoliotic deformity of the spine with progressing neurological disorders. Clinical and complex radiological assessment (spinal telemetry in sitting position, CT, MRI) of the pathology was performed. In connection with the atypical course of the disease, a pathohistological study of muscle tissue fragments was performed with their fixation in a solution of 10 % neutral formalin. After histological processing, the fragments were embedded in paraffin and stained with hematoxylin-eosin by the Masson trichromic method and by the PTAH method. The preparations were examined using the Pannoramic MIDI II BF hardware and software complex to obtain digital images using the Whole slide imaging technology in the Single layer and Extended focus modes and an AxioScope.A1 stereomicroscope with a digital camera.Results. Two patterns of distribution of nemaline rods of various density and configuration stained dark blue (by PTAH) were identified in sarcoplasm of parts of muscular tissues: diffusely throughout the myocyte and forming clusters of various sizes in transverse sections, and as filamentous structures – in longitudinal ones. Extensive fields of fatty degeneration, transformation of fibers into lipocytes, contracturely changed fibers, pictures of myophaga and areas of fibrosis of the interstitial space associated with residual myocytes were noted. Intramuscular nervous conductors were subjected to complete involution, singular nervous fibers were deformed, internal space was fibrotic. Neuromuscular spindles had unusually increased connective tissue capsule filled with lipocytes. Arterial vessels had fibrosis of t. adventicia and t. media, narrowed or obliterated lumen, and venous vessels were thin-walled and tortuous, which causes their permeability and can cause hemorrhage. The revealed changes in myocytes with the presence of nemaline rods are characteristic of primary nemaline myopathy.Conclusion. The atypicality of clinical manifestations, primarily of the neurological status in scoliosis, requires excluding neuromuscular disease by conducting a histopathological examination of the surgical material.
目标。提出一例脊柱畸形伴肌病的临床病例，该患者在脊柱手术后最初未被诊断并被评估为继发性肌病。材料和方法。研究设计:临床观察和文献回顾。一名51岁女性患者因脊柱侧凸畸形伴进展性神经系统疾病而多次手术。对病理进行临床和复杂的放射学评估(坐位脊柱遥测、CT、MRI)。与疾病的非典型病程有关，对肌肉组织碎片进行病理组织学研究，并将其固定在10%中性福尔马林溶液中。经组织学处理后，切片包埋于石蜡中，用马松三色法和PTAH法对苏木精-伊红染色。使用Pannoramic MIDI II BF硬件和软件复合体进行检测，使用单层和扩展对焦模式下的全幻灯片成像技术和AxioScope获得数字图像。带数码相机的A1立体显微镜。在部分肌肉组织的肌质中发现了两种不同密度和形态的线状棒的分布模式(通过PTAH):在横切面上弥漫在肌细胞中形成不同大小的簇，在纵向上呈丝状结构。广泛的脂肪变性，纤维转化为脂肪细胞，纤维收缩改变，肌噬和与残留肌细胞相关的间质间隙纤维化的图片被注意到。肌内神经传导完全内陷，单根神经纤维变形，肌内间隙纤维化。神经肌肉纺锤体异常增加，结缔组织囊充满脂肪细胞。动脉血管外膜、中膜支原体纤维化，管腔变窄或闭塞，静脉血管薄壁弯曲，通透性强，可引起出血。随着线状棒的出现，肌细胞的改变是原发性线状棒性肌病的特征。临床表现的非典型性，主要是脊柱侧凸的神经系统状态，需要通过对手术材料进行组织病理学检查来排除神经肌肉疾病。
{"title":"Progressing nemaline myopathy in a patient repeatedly operated on the spine: clinical case and literature review","authors":"O. Prudnikova, A. Kotelnikov, N. S. Migalkin, G. Filimonova","doi":"10.14531/ss2022.1.15-21","DOIUrl":"https://doi.org/10.14531/ss2022.1.15-21","url":null,"abstract":"Objective. To present a clinical case of a patient with spinal deformity associated with myopathy, which was initially undiagnosed and assessed as secondary myopathy after performed spinal surgeries.Material and Methods. Study design: clinical observation and review of the literature. A 51-year-old female patient has been repeatedly operated on for scoliotic deformity of the spine with progressing neurological disorders. Clinical and complex radiological assessment (spinal telemetry in sitting position, CT, MRI) of the pathology was performed. In connection with the atypical course of the disease, a pathohistological study of muscle tissue fragments was performed with their fixation in a solution of 10 % neutral formalin. After histological processing, the fragments were embedded in paraffin and stained with hematoxylin-eosin by the Masson trichromic method and by the PTAH method. The preparations were examined using the Pannoramic MIDI II BF hardware and software complex to obtain digital images using the Whole slide imaging technology in the Single layer and Extended focus modes and an AxioScope.A1 stereomicroscope with a digital camera.Results. Two patterns of distribution of nemaline rods of various density and configuration stained dark blue (by PTAH) were identified in sarcoplasm of parts of muscular tissues: diffusely throughout the myocyte and forming clusters of various sizes in transverse sections, and as filamentous structures – in longitudinal ones. Extensive fields of fatty degeneration, transformation of fibers into lipocytes, contracturely changed fibers, pictures of myophaga and areas of fibrosis of the interstitial space associated with residual myocytes were noted. Intramuscular nervous conductors were subjected to complete involution, singular nervous fibers were deformed, internal space was fibrotic. Neuromuscular spindles had unusually increased connective tissue capsule filled with lipocytes. Arterial vessels had fibrosis of t. adventicia and t. media, narrowed or obliterated lumen, and venous vessels were thin-walled and tortuous, which causes their permeability and can cause hemorrhage. The revealed changes in myocytes with the presence of nemaline rods are characteristic of primary nemaline myopathy.Conclusion. The atypicality of clinical manifestations, primarily of the neurological status in scoliosis, requires excluding neuromuscular disease by conducting a histopathological examination of the surgical material.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"542 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":"116498903","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. Malamashin, A. Mushkin, D. A. Glukhov, V. P. Snishchuk
Objective: to present different variants of the clinical course and surgical treatment of an extremely rare vertebral pathology – enchondromatosis with involvement of the cervical vertebrae in children. Two cases of local and multiple forms of bone dyschondroplasia with damage to the cervical vertebrae, accompanied by orthopedic and neurological complications in children aged 7 and 11, are described. As a result of the operation, complaints were completely stopped in one child and neurological disorders were eliminated in another. The diagnosis was verified histologically. The results were followed up for more than 2 years and 1 year after the operation, respectively. Present-day data on Ollie’s disease in children are presented. Indications, timing and volume of surgical intervention for bone dyschondroplasia are determined individually, depending on the size, location, and number of enchondromas. However, if the cervical spine involvement is complicated by increasing pain and neurological disorders, it is precisely decompression of the spinal cord that should be set as a priority aim of the surgery.
{"title":"Enchondromatosis with cervical spine involvement in children: small series and review","authors":"D. Malamashin, A. Mushkin, D. A. Glukhov, V. P. Snishchuk","doi":"10.14531/ss2022.1.56-62","DOIUrl":"https://doi.org/10.14531/ss2022.1.56-62","url":null,"abstract":"Objective: to present different variants of the clinical course and surgical treatment of an extremely rare vertebral pathology – enchondromatosis with involvement of the cervical vertebrae in children. Two cases of local and multiple forms of bone dyschondroplasia with damage to the cervical vertebrae, accompanied by orthopedic and neurological complications in children aged 7 and 11, are described. As a result of the operation, complaints were completely stopped in one child and neurological disorders were eliminated in another. The diagnosis was verified histologically. The results were followed up for more than 2 years and 1 year after the operation, respectively. Present-day data on Ollie’s disease in children are presented. Indications, timing and volume of surgical intervention for bone dyschondroplasia are determined individually, depending on the size, location, and number of enchondromas. However, if the cervical spine involvement is complicated by increasing pain and neurological disorders, it is precisely decompression of the spinal cord that should be set as a priority aim of the surgery.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"15 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":"115084902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-24DOI: 10.14531/ss2021.4.101-110
M. S. Vetrile, A. Kuleshov, S. N. Makarov, I. N. Lisyansky, N. A. Aganesov, V. R. Zakharin
The paper presents the second part of literature review devoted to modern techniques of spinopelvic fixation for various pathologies of the spine and injuries to the spine and pelvis. The review is non-systematic and was conducted using PubMed and eLibrary databases of medical literature. Modern techniques of spinopelvic fixation using screws installed in the ilium are highlighted, including anatomical and biomechanical features, clinical results of application, as well as the implementation of spinopelvic fixation for tumor lesions of the sacrum, including the use of customized implants and additive technologies. The features of classical installation of iliac screws and installation by the S2AIS technique are considered, and their advantages and disadvantages and possible complications are evaluated.
{"title":"Spinopelvic fixation: modern technical solutions","authors":"M. S. Vetrile, A. Kuleshov, S. N. Makarov, I. N. Lisyansky, N. A. Aganesov, V. R. Zakharin","doi":"10.14531/ss2021.4.101-110","DOIUrl":"https://doi.org/10.14531/ss2021.4.101-110","url":null,"abstract":"The paper presents the second part of literature review devoted to modern techniques of spinopelvic fixation for various pathologies of the spine and injuries to the spine and pelvis. The review is non-systematic and was conducted using PubMed and eLibrary databases of medical literature. Modern techniques of spinopelvic fixation using screws installed in the ilium are highlighted, including anatomical and biomechanical features, clinical results of application, as well as the implementation of spinopelvic fixation for tumor lesions of the sacrum, including the use of customized implants and additive technologies. The features of classical installation of iliac screws and installation by the S2AIS technique are considered, and their advantages and disadvantages and possible complications are evaluated.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"174 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133628334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-24DOI: 10.14531/ss2021.4.111-118
G. Filimonova, N. V. Kubrak, V. Krasnov, S. Ryabykh
Objective. To conduct a morphometric analysis of the soleus muscle of rats after moderate spinal cord contusion injury.Material and Methods. Experiments were performed on female Wistar rats aged 8–12 months, weighing 270–320 g. Animals of the experimental group (n = 25) underwent laminectomy at the T9 level under general anesthesia and modeling of spinal contusion injury of moderate severity. Intact rats constituted the control group (n = 10). Euthanasia was performed on the 5th, 15th, 30th, 60th, 90th, and 180th days of the experiment. Paraffin sections were stained with hematoxylin-eosin and Masson, the diameters of muscle fibers were determined by computer morphometry, and histograms of their distribution were obtained.Results. In the soleus muscle, the signs of reversible reparative processes prevailed in response to neurotrophic damage. It was evidenced by a local increase in the diversity of myocyte diameters and the loss of polygonality of their profiles, focal destruction of muscle fibers, activation of the connective tissue component, disorganization of some intramuscular nerve conductors, and vascular fibrosis of perimysium. Nevertheless, the histostructure of an intact muscle prevailed in the course of the experiment, which was confirmed by the data of morphometric analysis. All histograms of the distribution of the muscle fiber diameters are unimodal with a mode in the range of 30–41 μm. On the 180th day, the maximum myocyte diameters in the histogram of the left limb muscle belonged to the range of 21–30 μm, which was typical for histograms in the intact group.Conclusion. The nature of the plastic reorganization of the soleus muscle when neurotrophic control is impaired indicates compensatory regeneration of muscle tissue by the type of restitution, which opens up the possibility of predicting the rehabilitation period. It is advisable to take this into account when developing medical and social programs and therapeutic measures, where the most important role is played by superficial neuromuscular and functional electrical stimulation.
{"title":"Histomorphometric study of the soleus muscle under conditions of modeling of spinal cord contusion injury: experimental morphological study","authors":"G. Filimonova, N. V. Kubrak, V. Krasnov, S. Ryabykh","doi":"10.14531/ss2021.4.111-118","DOIUrl":"https://doi.org/10.14531/ss2021.4.111-118","url":null,"abstract":"Objective. To conduct a morphometric analysis of the soleus muscle of rats after moderate spinal cord contusion injury.Material and Methods. Experiments were performed on female Wistar rats aged 8–12 months, weighing 270–320 g. Animals of the experimental group (n = 25) underwent laminectomy at the T9 level under general anesthesia and modeling of spinal contusion injury of moderate severity. Intact rats constituted the control group (n = 10). Euthanasia was performed on the 5th, 15th, 30th, 60th, 90th, and 180th days of the experiment. Paraffin sections were stained with hematoxylin-eosin and Masson, the diameters of muscle fibers were determined by computer morphometry, and histograms of their distribution were obtained.Results. In the soleus muscle, the signs of reversible reparative processes prevailed in response to neurotrophic damage. It was evidenced by a local increase in the diversity of myocyte diameters and the loss of polygonality of their profiles, focal destruction of muscle fibers, activation of the connective tissue component, disorganization of some intramuscular nerve conductors, and vascular fibrosis of perimysium. Nevertheless, the histostructure of an intact muscle prevailed in the course of the experiment, which was confirmed by the data of morphometric analysis. All histograms of the distribution of the muscle fiber diameters are unimodal with a mode in the range of 30–41 μm. On the 180th day, the maximum myocyte diameters in the histogram of the left limb muscle belonged to the range of 21–30 μm, which was typical for histograms in the intact group.Conclusion. The nature of the plastic reorganization of the soleus muscle when neurotrophic control is impaired indicates compensatory regeneration of muscle tissue by the type of restitution, which opens up the possibility of predicting the rehabilitation period. It is advisable to take this into account when developing medical and social programs and therapeutic measures, where the most important role is played by superficial neuromuscular and functional electrical stimulation.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127519594","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. Afaunov, N. S. Chaikin, I. Basankin, K. Takhmazyan
Objective of the review was to identify, basing on literature data, the most reliable X-ray and CT signs of damage to the posterior ligamentous complex (PLC) in fractures of the vertebral bodies of the thoracolumbar junction, initially interpreted as type A according to the AOSpine classification. The systematic review was carried out according to the recommendations of PRISMA. The search in PubMed, MEDLINE and Cochrane Library databases revealed 491 articles on relevant issues. Once the inclusion and exclusion criteria have been met, 7 original articles from peer-reviewed scientific journals for the last 10 years were selected for a systematic review, 6 of which were included in the meta-analysis. In all articles, the authors identified two groups of patients: with and without damage to the PLC. The PLC damages were confirmed by MRI and intraoperatively. Radiographic and CT spondylometric parameters were identified, which had statistically significant differences between the groups. To determine predictors of PLC damage, the values of these parameters were subjected to regression analysis. This was followed by a meta-analysis of random and fixed effects models depending on the homogeneity of the data. Statistical heterogeneity was assessed using the X-square test with the null hypothesis of the absence of significant differences in all studies, as well as the heterogeneity index – I2. For the graphical display of the results, forest plots were built. Local kyphosis angle >25°, Cobb angle >16° and difference between interspinous distances >2.54 mm are CT scan predictors of PLC damage. The parameters characterizing the interspinous relationship were studied in no more than two studies, but at the same time they always had statistically significant differences between the groups with and without PLC injuries, therefore, they cannot be ignored during diagnosis. Anterior/posterior vertebral height ratio, anterior vertebral height ratio, sagittal index and suprajacent/subjacent parameters are not the predictors of PLC damage.
{"title":"X-ray and CT scan predictors of damage to the posterior ligamentous complex in fractures of the vertebral bodies of the thoracolumbar junction: systematic review and meta-analysis","authors":"A. Afaunov, N. S. Chaikin, I. Basankin, K. Takhmazyan","doi":"10.14531/ss2021.4.55-67","DOIUrl":"https://doi.org/10.14531/ss2021.4.55-67","url":null,"abstract":"Objective of the review was to identify, basing on literature data, the most reliable X-ray and CT signs of damage to the posterior ligamentous complex (PLC) in fractures of the vertebral bodies of the thoracolumbar junction, initially interpreted as type A according to the AOSpine classification. The systematic review was carried out according to the recommendations of PRISMA. The search in PubMed, MEDLINE and Cochrane Library databases revealed 491 articles on relevant issues. Once the inclusion and exclusion criteria have been met, 7 original articles from peer-reviewed scientific journals for the last 10 years were selected for a systematic review, 6 of which were included in the meta-analysis. In all articles, the authors identified two groups of patients: with and without damage to the PLC. The PLC damages were confirmed by MRI and intraoperatively. Radiographic and CT spondylometric parameters were identified, which had statistically significant differences between the groups. To determine predictors of PLC damage, the values of these parameters were subjected to regression analysis. This was followed by a meta-analysis of random and fixed effects models depending on the homogeneity of the data. Statistical heterogeneity was assessed using the X-square test with the null hypothesis of the absence of significant differences in all studies, as well as the heterogeneity index – I2. For the graphical display of the results, forest plots were built. Local kyphosis angle >25°, Cobb angle >16° and difference between interspinous distances >2.54 mm are CT scan predictors of PLC damage. The parameters characterizing the interspinous relationship were studied in no more than two studies, but at the same time they always had statistically significant differences between the groups with and without PLC injuries, therefore, they cannot be ignored during diagnosis. Anterior/posterior vertebral height ratio, anterior vertebral height ratio, sagittal index and suprajacent/subjacent parameters are not the predictors of PLC damage.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133479287","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. P. Saifullin, A. E. Bokov, A. Aleynik, Y. A. Israelyan, S. Mlyavykh
Objective. To conduct a systematic review of the literature on the use of enhanced recovery after surgery (ERAS) protocols in spinalsurgery of children and adolescents to determine the existing evidence of the effectiveness of ERAS implementation in clinical practice.Material and Methods. The authors conducted a systematic review of the literature on ERAS in spinal and spinal cord surgery in children and adolescents selected in the databases of medical literature and search resources of PUBMED/MEDLINE, Google Scholar, Cochrane Library and eLibrary according to the PRISMA guidelines and the PICOS inclusion and exclusion criteria.Results. A total of 12 publications containing information on the treatment of 2,145 children, whose average age was 14.0 years (from 7.2 to 16.1), were analyzed. In the reviewed publications, the average number of key elements of the ERAS program was 9 (from 2 to 20), and a total of 23 elements used in spinal surgery in children and adolescents were identified. The most commonly used elements were preoperative education and counseling, prevention of infectious complications and intestinal obstruction, multimodal analgesia, refusal of routine use of drains, nasogastric probes and urinary catheters, standardized anesthesia protocol, early mobilization and enteral loading. The introduction of the ERAS protocol into clinical practice allowed to reduce the complication rate in comparison with the control group by 8.2 %(from 2 to 19 %), the volume of blood loss by 230 ml (from 75 to 427 ml), the operation time by 83 minutes (from 23 to 144 minutes), theduration of hospitalization by 1.5 days (from 0.5 to 3 days) and the total cost of treatment by 2258.5 dollars (from 860 to 5280 dollars).The ERAS program was implemented in pediatric clinics in the USA (75 %), France (8 %) and Canada (17 %).Conclusion. The conducted systematic review of the literature allows us to conclude that the technology of enhanced recovery after surgery is a promising technology that improves surgical outcomes and is applicable in pediatric practice. There is a significant shortage of published studies evaluating the implementation of ERAS in pediatric surgical practice in general, and in spinal surgery in particular, which requires further prospective randomized studies to evaluate ERAS in spinal surgery in children and adolescents.
{"title":"Enhanced recovery after surgery in pediatric spine surgery: systematic review","authors":"A. P. Saifullin, A. E. Bokov, A. Aleynik, Y. A. Israelyan, S. Mlyavykh","doi":"10.14531/ss2021.4.6-27","DOIUrl":"https://doi.org/10.14531/ss2021.4.6-27","url":null,"abstract":"Objective. To conduct a systematic review of the literature on the use of enhanced recovery after surgery (ERAS) protocols in spinalsurgery of children and adolescents to determine the existing evidence of the effectiveness of ERAS implementation in clinical practice.Material and Methods. The authors conducted a systematic review of the literature on ERAS in spinal and spinal cord surgery in children and adolescents selected in the databases of medical literature and search resources of PUBMED/MEDLINE, Google Scholar, Cochrane Library and eLibrary according to the PRISMA guidelines and the PICOS inclusion and exclusion criteria.Results. A total of 12 publications containing information on the treatment of 2,145 children, whose average age was 14.0 years (from 7.2 to 16.1), were analyzed. In the reviewed publications, the average number of key elements of the ERAS program was 9 (from 2 to 20), and a total of 23 elements used in spinal surgery in children and adolescents were identified. The most commonly used elements were preoperative education and counseling, prevention of infectious complications and intestinal obstruction, multimodal analgesia, refusal of routine use of drains, nasogastric probes and urinary catheters, standardized anesthesia protocol, early mobilization and enteral loading. The introduction of the ERAS protocol into clinical practice allowed to reduce the complication rate in comparison with the control group by 8.2 %(from 2 to 19 %), the volume of blood loss by 230 ml (from 75 to 427 ml), the operation time by 83 minutes (from 23 to 144 minutes), theduration of hospitalization by 1.5 days (from 0.5 to 3 days) and the total cost of treatment by 2258.5 dollars (from 860 to 5280 dollars).The ERAS program was implemented in pediatric clinics in the USA (75 %), France (8 %) and Canada (17 %).Conclusion. The conducted systematic review of the literature allows us to conclude that the technology of enhanced recovery after surgery is a promising technology that improves surgical outcomes and is applicable in pediatric practice. There is a significant shortage of published studies evaluating the implementation of ERAS in pediatric surgical practice in general, and in spinal surgery in particular, which requires further prospective randomized studies to evaluate ERAS in spinal surgery in children and adolescents.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133519739","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. Tararykova, A. A. Fedenko, E. Musaev, A. Valiev, R. M. Kabardaev, K. A. Borzov, Valeria Igorevna Melnikova
Objective. To assess the effect of the combined treatment method including preoperative denosumab therapy on the results of treatment of patients with giant cell tumors of the spine.Material and Methods. A single-center retrospective-prospective study of a series of clinical cases included 15 patients with giant cell tumors of vertebrae. The average follow-up period was 56 months. A total of 11 patients received denosumab therapy according to the following scheme: 120 mg subcutaneously on the 1st, 8th, 15th and 28th days of the first month and then once every 28 days. Surgical options included marginal resection, segmental resection, or en-bloc resection with or without spinal reconstruction/stabilization. In the case of locally advanced and inoperable disease, long-term therapy with denosumab was carried out until the disease progressed or serious adverse events appeared.Results. Thoracic vertebrae were involved in 7 (46.6 %) of 15 cases, lumbar in 4 (26.7 %) and cervical in 4 (26.7 %). Local recurrence rate after surgery alone was 40 % (2/5), average time to recurrence onset was 4.5 months. No relapses were observed after combined treatment performed in four patients. Disease progression during long-term denosumab therapy for inoperable disease recurrence was not recorded (0/7). The average number of denosumab injections before surgery and during long-term therapy was 15 and 24 injections, respectively. Denosumab therapy allows reducing the duration of surgery and the volume of blood loss.Conclusion. Combined therapy of giant cell vertebral tumor allows to reduce the risk of recurrence of the disease, as well as to reduce surgery duration and blood loss. Long-term continuous therapy for inoperable cases allows achieving long-term stabilization of the effect. Due to the rarity of giant cell tumors of the spine, a further prospective recruitment of patients is required to study the efficacy and safety of combined therapies.
{"title":"The role of denosumab in the complex treatment of giant cell tumor of the spine: reducing of local recurrence rate, surgery time and blood loss","authors":"A. Tararykova, A. A. Fedenko, E. Musaev, A. Valiev, R. M. Kabardaev, K. A. Borzov, Valeria Igorevna Melnikova","doi":"10.14531/ss2021.4.81-90","DOIUrl":"https://doi.org/10.14531/ss2021.4.81-90","url":null,"abstract":"Objective. To assess the effect of the combined treatment method including preoperative denosumab therapy on the results of treatment of patients with giant cell tumors of the spine.Material and Methods. A single-center retrospective-prospective study of a series of clinical cases included 15 patients with giant cell tumors of vertebrae. The average follow-up period was 56 months. A total of 11 patients received denosumab therapy according to the following scheme: 120 mg subcutaneously on the 1st, 8th, 15th and 28th days of the first month and then once every 28 days. Surgical options included marginal resection, segmental resection, or en-bloc resection with or without spinal reconstruction/stabilization. In the case of locally advanced and inoperable disease, long-term therapy with denosumab was carried out until the disease progressed or serious adverse events appeared.Results. Thoracic vertebrae were involved in 7 (46.6 %) of 15 cases, lumbar in 4 (26.7 %) and cervical in 4 (26.7 %). Local recurrence rate after surgery alone was 40 % (2/5), average time to recurrence onset was 4.5 months. No relapses were observed after combined treatment performed in four patients. Disease progression during long-term denosumab therapy for inoperable disease recurrence was not recorded (0/7). The average number of denosumab injections before surgery and during long-term therapy was 15 and 24 injections, respectively. Denosumab therapy allows reducing the duration of surgery and the volume of blood loss.Conclusion. Combined therapy of giant cell vertebral tumor allows to reduce the risk of recurrence of the disease, as well as to reduce surgery duration and blood loss. Long-term continuous therapy for inoperable cases allows achieving long-term stabilization of the effect. Due to the rarity of giant cell tumors of the spine, a further prospective recruitment of patients is required to study the efficacy and safety of combined therapies.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129246122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-23DOI: 10.14531/ss2021.4.91-100
I. A. Eliseenko, S. G. Struts, V. Lukinov, V. Stupak
Objective. To assess the significance of clinical factors of extramedullary tumors and new methods of their resection as potential predictors of their recurrence and continued growth.Material and Methods. The long-term results of removal of primary extramedullary tumors in 412 patients operated on in 1998–2014 were analyzed comparing the use of standard methods of microsurgical technique for tumor removal (277 patients) and of those with additional use of neodymium laser radiation (135 patients).Results. The use of laser technologies for resection of extramedullary tumors can significantly reduce the number of their recurrences and continued growth, along with other clinical factors is a significant prognostic indicator in determining the nature of the disease course and can be a predictor of their occurrence. The most reliable clinical factors determining the prognosis of a decrease in the incidence of recurrences and continued growth when using laser techniques of surgical resection were repeated operations (p = 0.002), the presence of ependymomas of the cone and cauda equina (p = 0.017), operations for primary tumors in the thoracic spine (p = 0.039) and extramedullary tumors with Grade I anaplasia (p = 0.007). An increase in the number of these conditions was associated with operations on the cervical spine (p = 0.027), the presence of a tumor with Grade II anaplasia (p = 0.007), and a primary extramedullary tumor involving more than three vertebrae (p = 0.017).Conclusion. The use of the laser is indicated for reoperations when removing neoplasms, that have arisen as a result of recurrence or continued growth of extramedullary tumors of any level and length after removal of primary neoplasms with a Grade I malignancy confirmed by intraoperative cytological examination involving no more than three vertebrae in the thoracic, lumbar and sacral spine and during resection of ependymomas with extramedullary growth.
{"title":"Factors influencing the development of recurrence and continued growth of primary extramedullary tumors removed using Nd:YAG laser","authors":"I. A. Eliseenko, S. G. Struts, V. Lukinov, V. Stupak","doi":"10.14531/ss2021.4.91-100","DOIUrl":"https://doi.org/10.14531/ss2021.4.91-100","url":null,"abstract":"Objective. To assess the significance of clinical factors of extramedullary tumors and new methods of their resection as potential predictors of their recurrence and continued growth.Material and Methods. The long-term results of removal of primary extramedullary tumors in 412 patients operated on in 1998–2014 were analyzed comparing the use of standard methods of microsurgical technique for tumor removal (277 patients) and of those with additional use of neodymium laser radiation (135 patients).Results. The use of laser technologies for resection of extramedullary tumors can significantly reduce the number of their recurrences and continued growth, along with other clinical factors is a significant prognostic indicator in determining the nature of the disease course and can be a predictor of their occurrence. The most reliable clinical factors determining the prognosis of a decrease in the incidence of recurrences and continued growth when using laser techniques of surgical resection were repeated operations (p = 0.002), the presence of ependymomas of the cone and cauda equina (p = 0.017), operations for primary tumors in the thoracic spine (p = 0.039) and extramedullary tumors with Grade I anaplasia (p = 0.007). An increase in the number of these conditions was associated with operations on the cervical spine (p = 0.027), the presence of a tumor with Grade II anaplasia (p = 0.007), and a primary extramedullary tumor involving more than three vertebrae (p = 0.017).Conclusion. The use of the laser is indicated for reoperations when removing neoplasms, that have arisen as a result of recurrence or continued growth of extramedullary tumors of any level and length after removal of primary neoplasms with a Grade I malignancy confirmed by intraoperative cytological examination involving no more than three vertebrae in the thoracic, lumbar and sacral spine and during resection of ependymomas with extramedullary growth.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"60 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124556306","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. Grin, I. Lvov, A. Kordonskiy, N. Konovalov, V. Krylov
Objective. To review the literature on atlanto-occipital dislocation (AOD) in adults to determine the optimal classification, diagnostic method and treatment.Material and Methods. A search was conducted in the PubMed database for the period from 1966 to 2020. The initial search revealed 564 abstracts of articles. A total of 95 studies were selected for a detailed study of the full text, of which 47 studies describing data from 130 patients were included in this review.Results. The paper describes all the available AOD classifications, and discusses their advantages and disadvantages. The clinical picture, features of the diagnosis in published observations of AOD in adults, as well as the applied treatment methods and their results are presented.Conclusion. Atlanto-occipital dislocation is one of the most severe types of injuries of the cervical spine in adults, which is accompanied by damage to the medulla oblongata and gross neurological deficit in 70 % of cases. The sensitivity of radiography for the diagnosis of AOD was 56.3 %. In 18.5 % of patients, its use led to untimely diagnosis and could cause subsequent deterioration. The CT sensitivity was 96.8 %. The most accurate method of AOD verification was to determine the atlanto-occipital interval (100 % sensitivity and specificity). The optimal method of treating victims with AOD is surgical one.
{"title":"Actual concepts of classification, diagnosis and treatment of atlanto-occipital dislocations in adults: non-systematic literature review","authors":"A. Grin, I. Lvov, A. Kordonskiy, N. Konovalov, V. Krylov","doi":"10.14531/ss2021.4.68-80","DOIUrl":"https://doi.org/10.14531/ss2021.4.68-80","url":null,"abstract":"Objective. To review the literature on atlanto-occipital dislocation (AOD) in adults to determine the optimal classification, diagnostic method and treatment.Material and Methods. A search was conducted in the PubMed database for the period from 1966 to 2020. The initial search revealed 564 abstracts of articles. A total of 95 studies were selected for a detailed study of the full text, of which 47 studies describing data from 130 patients were included in this review.Results. The paper describes all the available AOD classifications, and discusses their advantages and disadvantages. The clinical picture, features of the diagnosis in published observations of AOD in adults, as well as the applied treatment methods and their results are presented.Conclusion. Atlanto-occipital dislocation is one of the most severe types of injuries of the cervical spine in adults, which is accompanied by damage to the medulla oblongata and gross neurological deficit in 70 % of cases. The sensitivity of radiography for the diagnosis of AOD was 56.3 %. In 18.5 % of patients, its use led to untimely diagnosis and could cause subsequent deterioration. The CT sensitivity was 96.8 %. The most accurate method of AOD verification was to determine the atlanto-occipital interval (100 % sensitivity and specificity). The optimal method of treating victims with AOD is surgical one.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125856868","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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