A. K. Dulaev, D. Kutyanov, S. V. Iskrovskiy, N. Menshova, P. Zhelnov
Objective. To evaluate the composition and content of the recommendatory base for delivery of specialized medical care to patients with spine and spinal cord injury on the territory of the Russian Federation.Material and Methods. The published recommendations specifying the content of the diagnostic, therapeutic, rehabilitation and preventive components of the provision of medical care to patients with spine and spinal cord injury were reviewed. The search for information was carried out in the eLibrary.ru bibliographic resource, documents of the Ministry of Health of the Russian Federation, publications of specialized medical professional non-profit organizations, and other manuals. The depth of information selection was 18 years (since 2003). The review was prepared following the PRISMA-ScR and PRISMA-S guidelines.Results. The current Russian recommendatory base in the field under consideration includes articles in peer-reviewed scientific journals, practical guidelines, regulatory documents and eight clinical guidelines prepared by the Association of Traumatologists and Orthopedists of Russia and by the Association of Neurosurgeons of Russia approved or submitted for approval by the Ministry of Health. A significant degree of cross-use of information has been established, in general covering a wide range of diagnostic, therapeutic, rehabilitation and preventive issues.Conclusion. Most of the Russian recommendations on the provision of medical care to patients with spine and spinal cord injury do not have high strength, are not based on high-certainty evidence, are general in nature, especially in terms of diagnostic and therapeutic tactics, and are created without consideration of the medical care delivery setting. The methodology for their development is reported extremely poorly.
{"title":"Recommendatory base for the delivery of specialized medical care to patients with spine and spinal cord injury in Russia: subject field review","authors":"A. K. Dulaev, D. Kutyanov, S. V. Iskrovskiy, N. Menshova, P. Zhelnov","doi":"10.14531/ss2021.4.41-54","DOIUrl":"https://doi.org/10.14531/ss2021.4.41-54","url":null,"abstract":"Objective. To evaluate the composition and content of the recommendatory base for delivery of specialized medical care to patients with spine and spinal cord injury on the territory of the Russian Federation.Material and Methods. The published recommendations specifying the content of the diagnostic, therapeutic, rehabilitation and preventive components of the provision of medical care to patients with spine and spinal cord injury were reviewed. The search for information was carried out in the eLibrary.ru bibliographic resource, documents of the Ministry of Health of the Russian Federation, publications of specialized medical professional non-profit organizations, and other manuals. The depth of information selection was 18 years (since 2003). The review was prepared following the PRISMA-ScR and PRISMA-S guidelines.Results. The current Russian recommendatory base in the field under consideration includes articles in peer-reviewed scientific journals, practical guidelines, regulatory documents and eight clinical guidelines prepared by the Association of Traumatologists and Orthopedists of Russia and by the Association of Neurosurgeons of Russia approved or submitted for approval by the Ministry of Health. A significant degree of cross-use of information has been established, in general covering a wide range of diagnostic, therapeutic, rehabilitation and preventive issues.Conclusion. Most of the Russian recommendations on the provision of medical care to patients with spine and spinal cord injury do not have high strength, are not based on high-certainty evidence, are general in nature, especially in terms of diagnostic and therapeutic tactics, and are created without consideration of the medical care delivery setting. The methodology for their development is reported extremely poorly.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"113 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":"124691126","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 literature data on the frequency of junctional kyphosis in surgery for Scheuermann’s disease, its relationship withspinopelvic parameters, risk factors and prevention of its development.Material and Methods. A search for sources in Scopus and Web of Science databases revealed 62 articles published from 1975 to 2021 and containing the required information. Of these, 56 publications meet the inclusion criteria.Results. The selected 56 articles contain data on 2,110 patients. In total, 247 (11.8 %) cases of proximal junctional kyphosis were diagnosed, including 6 (0.3 %) cases of proximal junctional failure. The total number of distal junctional kyphosis cases was 124 (5.9 %). Forty-five reoperations were performed. Many potential risk factors have been identified in publications, but there is no consensus on any of them.As a result, there is no a well-founded common position on the prevention of junctional kyphosis development. Spinopelvic parameters in Scheuermann’s disease are significantly less than those in the general population and do not tend to change after surgical correction of kyphosis. As for their relationship with the risk of development of proximal and distal junctional kyphosis, there is no consensus to date.Conclusion. This review is the largest in terms of coverage of literary sources on the problem of the development of junctional kyphosis in surgery for Scheuermann’s disease. The causes for the development of this complication remain unknown, hence there is the lack of generally accepted methods of prevention. New studies with long postoperative follow-up are needed.
目标。目的:分析舒尔曼病手术中结缔性后凸的发生率、与脊柱骨盆参数的关系、危险因素及预防措施。材料和方法。在Scopus和Web of Science数据库中搜索来源，发现从1975年到2021年发表的62篇文章包含了所需的信息。其中56篇符合纳入标准。入选的56篇文章包含2110名患者的数据。共有247例(11.8%)诊断为近端结膜后凸，其中6例(0.3%)为近端结膜衰竭。远端关节后凸124例(5.9%)。再手术45例。许多潜在的危险因素已经在出版物中被确定，但对任何一个都没有达成共识。因此，在预防关节后凸发展方面没有一个有充分根据的共同立场。Scheuermann病患者的脊柱参数明显小于一般人群，并且在手术矫正后不倾向于改变脊柱后凸。至于它们与近端和远端关节后凸发生风险的关系，迄今尚无共识。这篇综述是最大的文献来源覆盖的问题发展的结界后凸在手术治疗舒尔曼病。这种并发症发生的原因尚不清楚，因此缺乏普遍接受的预防方法。需要新的术后长期随访研究。
{"title":"Scheuermann’s disease surgery. Major problems: non-systematic literature review (part II)","authors":"M. Mikhaylovskiy","doi":"10.14531/ss2021.4.28-40","DOIUrl":"https://doi.org/10.14531/ss2021.4.28-40","url":null,"abstract":"Objective. To analyze literature data on the frequency of junctional kyphosis in surgery for Scheuermann’s disease, its relationship withspinopelvic parameters, risk factors and prevention of its development.Material and Methods. A search for sources in Scopus and Web of Science databases revealed 62 articles published from 1975 to 2021 and containing the required information. Of these, 56 publications meet the inclusion criteria.Results. The selected 56 articles contain data on 2,110 patients. In total, 247 (11.8 %) cases of proximal junctional kyphosis were diagnosed, including 6 (0.3 %) cases of proximal junctional failure. The total number of distal junctional kyphosis cases was 124 (5.9 %). Forty-five reoperations were performed. Many potential risk factors have been identified in publications, but there is no consensus on any of them.As a result, there is no a well-founded common position on the prevention of junctional kyphosis development. Spinopelvic parameters in Scheuermann’s disease are significantly less than those in the general population and do not tend to change after surgical correction of kyphosis. As for their relationship with the risk of development of proximal and distal junctional kyphosis, there is no consensus to date.Conclusion. This review is the largest in terms of coverage of literary sources on the problem of the development of junctional kyphosis in surgery for Scheuermann’s disease. The causes for the development of this complication remain unknown, hence there is the lack of generally accepted methods of prevention. New studies with long postoperative follow-up are needed.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129262519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Shapovalov, I. Basankin, A. Afaunov, A. Gulzatyan, K. Takhmazyan, D. A. Tayursky, M. Tomina
Objective. To analyze the results of treatment of patients with implant-associated surgical site infection after decompression and stabilization surgery performed for lumbar spinal stenosis.Material and Methods. Results of treatment of 43 patients with early (up to 90 days after the operation) suppuration of the surgical wound after decompression and stabilization operations for lumbar spinal stenosis were analyzed.Results. A total of 4033 operations for lumbar spinal stenosis with implantation of stabilization systems were performed from 2015 to 2019. There were 43 (1.06 %) cases of early suppuration of the surgical wound with the installed instrumentation. Out of them seven (16.27 %) cases were superficial and 36 (83.78 %) – deep. In all cases, the wound revision, surgical debridement and installation of a vacuum assisted closure (VAC-dressing) were performed. The treatment of superficial suppuration was accompanied by a single installation of a VAC-dressing before wound closure, and in deep suppuration from 2 to 8 (on average 4.10 ± 1.73) VAC-dressings were changed. Wound healing was achieved in all patients within 14–55 (average 29.10 ± 10.06) days. Timely diagnosis of the complication and application of negative pressure therapy allowed arresting the inflammatory process and preserving the implants in all patients with a follow-up period of 12 months.Conclusion. In the case of development of early suppuration of the surgical wound, the patient needs an urgent sanitizing operation. Negative pressure treatment with VAC-dressings is an effective and safe way to relieve this complication. This method combined with etiotropic antibiotic therapy makes it possible to quickly cleanse and heal the wound while preserving the implanted instrumentation.
{"title":"Use of vacuum systems for early implant-associated infection after decompression and stabilization surgery for lumbar spinal stenosis","authors":"V. Shapovalov, I. Basankin, A. Afaunov, A. Gulzatyan, K. Takhmazyan, D. A. Tayursky, M. Tomina","doi":"10.14531/ss2021.3.53-60","DOIUrl":"https://doi.org/10.14531/ss2021.3.53-60","url":null,"abstract":"Objective. To analyze the results of treatment of patients with implant-associated surgical site infection after decompression and stabilization surgery performed for lumbar spinal stenosis.Material and Methods. Results of treatment of 43 patients with early (up to 90 days after the operation) suppuration of the surgical wound after decompression and stabilization operations for lumbar spinal stenosis were analyzed.Results. A total of 4033 operations for lumbar spinal stenosis with implantation of stabilization systems were performed from 2015 to 2019. There were 43 (1.06 %) cases of early suppuration of the surgical wound with the installed instrumentation. Out of them seven (16.27 %) cases were superficial and 36 (83.78 %) – deep. In all cases, the wound revision, surgical debridement and installation of a vacuum assisted closure (VAC-dressing) were performed. The treatment of superficial suppuration was accompanied by a single installation of a VAC-dressing before wound closure, and in deep suppuration from 2 to 8 (on average 4.10 ± 1.73) VAC-dressings were changed. Wound healing was achieved in all patients within 14–55 (average 29.10 ± 10.06) days. Timely diagnosis of the complication and application of negative pressure therapy allowed arresting the inflammatory process and preserving the implants in all patients with a follow-up period of 12 months.Conclusion. In the case of development of early suppuration of the surgical wound, the patient needs an urgent sanitizing operation. Negative pressure treatment with VAC-dressings is an effective and safe way to relieve this complication. This method combined with etiotropic antibiotic therapy makes it possible to quickly cleanse and heal the wound while preserving the implanted instrumentation. ","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116062744","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, K. S. Sergeyev, A. O. Faryon, R. V. Paskov, I. Lebedev
Objective. To analyze lethal outcomes in patients with hematogenous vertebral osteomyelitis.Material and Methods. Study design: retrospective analysis of medical records. A total of 209 medical records of inpatients who underwent treatment for hematogenous vertebral osteomyelitis in 2006–2017 were analyzed. Out of them 68 patients (32.5 %) were treated conservatively, and 141 (67.5 %) – surgically. The risk factors for lethal outcomes were studied for various methods of treatment, and a statistical analysis was performed.Results. Hospital mortality (n = 9) was 4.3 %. In patients who died in hospital, average time for diagnosis making was 4 times less (p = 0.092). The main factors affecting mortality were diabetes mellitus (p = 0.033), type C lesion according to the Pola classification (p = 0.014) and age over 70 years (p = 0.006). To assess the relationship between hospital mortality and the revealed differences between the groups, a regression analysis was performed, which showed that factors associated with mortality were Pola type C.4 lesions (OR 9.73; 95 % CI 1.75–54.20), diabetes mellitus (OR 5.86; 95 % CI 1.14–30.15) and age over 70 years (OR 12.58; 95 % CI 2.50–63.34). The combination of these factors increased the likelihood of hospital mortality (p = 0.001). Sensitivity (77.8 %) and specificity (84.2 %) were calculated using the ROC curve. In the group with mortality, the comorbidity index (CCI) was significantly higher (≥4) than in the group without mortality (p = 0.002). With a CCI of 4 or more, the probability of hospital death increases significantly (OR 10.23; 95 % CI 2.06–50.82), p = 0.005. Long-term mortality was 4.3 % (n = 9), in 77.8 % of cases the cause was acute cardiovascular pathology, and no recurrence of vertebral osteomyelitis was detected.Conclusion. Hospital mortality was 4.3 %, and there was no mortality among patients treated conservatively. The main risk factors were diabetes mellitus, type C lesion according to Pola and age over 70 years. There was a significant mutual burdening of these factors (p = 0.001). With CCI ≥4, the probability of death is higher (p = 0.005).
目标。分析血液性椎体骨髓炎患者的致死结局。材料和方法。研究设计:回顾性分析医疗记录。分析2006-2017年209例住院血液性椎体骨髓炎患者的病历。其中68例(32.5%)采用保守治疗，141例(67.5%)采用手术治疗。研究了不同治疗方法致死性结局的危险因素，并进行了统计分析。住院死亡率(n = 9)为4.3%。住院死亡患者平均诊断时间缩短4倍(p = 0.092)。影响死亡的主要因素为糖尿病(p = 0.033)、Pola分型C型病变(p = 0.014)和年龄≥70岁(p = 0.006)。为了评估住院死亡率与组间差异之间的关系，进行了回归分析，结果显示与死亡率相关的因素是Pola C.4型病变(OR 9.73;95% CI 1.75-54.20)，糖尿病(OR 5.86;95% CI 1.14-30.15)和年龄超过70岁(OR 12.58;95% ci 2.50-63.34)。这些因素的组合增加了住院死亡率的可能性(p = 0.001)。采用ROC曲线计算灵敏度(77.8%)和特异度(84.2%)。死亡率组共病指数(CCI)显著高于无死亡率组(p = 0.002)(≥4)。CCI大于等于4时，住院死亡的概率显著增加(or 10.23;95% CI 2.06 ~ 50.82)， p = 0.005。长期死亡率为4.3% (n = 9)， 77.8%的病例为急性心血管病，未发现椎体骨髓炎复发。住院死亡率为4.3%，保守治疗的患者无死亡率。糖尿病为主要危险因素，Pola为C型病变，年龄大于70岁。这些因素之间存在显著的相互负担(p = 0.001)。CCI≥4时，死亡概率较高(p = 0.005)。
{"title":"Hospital mortality in hematogenous vertebral osteomyelitis","authors":"A. Bazarov, K. S. Sergeyev, A. O. Faryon, R. V. Paskov, I. Lebedev","doi":"10.14531/ss2021.3.86-93","DOIUrl":"https://doi.org/10.14531/ss2021.3.86-93","url":null,"abstract":"Objective. To analyze lethal outcomes in patients with hematogenous vertebral osteomyelitis.Material and Methods. Study design: retrospective analysis of medical records. A total of 209 medical records of inpatients who underwent treatment for hematogenous vertebral osteomyelitis in 2006–2017 were analyzed. Out of them 68 patients (32.5 %) were treated conservatively, and 141 (67.5 %) – surgically. The risk factors for lethal outcomes were studied for various methods of treatment, and a statistical analysis was performed.Results. Hospital mortality (n = 9) was 4.3 %. In patients who died in hospital, average time for diagnosis making was 4 times less (p = 0.092). The main factors affecting mortality were diabetes mellitus (p = 0.033), type C lesion according to the Pola classification (p = 0.014) and age over 70 years (p = 0.006). To assess the relationship between hospital mortality and the revealed differences between the groups, a regression analysis was performed, which showed that factors associated with mortality were Pola type C.4 lesions (OR 9.73; 95 % CI 1.75–54.20), diabetes mellitus (OR 5.86; 95 % CI 1.14–30.15) and age over 70 years (OR 12.58; 95 % CI 2.50–63.34). The combination of these factors increased the likelihood of hospital mortality (p = 0.001). Sensitivity (77.8 %) and specificity (84.2 %) were calculated using the ROC curve. In the group with mortality, the comorbidity index (CCI) was significantly higher (≥4) than in the group without mortality (p = 0.002). With a CCI of 4 or more, the probability of hospital death increases significantly (OR 10.23; 95 % CI 2.06–50.82), p = 0.005. Long-term mortality was 4.3 % (n = 9), in 77.8 % of cases the cause was acute cardiovascular pathology, and no recurrence of vertebral osteomyelitis was detected.Conclusion. Hospital mortality was 4.3 %, and there was no mortality among patients treated conservatively. The main risk factors were diabetes mellitus, type C lesion according to Pola and age over 70 years. There was a significant mutual burdening of these factors (p = 0.001). With CCI ≥4, the probability of death is higher (p = 0.005).","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"94 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127328712","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. Lastevsky, A. Popelyukh, S. Veselov, V. A. Bataev, V. Rerikh
Objective. To study the influence of thoracic inlet angle (TIA) and the fracture of the articular process on the initial strength of the fixation of the spinal segment during its anterior and circular instrumental surgical stabilization in an experiment on a model of the lower cervical spinal segment.Material and Methods. The material of the study was assembled models of C6–C7 spinal segments made using addictive technologies by 3D printing. After preliminary instrumentation, spinal segments were installed on the stand testing machine using specially manufactured equipment. A metered axial load simulating the native one was applied along the axis of the parameters SVA COG–C7 and C2–C7 SVA, which values were close to the value of 20 mm, at a rate of 1 mm/min until the shear strain was reached. The system’s resistance to displacement was measured, and the resulting load was evaluated. Four study groups were formed depending on the modeling of the T1 slope parameter, the integrity of the facets, and the type of instrumentation. Three tests were conducted in each group. The graphical curves were analyzed, and the values of the parameters of the neutral and elastic zones, the yield point, time to yield point, and the value of the applied load for the implementation of shear displacement were recorded. The data were subjected to comparative analysis.Results. In Group 1, anterior shear displacement of the C6 vertebra could not be induced in all series. In groups 2, 3, and 4 a shear displacement of ≥4 mm was noted in all series. In Group 3 where a fracture of the articular process was additionally modeled, the average value of the yield point was 423.5 ± 46.8 N. Elastic zone, the time to the onset of the yield point, the time at the end point or at a shear of C6 ≥4 mm did not differ significantly. In Group 4, a translational displacement of ≥4 mm was observed, though the average yield point was 1536.0 ± 40.0 N.Conclusion. The direction of the load applied to the fixed spinal segment, as well as the presence of damage to the articular processes, play a crucial role in maintaining resistance to shear deformation of the spinal segment during its instrumental stabilization. At high values of TIA (T1 slope) and the presence of fractures of the articular processes, the isolated anterior stabilization is less effective, circular fixation of 360° under these conditions gives a high initial stability to the spinal segment.
{"title":"Biomechanical aspects of the initial stability of instrumental fixation in the treatment of subaxial cervical dislocations: an experimental study","authors":"A. Lastevsky, A. Popelyukh, S. Veselov, V. A. Bataev, V. Rerikh","doi":"10.14531/ss2021.3.43-52","DOIUrl":"https://doi.org/10.14531/ss2021.3.43-52","url":null,"abstract":"Objective. To study the influence of thoracic inlet angle (TIA) and the fracture of the articular process on the initial strength of the fixation of the spinal segment during its anterior and circular instrumental surgical stabilization in an experiment on a model of the lower cervical spinal segment.Material and Methods. The material of the study was assembled models of C6–C7 spinal segments made using addictive technologies by 3D printing. After preliminary instrumentation, spinal segments were installed on the stand testing machine using specially manufactured equipment. A metered axial load simulating the native one was applied along the axis of the parameters SVA COG–C7 and C2–C7 SVA, which values were close to the value of 20 mm, at a rate of 1 mm/min until the shear strain was reached. The system’s resistance to displacement was measured, and the resulting load was evaluated. Four study groups were formed depending on the modeling of the T1 slope parameter, the integrity of the facets, and the type of instrumentation. Three tests were conducted in each group. The graphical curves were analyzed, and the values of the parameters of the neutral and elastic zones, the yield point, time to yield point, and the value of the applied load for the implementation of shear displacement were recorded. The data were subjected to comparative analysis.Results. In Group 1, anterior shear displacement of the C6 vertebra could not be induced in all series. In groups 2, 3, and 4 a shear displacement of ≥4 mm was noted in all series. In Group 3 where a fracture of the articular process was additionally modeled, the average value of the yield point was 423.5 ± 46.8 N. Elastic zone, the time to the onset of the yield point, the time at the end point or at a shear of C6 ≥4 mm did not differ significantly. In Group 4, a translational displacement of ≥4 mm was observed, though the average yield point was 1536.0 ± 40.0 N.Conclusion. The direction of the load applied to the fixed spinal segment, as well as the presence of damage to the articular processes, play a crucial role in maintaining resistance to shear deformation of the spinal segment during its instrumental stabilization. At high values of TIA (T1 slope) and the presence of fractures of the articular processes, the isolated anterior stabilization is less effective, circular fixation of 360° under these conditions gives a high initial stability to the spinal segment.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"122 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115780982","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}
E. V. Kovalev, S. Kirilenko, A. Mazurenko, A. E. Filiustin, V. V. Dubrovsky
Objective. To present a virtual three-dimensional model of pathologically altered segments of the patient’s spine and to analyze the results of its application when planning a surgical intervention in the smartphone-assisted augmented reality.Material and Methods. A three-dimensional modeling of the target area of the intended surgical site was performed based on computed tomography data of five patients with various spinal deformities. A smartphone application has been developed that allows displaying a three-dimensional object of the intended surgical site in the form of augmented reality.Results. The created virtual three-dimensional models were successfully used in five cases for preoperative planning and simulation training before surgery, which allowed to see in detail the anatomical features of the spine, the location of vascular structures when contrasting them, and to plan the direction of the screws. The potential of using augmented reality in clinical practice was demonstrated.Conclusion. The advantages of the smartphone-assisted augmented reality technology for preoperative planning in spine surgery are the simplicity of creating a computer model, the possibility for a surgeon to use a three-dimensional model for orientation in complex anatomical zone at any time of surgery, and the reduction in the risk of technical errors.
{"title":"Smartphone-assisted augmented reality technology for preoperative planning in spine surgery","authors":"E. V. Kovalev, S. Kirilenko, A. Mazurenko, A. E. Filiustin, V. V. Dubrovsky","doi":"10.14531/ss2021.3.94-99","DOIUrl":"https://doi.org/10.14531/ss2021.3.94-99","url":null,"abstract":"Objective. To present a virtual three-dimensional model of pathologically altered segments of the patient’s spine and to analyze the results of its application when planning a surgical intervention in the smartphone-assisted augmented reality.Material and Methods. A three-dimensional modeling of the target area of the intended surgical site was performed based on computed tomography data of five patients with various spinal deformities. A smartphone application has been developed that allows displaying a three-dimensional object of the intended surgical site in the form of augmented reality.Results. The created virtual three-dimensional models were successfully used in five cases for preoperative planning and simulation training before surgery, which allowed to see in detail the anatomical features of the spine, the location of vascular structures when contrasting them, and to plan the direction of the screws. The potential of using augmented reality in clinical practice was demonstrated.Conclusion. The advantages of the smartphone-assisted augmented reality technology for preoperative planning in spine surgery are the simplicity of creating a computer model, the possibility for a surgeon to use a three-dimensional model for orientation in complex anatomical zone at any time of surgery, and the reduction in the risk of technical errors.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"191 Suppl 1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122659040","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. Kolesov, V. Pereverzev, A. Panteleyev, V. V. Shvets, D. Gorbatyuk
Objective. To describe the technique of anterior scoliosis correction in patients with completed growth and to analyze immediate results of its application.Material and Methods. Study design: retrospective clinical series. Level of evidence IV (D). A retrospective analysis of clinical and radiological data of 19 patients aged 13–44 years, who underwent anterior dynamic correction of typical idiopathic scoliosis, was performed. Patients were divided into groups as follows: Group 1 (Lenke type 1 scoliosis) – 8 patients; Group 2 (Lenke 3) – 4 patients; and Group 3 (Lenke 5) – 7 patients. When analyzing clinical and radiological data, the age was taken into account; the deformity magnitude before and after surgery, and correction angle, were studied; and intraoperative blood loss, the number of fixed levels, duration of surgery and hospital stay length were evaluated. The functional status was assessed using the VAS and the SRS-22 questionnaire. Control examinations were carried out before and after surgery as well as at 4–6 weeks and 3, 6, and 12 months after surgery. The search for statistically significant differences was carried out between all groups in pairs: between groups 1 and 2, 2 and 3, and 1 and 3. Statistical analysis was conducted using Mann – Whitney U-test. The SRS-22 and VAS data were processed using the Wilcoxon W-test.Results. The number of dynamically fixed levels varied from 6 to 12. The most proximal level of fixation was T5, the most distal – L4. The average time of surgery was 181 ± 28 minutes for transthoracic access and 198 ± 34 minutes for thoracophrenolumbotomy. The average length of hospital stay was 7.2 ± 1.5 days. In the intergroup comparison of indicators of age, mean angle of deformity before and after surgery, mean angle of correction and blood loss between groups with Lenke 1 and 3 scoliosis, no statistically significant differences were found. Comparison of the same indicators for groups with Lenke 1 and 5 scoliosis showed significant differences in the angles of deformity after surgery and in the number of fixed levels (p = 0.024 and p = 0.006, respectively). There were also no statistical differences between types 1 and 5. At 3 months after surgery the average SRS-22 score for all patients was 4.0 ± 0.42 (from 3.00 to 4.95). The VAS score changed from 6.9 ± 1.5 (4.0–9.0) before surgery to 4.4 ± 1.6 (1.0–7.0) which indicates the effectiveness of the treatment in the short term.Conclusion. Analysis of the immediate results of anterior dynamic correction of Lenke type 1, 3 and 5 scoliotic deformities in physically active young adults showed positive primary effectiveness in terms of VAS and SRS-22, which makes it possible to recommend this technique for use in the presented cohort of patients. The method is effective for all studied types of scoliosis, with a greater efficiency in Lenke types 1 and 5. Further evaluation of long-term results on a larger clinical material will allow developing more precise ind
{"title":"The first experience of anterior dynamic correction of scoliosis in adolescents with complete growth and adults: surgical technique and immediate results","authors":"S. Kolesov, V. Pereverzev, A. Panteleyev, V. V. Shvets, D. Gorbatyuk","doi":"10.14531/ss2021.3.19-29","DOIUrl":"https://doi.org/10.14531/ss2021.3.19-29","url":null,"abstract":"Objective. To describe the technique of anterior scoliosis correction in patients with completed growth and to analyze immediate results of its application.Material and Methods. Study design: retrospective clinical series. Level of evidence IV (D). A retrospective analysis of clinical and radiological data of 19 patients aged 13–44 years, who underwent anterior dynamic correction of typical idiopathic scoliosis, was performed. Patients were divided into groups as follows: Group 1 (Lenke type 1 scoliosis) – 8 patients; Group 2 (Lenke 3) – 4 patients; and Group 3 (Lenke 5) – 7 patients. When analyzing clinical and radiological data, the age was taken into account; the deformity magnitude before and after surgery, and correction angle, were studied; and intraoperative blood loss, the number of fixed levels, duration of surgery and hospital stay length were evaluated. The functional status was assessed using the VAS and the SRS-22 questionnaire. Control examinations were carried out before and after surgery as well as at 4–6 weeks and 3, 6, and 12 months after surgery. The search for statistically significant differences was carried out between all groups in pairs: between groups 1 and 2, 2 and 3, and 1 and 3. Statistical analysis was conducted using Mann – Whitney U-test. The SRS-22 and VAS data were processed using the Wilcoxon W-test.Results. The number of dynamically fixed levels varied from 6 to 12. The most proximal level of fixation was T5, the most distal – L4. The average time of surgery was 181 ± 28 minutes for transthoracic access and 198 ± 34 minutes for thoracophrenolumbotomy. The average length of hospital stay was 7.2 ± 1.5 days. In the intergroup comparison of indicators of age, mean angle of deformity before and after surgery, mean angle of correction and blood loss between groups with Lenke 1 and 3 scoliosis, no statistically significant differences were found. Comparison of the same indicators for groups with Lenke 1 and 5 scoliosis showed significant differences in the angles of deformity after surgery and in the number of fixed levels (p = 0.024 and p = 0.006, respectively). There were also no statistical differences between types 1 and 5. At 3 months after surgery the average SRS-22 score for all patients was 4.0 ± 0.42 (from 3.00 to 4.95). The VAS score changed from 6.9 ± 1.5 (4.0–9.0) before surgery to 4.4 ± 1.6 (1.0–7.0) which indicates the effectiveness of the treatment in the short term.Conclusion. Analysis of the immediate results of anterior dynamic correction of Lenke type 1, 3 and 5 scoliotic deformities in physically active young adults showed positive primary effectiveness in terms of VAS and SRS-22, which makes it possible to recommend this technique for use in the presented cohort of patients. The method is effective for all studied types of scoliosis, with a greater efficiency in Lenke types 1 and 5. Further evaluation of long-term results on a larger clinical material will allow developing more precise ind","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131576923","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. Ptashnikov, S. Magomedov, S. Rominskiy, P. Mytyga
Objective. To carry out a comparative analysis of two methods of the posterior bone block formation (with autograft bone chips or with a whole vertebral arch) and to assess the rate of bone block formation, the degree of surgery invasiveness and the patient-reported cosmetic satisfaction with the results.Material and Methods. The study involved 31 patients with kyphotic deformity of the thoracic spine, of which 15 patients underwent spinal fusion using autograft bone chips (control group), and 16 were operated on using a new technique with a whole vertebral arch. The results of treatment were assessed using a modified MacNab scale. During the follow-up period from 1.5 to 2 years, pain syndrome was assessed according to VAS, quality of life according the Oswestry Disability Index, and cosmetic satisfaction was assessed using the SRS-22 scale.Results. In the course of the work, it was revealed that in patients who were operated on using new method, the time of bone block formation according to CT data was shorter, the overall satisfaction with surgery result was higher (mainly due to the absence of a cosmetic defect), and the indicators of the operation duration and blood loss did not differ compared to those in the control group.Conclusion. Based on the results obtained, spinal fusion using a whole vertebral arch can be recommended in clinical practice for surgical interventions in patients with kyphotic deformities of the spine.
{"title":"Assessment of new method of posterior spinal fusion in the treatment of patients with posttraumatic kyphotic deformity of the thoracic and lumbar spine","authors":"D. Ptashnikov, S. Magomedov, S. Rominskiy, P. Mytyga","doi":"10.14531/ss2021.3.30-35","DOIUrl":"https://doi.org/10.14531/ss2021.3.30-35","url":null,"abstract":"Objective. To carry out a comparative analysis of two methods of the posterior bone block formation (with autograft bone chips or with a whole vertebral arch) and to assess the rate of bone block formation, the degree of surgery invasiveness and the patient-reported cosmetic satisfaction with the results.Material and Methods. The study involved 31 patients with kyphotic deformity of the thoracic spine, of which 15 patients underwent spinal fusion using autograft bone chips (control group), and 16 were operated on using a new technique with a whole vertebral arch. The results of treatment were assessed using a modified MacNab scale. During the follow-up period from 1.5 to 2 years, pain syndrome was assessed according to VAS, quality of life according the Oswestry Disability Index, and cosmetic satisfaction was assessed using the SRS-22 scale.Results. In the course of the work, it was revealed that in patients who were operated on using new method, the time of bone block formation according to CT data was shorter, the overall satisfaction with surgery result was higher (mainly due to the absence of a cosmetic defect), and the indicators of the operation duration and blood loss did not differ compared to those in the control group.Conclusion. Based on the results obtained, spinal fusion using a whole vertebral arch can be recommended in clinical practice for surgical interventions in patients with kyphotic deformities of the spine.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116155436","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 multivariate comparison of two surgical strategies in the treatment of patients with severe Scheuermann’s disease.Material and Methods. The search of sources (in Scopus and Web of Science databases) revealed 56 publications containing the required information. The literature data were analyzed in four directions: the results of one- and two-stage interventions are compared in terms of the magnitude of achieved correction and its preservation, the complication rate, the surgery duration and the volume of intraoperative blood loss, and the quality of life of patients in the postoperative period.Results. The magnitude of the achieved correction of kyphotic deformity and postoperative loss of correction in patients after one- and two-stage operations are almost identical. Implant-associated complications are more often observed after one-stage operations, and purulent, neurological and other complications – after two-stage operations. Surgery duration and intraoperative blood loss volume are greater in two-stage operations. The quality of life assessed by various questionnaires is significantly improved, regardless of the type of surgery.Conclusion. Two-stage surgical correction of Scheuermann’s kyphosis has no noticeable advantages over one-stage surgery, however, new studies with long (more than 15–18 years) postoperative follow-up are needed.
目标。目的:比较两种手术方式治疗严重舒曼氏病的疗效。材料和方法。来源搜索(在Scopus和Web of Science数据库中)显示了56篇包含所需信息的出版物。对文献资料进行四个方面的分析:比较一期和二期干预的结果，包括完成的矫正程度和保存程度、并发症发生率、手术时间和术中出血量、术后患者的生活质量。一期和二期手术患者后凸畸形的矫正程度和术后矫正损失几乎相同。一期手术后更常观察到种植体相关并发症，两期手术后更常观察到化脓性、神经性和其他并发症。两阶段手术的手术时间和术中出血量较大。不论手术类型如何，通过各种问卷评估的生活质量均有显著改善。两期手术矫正Scheuermann后凸与一期手术相比没有明显的优势，但需要进行术后长时间(超过15-18年)随访的新研究。
{"title":"Scheuermann’s disease surgery. Major problems: non-systematic literature review (part I).","authors":"M. Mikhaylovskiy, V. Lukinov","doi":"10.14531/ss2021.3.6-18","DOIUrl":"https://doi.org/10.14531/ss2021.3.6-18","url":null,"abstract":"Objective. To perform multivariate comparison of two surgical strategies in the treatment of patients with severe Scheuermann’s disease.Material and Methods. The search of sources (in Scopus and Web of Science databases) revealed 56 publications containing the required information. The literature data were analyzed in four directions: the results of one- and two-stage interventions are compared in terms of the magnitude of achieved correction and its preservation, the complication rate, the surgery duration and the volume of intraoperative blood loss, and the quality of life of patients in the postoperative period.Results. The magnitude of the achieved correction of kyphotic deformity and postoperative loss of correction in patients after one- and two-stage operations are almost identical. Implant-associated complications are more often observed after one-stage operations, and purulent, neurological and other complications – after two-stage operations. Surgery duration and intraoperative blood loss volume are greater in two-stage operations. The quality of life assessed by various questionnaires is significantly improved, regardless of the type of surgery.Conclusion. Two-stage surgical correction of Scheuermann’s kyphosis has no noticeable advantages over one-stage surgery, however, new studies with long (more than 15–18 years) postoperative follow-up are needed.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114463329","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 : 2021-09-15DOI: 10.14531/ss2021.3.100-110
M. S. Vetrile, A. A. Kuleshov, N. A. Aganesov, V. R. Zakharin
A review of the literature on performing spinopelvic fixation for injuries and various pathologies of the spine and pelvis is presented. The review is analytical in nature and was carried out using databases of medical literature and search resources of PubMed and eLibrary. The following aspects are highlighted: the relevance and indications for performing spinopelvic fixation and its anatomical and biomechanical features. The historical aspects of the development of methods for performing spinopelvic fixation are considered and structured. The analysis of various methods of spinopelvic fixation (using hooks, screw insertion into the S2 sacral wings, L-shaped Luque rods, distractors, transiliac rods, Jackson, Harrington and Galveston techniques) was carried out. The features of surgical techniques, their advantages, disadvantages and complications are considered.
{"title":"Spinopelvic fixation: indications, anatomical and biomechanical aspects and historical development of methods","authors":"M. S. Vetrile, A. A. Kuleshov, N. A. Aganesov, V. R. Zakharin","doi":"10.14531/ss2021.3.100-110","DOIUrl":"https://doi.org/10.14531/ss2021.3.100-110","url":null,"abstract":"A review of the literature on performing spinopelvic fixation for injuries and various pathologies of the spine and pelvis is presented. The review is analytical in nature and was carried out using databases of medical literature and search resources of PubMed and eLibrary. The following aspects are highlighted: the relevance and indications for performing spinopelvic fixation and its anatomical and biomechanical features. The historical aspects of the development of methods for performing spinopelvic fixation are considered and structured. The analysis of various methods of spinopelvic fixation (using hooks, screw insertion into the S2 sacral wings, L-shaped Luque rods, distractors, transiliac rods, Jackson, Harrington and Galveston techniques) was carried out. The features of surgical techniques, their advantages, disadvantages and complications are considered.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131788651","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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