Objective. To assess the effect of neodymium laser radiation on the recurrence rate and continued growth of primary extramedullary tumors on the basis of clinical data obtained in the long-term follow-up period in operated patients with extramedullary tumors.Material and Methods. The long-term results of surgical treatment of two groups of patients (n = 412) with primary extramedullary tumors operated on from 1998 to 2014 were studied and systematized. Patients of comparison group (n = 277; 67.2 %) underwent removal of tumors using standard microsurgical techniques, and the neoplasms in patients of the study group (n = 135; 32.8 %) were removed with additionally used neodymium (Nd:YAG) laser.Results. The use of the developed laser technologies for the resection of extramedullary intracanal primary tumors made it possible to reliably reduce the relative number of recurrence and continued growth from 11.1 % to 1.2% compared with patients treated with standard surgery methods. The proportion of recurrences was 3.5 %, all of them were detected only in the group with the classical technique of tumor resection (p <0.01).Conclusion. The use of a neodymium laser as an additional technology to the classical microsurgical resection of extramedullary tumors is effective for the prevention of their recurrence and continued growth.
{"title":"Influence of neodymium laser radiation on the frequency of recurrence and continued growth of extramedullary tumors","authors":"I. A. Eliseenko, S. G. Struts, V. Stupak","doi":"10.14531/ss2021.3.77-85","DOIUrl":"https://doi.org/10.14531/ss2021.3.77-85","url":null,"abstract":"Objective. To assess the effect of neodymium laser radiation on the recurrence rate and continued growth of primary extramedullary tumors on the basis of clinical data obtained in the long-term follow-up period in operated patients with extramedullary tumors.Material and Methods. The long-term results of surgical treatment of two groups of patients (n = 412) with primary extramedullary tumors operated on from 1998 to 2014 were studied and systematized. Patients of comparison group (n = 277; 67.2 %) underwent removal of tumors using standard microsurgical techniques, and the neoplasms in patients of the study group (n = 135; 32.8 %) were removed with additionally used neodymium (Nd:YAG) laser.Results. The use of the developed laser technologies for the resection of extramedullary intracanal primary tumors made it possible to reliably reduce the relative number of recurrence and continued growth from 11.1 % to 1.2% compared with patients treated with standard surgery methods. The proportion of recurrences was 3.5 %, all of them were detected only in the group with the classical technique of tumor resection (p <0.01).Conclusion. The use of a neodymium laser as an additional technology to the classical microsurgical resection of extramedullary tumors is effective for the prevention of their recurrence and continued growth.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"202 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":"115587991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. V. Kosulin, D. V. Elyakin, D. O. Korchagina, N. Lukina, Yu. I. Shibutova, E. Kolesnikova
Objective. To assess the correctness of transpedicular screw insertion in thoracic and lumbar vertebrae using two-level navigation templates for narrow pedicles.Material and Methods. Two-level navigation templates were used in surgical treatment of four patients aged 14–17 years with scoliotic deformity and multiple pedicles of small width (less than 4.35 mm). In each patient, the least favorable zones were selected for implantation using navigation templates. The rest of planned pedicle screws were inserted using free-hand technique. All patients underwent CT scanning postoperatively. Screws inserted to pedicles less than 4.35 mm in width were classified as correctly placed if they did not extend beyond the medial cortical layer by more than 2 mm.Results. Out of 68 pedicles planned for screw placement, 42 were narrower than 4.35 mm. In the pedicles difficult for implantation, 29 screws were inserted using navigation templates and 13 by free-hand technique. Screws classified as correctly placed were 28 from those inserted with navigation templates and 9 from those implanted by free-hand technique. Difference in results of screw placement in narrow pedicles with navigation templates and by free-hand technique was statistically significant (exact Fisher test, p < 0.05).Conclusion. Transpedicular screw placement with two-level navigation templates in narrow pedicles is more correct than insertion by free hand technique.
{"title":"Transpedicular fixation of the spine with two-level navigation templates for narrow pedicles","authors":"A. V. Kosulin, D. V. Elyakin, D. O. Korchagina, N. Lukina, Yu. I. Shibutova, E. Kolesnikova","doi":"10.14531/SS2021.2.26-33","DOIUrl":"https://doi.org/10.14531/SS2021.2.26-33","url":null,"abstract":"Objective. To assess the correctness of transpedicular screw insertion in thoracic and lumbar vertebrae using two-level navigation templates for narrow pedicles.Material and Methods. Two-level navigation templates were used in surgical treatment of four patients aged 14–17 years with scoliotic deformity and multiple pedicles of small width (less than 4.35 mm). In each patient, the least favorable zones were selected for implantation using navigation templates. The rest of planned pedicle screws were inserted using free-hand technique. All patients underwent CT scanning postoperatively. Screws inserted to pedicles less than 4.35 mm in width were classified as correctly placed if they did not extend beyond the medial cortical layer by more than 2 mm.Results. Out of 68 pedicles planned for screw placement, 42 were narrower than 4.35 mm. In the pedicles difficult for implantation, 29 screws were inserted using navigation templates and 13 by free-hand technique. Screws classified as correctly placed were 28 from those inserted with navigation templates and 9 from those implanted by free-hand technique. Difference in results of screw placement in narrow pedicles with navigation templates and by free-hand technique was statistically significant (exact Fisher test, p < 0.05).Conclusion. Transpedicular screw placement with two-level navigation templates in narrow pedicles is more correct than insertion by free hand technique.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127399984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. N. Kravtsov, I. Kruglov, S. D. Mirzametov, A. S. Seleznev, N. P. Alekseyeva, V. A. Manukovskiy, B. V. Gaidar, D. V. Svistov
Objective. To compare the effectiveness of surgical methods for treating patients with recurrent lumbar disc herniation.Material and Methods. The sample consisted of 160 patients operated on in 2014–2019 for recurrent lumbar disc herniation by percutaneous endoscopic discectomy (Group 1), microsurgical discectomy (Group 2), single-level transforaminal interbody fusion (Group 3) and single-level total intervertebral disc replacement (Group 4). The effectiveness of surgical treatment was evaluated using the NRS-11, ODI, and MacNab questionnaires.Results. Assessment of the pain syndrome severity and the vital activity level of patients revealed significant (p < 0.05) differences in favor of total intervertebral disc replacement. Excellent and good outcomes after arthroplasty according to MacNab criteria were noted in all patients in this group. Similar outcomes were reported in 77.5 % (31/40) of patients in the TLIF group, in 75.1 % (24/32) of patients in the percutaneous endoscopic discectomy group and in 72.6 % (45/62) of patients in the microdiscectomy group. The operation time and length of hospital stay were shorter in the endoscopic and microsurgical discectomy groups (p < 0.001). However, the lower incidence of complications and reoperations was observed in groups of posterior interbody fusion and arthroplasty (p > 0.05).Conclusion. Arthroplasty with the M6-L implant expands the possibilities of surgery for recurrent lumbar disc herniation. Total intervertebral disc replacement and posterior interbody fusion for recurrent lumbar disc herniation are more effective in comparison with decompressive operations, which is reflected in the improvement of clinical treatment outcomes, reduction of perioperative complications and frequency of repeated interventions.
{"title":"Evaluation of the effectiveness of surgical methods for the treatment of recurrent lumbar disc herniation: a cohort retrospective study","authors":"M. N. Kravtsov, I. Kruglov, S. D. Mirzametov, A. S. Seleznev, N. P. Alekseyeva, V. A. Manukovskiy, B. V. Gaidar, D. V. Svistov","doi":"10.14531/ss2021.2.34-43","DOIUrl":"https://doi.org/10.14531/ss2021.2.34-43","url":null,"abstract":"Objective. To compare the effectiveness of surgical methods for treating patients with recurrent lumbar disc herniation.Material and Methods. The sample consisted of 160 patients operated on in 2014–2019 for recurrent lumbar disc herniation by percutaneous endoscopic discectomy (Group 1), microsurgical discectomy (Group 2), single-level transforaminal interbody fusion (Group 3) and single-level total intervertebral disc replacement (Group 4). The effectiveness of surgical treatment was evaluated using the NRS-11, ODI, and MacNab questionnaires.Results. Assessment of the pain syndrome severity and the vital activity level of patients revealed significant (p < 0.05) differences in favor of total intervertebral disc replacement. Excellent and good outcomes after arthroplasty according to MacNab criteria were noted in all patients in this group. Similar outcomes were reported in 77.5 % (31/40) of patients in the TLIF group, in 75.1 % (24/32) of patients in the percutaneous endoscopic discectomy group and in 72.6 % (45/62) of patients in the microdiscectomy group. The operation time and length of hospital stay were shorter in the endoscopic and microsurgical discectomy groups (p < 0.001). However, the lower incidence of complications and reoperations was observed in groups of posterior interbody fusion and arthroplasty (p > 0.05).Conclusion. Arthroplasty with the M6-L implant expands the possibilities of surgery for recurrent lumbar disc herniation. Total intervertebral disc replacement and posterior interbody fusion for recurrent lumbar disc herniation are more effective in comparison with decompressive operations, which is reflected in the improvement of clinical treatment outcomes, reduction of perioperative complications and frequency of repeated interventions.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114542372","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}
K. T. Erdyneev, V. Sorokovikov, D. N. Sambuev, V. P. Saganov, P. M. Zherbakhanov
The paper is a review of the current literature data on the use of various materials and drugs for the prevention of the development of postoperative lumbar epidural fibrosis. Literature searches were performed in the Pubmed, Medline, EMBASE, Cochrane Library and eLibrary databases. The formation and growth of fibrous tissue in the epidural space, followed by tissue adhesion to the dura mater, is the leading cause of pain afferentation in the lumbar spine and/or lower extremities. Several molecular and cellular mechanisms play an important role in the pathophysiology of connective tissue formation in the epidural space. An analysis of experimental and clinical studies examining the effectiveness of various materials and drugs is presented. The authors present the current data on new therapeutic approaches to the prevention of postoperative epidural fibrosis. Topical, unresolved issues which necessitate further research on the pathophysiology of epidural fibrosis are indicated.
{"title":"The use of various materials and drugs for the prevention of the development of postoperative lumbar epidural fibrosis: literature review","authors":"K. T. Erdyneev, V. Sorokovikov, D. N. Sambuev, V. P. Saganov, P. M. Zherbakhanov","doi":"10.14531/SS2021.2.83-92","DOIUrl":"https://doi.org/10.14531/SS2021.2.83-92","url":null,"abstract":"The paper is a review of the current literature data on the use of various materials and drugs for the prevention of the development of postoperative lumbar epidural fibrosis. Literature searches were performed in the Pubmed, Medline, EMBASE, Cochrane Library and eLibrary databases. The formation and growth of fibrous tissue in the epidural space, followed by tissue adhesion to the dura mater, is the leading cause of pain afferentation in the lumbar spine and/or lower extremities. Several molecular and cellular mechanisms play an important role in the pathophysiology of connective tissue formation in the epidural space. An analysis of experimental and clinical studies examining the effectiveness of various materials and drugs is presented. The authors present the current data on new therapeutic approaches to the prevention of postoperative epidural fibrosis. Topical, unresolved issues which necessitate further research on the pathophysiology of epidural fibrosis are indicated.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117016264","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}
Neurological symptoms in Scheuermann’s disease are very rare, only a few dozen cases have been described. The main causes of spinal cord compression with the development of neurological symptoms in spinal deformities due to Scheuermann’s disease are compression by the anterior wall of the spinal canal, together with the dorsal leaflet of the dura mater, intervertebral hernia, and extradural bone cyst. The review provides a description of 38 clinical observations found in the literature. Compressing factors can also be spinal epidural lipomatosis and a displaced fragment of the annular apophysis. Scheuermann’s disease can be combined with syringomyelia. The magnitude of the kyphotic deformity does not correlate with the severity of neurological symptoms. Preoperative examination of a patient with Scheuermann’s disease should include methods that allow visualizing the condition of the spinal canal and its contents.
{"title":"Neurological symptoms in Scheuermann’s disease: review of rare clinical observations","authors":"M. Mikhaylovskiy, A. Alshevskaya, V. Stupak","doi":"10.14531/SS2021.2.1-19","DOIUrl":"https://doi.org/10.14531/SS2021.2.1-19","url":null,"abstract":"Neurological symptoms in Scheuermann’s disease are very rare, only a few dozen cases have been described. The main causes of spinal cord compression with the development of neurological symptoms in spinal deformities due to Scheuermann’s disease are compression by the anterior wall of the spinal canal, together with the dorsal leaflet of the dura mater, intervertebral hernia, and extradural bone cyst. The review provides a description of 38 clinical observations found in the literature. Compressing factors can also be spinal epidural lipomatosis and a displaced fragment of the annular apophysis. Scheuermann’s disease can be combined with syringomyelia. The magnitude of the kyphotic deformity does not correlate with the severity of neurological symptoms. Preoperative examination of a patient with Scheuermann’s disease should include methods that allow visualizing the condition of the spinal canal and its contents.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115010419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Gerasimenko, D. Tesakov, S. Makarevich, D. Tesakova, P. A. Bobrik, K. Krivorot, D. G. Satskevich, K. V. Pustavoitau
The experience of using the method of 3D design and prototyping is examplified in a clinical case of surgical treatment of a six-year-old patient with kyphoscoliotic deformity of the spine due to congenital malformation of the L1 vertebra. At the stage of diagnostics and preoperative preparation, a created model of the deformed spine was used in the form of a breadboard variant made according to the data of spiral X-ray CT on a 3D printer from a plastic polymer material. The use of the created model of the deformed spine made it possible to additionally visualize and touch the pathological object in full size, to really assess the anatomical features and parameters of the interested vertebral segments and the altered spinal canal, which provided significant constructive assistance in planning surgical intervention and its immediate technical implementation.
{"title":"3D design and prototyping in surgical treatment of congenital spine deformities in children: the first experience","authors":"M. Gerasimenko, D. Tesakov, S. Makarevich, D. Tesakova, P. A. Bobrik, K. Krivorot, D. G. Satskevich, K. V. Pustavoitau","doi":"10.14531/SS2021.1.24-30","DOIUrl":"https://doi.org/10.14531/SS2021.1.24-30","url":null,"abstract":"The experience of using the method of 3D design and prototyping is examplified in a clinical case of surgical treatment of a six-year-old patient with kyphoscoliotic deformity of the spine due to congenital malformation of the L1 vertebra. At the stage of diagnostics and preoperative preparation, a created model of the deformed spine was used in the form of a breadboard variant made according to the data of spiral X-ray CT on a 3D printer from a plastic polymer material. The use of the created model of the deformed spine made it possible to additionally visualize and touch the pathological object in full size, to really assess the anatomical features and parameters of the interested vertebral segments and the altered spinal canal, which provided significant constructive assistance in planning surgical intervention and its immediate technical implementation.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126095038","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. Buzunov, A. Vasyura, D. N. Dolotin, A. Sergunin, V. Novikov
Objective. To analyze the results of a multimodal approach in intraoperative neurophysiological monitoring during surgical correction of spinal deformities.Material and Methods. The paper describes a variant of intraoperative neurophysiological monitoring of the spinal cord and nerve root functions which was used in the correction of scoliotic deformity of the spine in 138 patients. Surgery was performed in 83 patients aged 10 to 17 years and in 55 patients older than 17 years. The average age of patients was 20.23 ± 8.3 years. There were 41 male and 97 female patients. The primary scoliotic curve was localized in the thoracic spine in 90 cases, in the thoracolumbar spine in 27 cases, and in the lumbar spine in 21 cases.Results. In the early postoperative period, two patients developed neurological deficit, the electrophysiological predictors of which were recorded during intraoperative neurophysiological monitoring. In one case, the deficit gradually regressed completely due to the measures taken by the operating team during surgery; in the second case, a persistent neurological deficit in the form of lower paraplegia persisted, despite the measures taken during the surgical treatment. In other cases, intraoperative neurophysiological monitoring did not reveal any changes in the spinal cord and nerve roots, which in the early postoperative period would lead to the appearance or aggravation of motor deficit.Conclusion. A multimodal approach to intraoperative neurophysiological monitoring provides an operating surgeon with an objective assessment of the state of the spinal cord and nerve roots at any stage of surgery, which allows timely identification and elimination of the causes of their damage, thereby reducing the likelihood of neurological deficit development or aggravation in the postoperative period.
{"title":"A multimodal approach to intraoperative neuromonitoring of the spinal cord during spinal deformity correction","authors":"A. Buzunov, A. Vasyura, D. N. Dolotin, A. Sergunin, V. Novikov","doi":"10.14531/SS2021.1.31-38","DOIUrl":"https://doi.org/10.14531/SS2021.1.31-38","url":null,"abstract":"Objective. To analyze the results of a multimodal approach in intraoperative neurophysiological monitoring during surgical correction of spinal deformities.Material and Methods. The paper describes a variant of intraoperative neurophysiological monitoring of the spinal cord and nerve root functions which was used in the correction of scoliotic deformity of the spine in 138 patients. Surgery was performed in 83 patients aged 10 to 17 years and in 55 patients older than 17 years. The average age of patients was 20.23 ± 8.3 years. There were 41 male and 97 female patients. The primary scoliotic curve was localized in the thoracic spine in 90 cases, in the thoracolumbar spine in 27 cases, and in the lumbar spine in 21 cases.Results. In the early postoperative period, two patients developed neurological deficit, the electrophysiological predictors of which were recorded during intraoperative neurophysiological monitoring. In one case, the deficit gradually regressed completely due to the measures taken by the operating team during surgery; in the second case, a persistent neurological deficit in the form of lower paraplegia persisted, despite the measures taken during the surgical treatment. In other cases, intraoperative neurophysiological monitoring did not reveal any changes in the spinal cord and nerve roots, which in the early postoperative period would lead to the appearance or aggravation of motor deficit.Conclusion. A multimodal approach to intraoperative neurophysiological monitoring provides an operating surgeon with an objective assessment of the state of the spinal cord and nerve roots at any stage of surgery, which allows timely identification and elimination of the causes of their damage, thereby reducing the likelihood of neurological deficit development or aggravation in the postoperative period.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"89 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125457780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I. Basankin, D. Ptashnikov, S. Masevnin, A. Afaunov, A. A. Giulzatyan, K. Takhmazyan
Objective. To analyze the significance of the influence of various risk factors on the development of proximal junctional kyphosis (PJK) and instability of instrumentation.Material and Methods. The results of surgical treatment of 382 patients with scoliotic deformities of the lumbar spine of type I and IIIb according to Aebi were analyzed. Patients were operated on through the posterior approach using the TLIF-PLIF technique with extended rigid transpedicular instrumentation. Potential risk factors influencing the development of proximal junctional kyphosis and instability of instrumentation were analyzed.Results. It was found that only three risk factors significantly affect the development of PJK: correction of lumbar lordosis more than 30° (p = 0.036) increases the likelihood of its development by 1.5 times, osteoporosis (p = 0.001) – by 2.5 times, and proximal junctionalangle ≥10° (p = 0.001) – by 3.5 times. Three factors showed a statistically significant effect on the incidence of instrumentation instability: correction of lumbar lordosis more than 30° (p = 0.034) increases the likelihood of its occurrence by 1.7 times, osteoporosis (p = 0.018) – by 1.8 times, and deviation of the sagittal vertical axis by more than 50 mm (p = 0.001) – by 3.3 times.Conclusion. The most significant risk factors for the occurrence of PJK and instability of instrumentation are osteoporosis, correction of lumbar lordosis more than 30°, an increase in the proximal junctional angle ≥10°, and an anterior deviation of sagittal vertical axis more than 50 mm. Consideration of these factors in the preoperative period, as well as during surgery, can decrease likelihood of the occurrence of PJK and instability of instrumentation.
{"title":"Significance of various risk factors for proximal junctional kyphosis and instability of instrumentation in surgical treatment for adult spinal deformities","authors":"I. Basankin, D. Ptashnikov, S. Masevnin, A. Afaunov, A. A. Giulzatyan, K. Takhmazyan","doi":"10.14531/SS2021.1.14-23","DOIUrl":"https://doi.org/10.14531/SS2021.1.14-23","url":null,"abstract":"Objective. To analyze the significance of the influence of various risk factors on the development of proximal junctional kyphosis (PJK) and instability of instrumentation.Material and Methods. The results of surgical treatment of 382 patients with scoliotic deformities of the lumbar spine of type I and IIIb according to Aebi were analyzed. Patients were operated on through the posterior approach using the TLIF-PLIF technique with extended rigid transpedicular instrumentation. Potential risk factors influencing the development of proximal junctional kyphosis and instability of instrumentation were analyzed.Results. It was found that only three risk factors significantly affect the development of PJK: correction of lumbar lordosis more than 30° (p = 0.036) increases the likelihood of its development by 1.5 times, osteoporosis (p = 0.001) – by 2.5 times, and proximal junctionalangle ≥10° (p = 0.001) – by 3.5 times. Three factors showed a statistically significant effect on the incidence of instrumentation instability: correction of lumbar lordosis more than 30° (p = 0.034) increases the likelihood of its occurrence by 1.7 times, osteoporosis (p = 0.018) – by 1.8 times, and deviation of the sagittal vertical axis by more than 50 mm (p = 0.001) – by 3.3 times.Conclusion. The most significant risk factors for the occurrence of PJK and instability of instrumentation are osteoporosis, correction of lumbar lordosis more than 30°, an increase in the proximal junctional angle ≥10°, and an anterior deviation of sagittal vertical axis more than 50 mm. Consideration of these factors in the preoperative period, as well as during surgery, can decrease likelihood of the occurrence of PJK and instability of instrumentation.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116224979","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. Petrova, O. Agranovich, M. Savina, E. L. Gabbasova, V. P. Snishchuk, A. Mushkin
Klippel-Feil syndrome is a congenital malformation, the leading component of which is a violation of segmentation of the cervical vertebral bodies. The syndrome can be combined with other skeletal anomalies: skull asymmetry, scoliosis, high shoulder blades, and cervical ribs. Treatment of the syndrome is usually symptomatic; indications for surgical treatment are progressive neurological disorders and persistent pain syndrome, which usually develop due to instability of unblocked segments, or neurogenic pain. A clinical case of treatment of a 17-year-old patient with Klippel-Feil syndrome who developed a picture of severe upper limb monoparesis during three years due to compression of the brachial plexus associated with cervical ribs is presented. Decompression of the brachial plexus was performed, which led to rapid relief of pain syndrome and gradual partial regression of motor disorders. Due to incomplete restoration of the gripping function, tendon-muscle plasty of the right hand was performed, which significantly improved the possibility of self-care. The results of radiation and staged neurophysiological studies are described, as well as a review of the literature on the Klippel-Feil syndrome.
{"title":"Staged surgical treatment of brachioplexopathy in an adolescent with Klippel-Feil syndrome: a rare clinical case and literature review","authors":"E. Petrova, O. Agranovich, M. Savina, E. L. Gabbasova, V. P. Snishchuk, A. Mushkin","doi":"10.14531/SS2021.1.6-13","DOIUrl":"https://doi.org/10.14531/SS2021.1.6-13","url":null,"abstract":"Klippel-Feil syndrome is a congenital malformation, the leading component of which is a violation of segmentation of the cervical vertebral bodies. The syndrome can be combined with other skeletal anomalies: skull asymmetry, scoliosis, high shoulder blades, and cervical ribs. Treatment of the syndrome is usually symptomatic; indications for surgical treatment are progressive neurological disorders and persistent pain syndrome, which usually develop due to instability of unblocked segments, or neurogenic pain. A clinical case of treatment of a 17-year-old patient with Klippel-Feil syndrome who developed a picture of severe upper limb monoparesis during three years due to compression of the brachial plexus associated with cervical ribs is presented. Decompression of the brachial plexus was performed, which led to rapid relief of pain syndrome and gradual partial regression of motor disorders. Due to incomplete restoration of the gripping function, tendon-muscle plasty of the right hand was performed, which significantly improved the possibility of self-care. The results of radiation and staged neurophysiological studies are described, as well as a review of the literature on the Klippel-Feil syndrome.","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125541781","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. M. Meredzhi, A. Orlov, A. Nazarov, Y. Belyakov, T. V. Lalayan, S. B. Singaevskiy
Objective. To evaluate clinical outcomes, safety, and technical peculiarities of percutaneous endoscopic transforaminal and interlaminar removal of the lumber spine cranially migrated disc hernias. Material and Methods. In 2015–2018, percutaneous endoscopic transforaminal and interlaminar removal of cranially migrated hernias of the lumbar spine was performed in 53 patients (23 men and 30 women): 2 (3.8 %) at L2–L3 level, 13 (24.5 %) at L3–L4, 18 (34.0 %) at L4–L5, and 20 (37.7 %) at L5–S1. The age of patients ranged from 25 to 76 years and averaged 43.4 ± 11.6 years. Transforaminal approach was performed at the L4–L5 level and higher (62.3 % of cases), and interlaminar approach – at the L5–S1 level (37.7 %). Based on MRI, hernias with cranial migration were divided into zones: zone I – hernias with migration to the lower edge of the superjacent vertebra pedicle – 21 (39.6 %) patients; and zone II – hernias with migration above this border – 32 (60.4 %). Results were evaluated using ODI, VAS, and the McNab scale. Statistical analysis of VAS indicators (leg and back pain) and ODI scores before and after surgery was performed using the R and Microsoft Excel 2007 software. Results. Data collection was carried out using patient questionnaires at in-person examination, telephone interviews and electronic communications. Follow-up data of different terms were monitored in all patients. In one case (when mastering this technology), at the second stage, microdiscectomy was performed at the L4–L5 level for a residual hernia fragment in migration zone II, and in another case, a conversion into microdiscectomy was performed at L3–L4 level with a hernia in zone II due to lack of venous bleeding control in a patient receiving anticoagulants. In other patients, the mean VAS scores of preoperative radicular and axial pain decreased from 7.5 ± 1.4 and 3.8 ± 1.2 to 1.4 ± 1.2 and 3.5 ± 1.3, respectively, on the next day, to 1.7 ± 1.4 and 3.2 ± 1.1 in 1 month, to 1.5 ± 1.3 and 2.8 ± 1.4 in 6 months, to 1.6 ± 1.2 and 2.0 ± 1.3 in 12 months, and to 1.6 ± 1.2 and 2.0 ± 1.3 in 24 months after surgery. In the long-term follow-up period, no radicular leg pain was observed in any patient. According to the McNab scale, up to 6 months treatment results were assessed as excellent by 19 (35.8 %) patients, and as good – by 32 (60.3 %). In the case of lumbar pain in the long term period, blockade of facet joints and radiofrequency ablation of the medial nerve branch were performed. Relapse of hernias and instability of the operated spinal segment were not revealed. The average ODI score improved from 66.4 ± 7.2 to 20.5 ± 3.2 in 1 month, to 13.6 ± 2.1 in 6 months, to 12.4 ± 2.3 in 12 months, and to 12.4 ± 2.3 in 24 months after surgery. Conclusion. Percutaneous endoscopic transforaminal and interlaminar discectomy for cranially migrated lumbar disc hernia, while adhering the surgical technique target and exclusion criteria, is a safe and effective method, avoids excessive resect
{"title":"Percutaneous endoscopic transforaminal and interlaminar lumbar discectomy for cranially migrated disc hernia","authors":"A. M. Meredzhi, A. Orlov, A. Nazarov, Y. Belyakov, T. V. Lalayan, S. B. Singaevskiy","doi":"10.14531/ss2020.3.81-90","DOIUrl":"https://doi.org/10.14531/ss2020.3.81-90","url":null,"abstract":"Objective. To evaluate clinical outcomes, safety, and technical peculiarities of percutaneous endoscopic transforaminal and interlaminar removal of the lumber spine cranially migrated disc hernias. Material and Methods. In 2015–2018, percutaneous endoscopic transforaminal and interlaminar removal of cranially migrated hernias of the lumbar spine was performed in 53 patients (23 men and 30 women): 2 (3.8 %) at L2–L3 level, 13 (24.5 %) at L3–L4, 18 (34.0 %) at L4–L5, and 20 (37.7 %) at L5–S1. The age of patients ranged from 25 to 76 years and averaged 43.4 ± 11.6 years. Transforaminal approach was performed at the L4–L5 level and higher (62.3 % of cases), and interlaminar approach – at the L5–S1 level (37.7 %). Based on MRI, hernias with cranial migration were divided into zones: zone I – hernias with migration to the lower edge of the superjacent vertebra pedicle – 21 (39.6 %) patients; and zone II – hernias with migration above this border – 32 (60.4 %). Results were evaluated using ODI, VAS, and the McNab scale. Statistical analysis of VAS indicators (leg and back pain) and ODI scores before and after surgery was performed using the R and Microsoft Excel 2007 software. Results. Data collection was carried out using patient questionnaires at in-person examination, telephone interviews and electronic communications. Follow-up data of different terms were monitored in all patients. In one case (when mastering this technology), at the second stage, microdiscectomy was performed at the L4–L5 level for a residual hernia fragment in migration zone II, and in another case, a conversion into microdiscectomy was performed at L3–L4 level with a hernia in zone II due to lack of venous bleeding control in a patient receiving anticoagulants. In other patients, the mean VAS scores of preoperative radicular and axial pain decreased from 7.5 ± 1.4 and 3.8 ± 1.2 to 1.4 ± 1.2 and 3.5 ± 1.3, respectively, on the next day, to 1.7 ± 1.4 and 3.2 ± 1.1 in 1 month, to 1.5 ± 1.3 and 2.8 ± 1.4 in 6 months, to 1.6 ± 1.2 and 2.0 ± 1.3 in 12 months, and to 1.6 ± 1.2 and 2.0 ± 1.3 in 24 months after surgery. In the long-term follow-up period, no radicular leg pain was observed in any patient. According to the McNab scale, up to 6 months treatment results were assessed as excellent by 19 (35.8 %) patients, and as good – by 32 (60.3 %). In the case of lumbar pain in the long term period, blockade of facet joints and radiofrequency ablation of the medial nerve branch were performed. Relapse of hernias and instability of the operated spinal segment were not revealed. The average ODI score improved from 66.4 ± 7.2 to 20.5 ± 3.2 in 1 month, to 13.6 ± 2.1 in 6 months, to 12.4 ± 2.3 in 12 months, and to 12.4 ± 2.3 in 24 months after surgery. Conclusion. Percutaneous endoscopic transforaminal and interlaminar discectomy for cranially migrated lumbar disc hernia, while adhering the surgical technique target and exclusion criteria, is a safe and effective method, avoids excessive resect","PeriodicalId":337711,"journal":{"name":"Hirurgiâ pozvonočnika (Spine Surgery)","volume":"353 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134229478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：