Aleksandr Igorevich Gorbunov, Mikhail Aleksandrovich Mushkin, Diana Airatovna Kaumova, Alexandr Nikolaevich Muraviev, Andrey Igorevich Gorelov, Nadezhda Valerievna Orlova, Anna Andreevna Gorelova
Objective. To study the relationship between clinical and radiation variants of myelopathy and types of the neurogenic dysfunction of the lower urinary tract in patients with infectious spondylitis. Material and Methods. A single-center cohort observational study was conducted with the analysis of medical records and a prospective examination of 20 patients with infectious spondylitis complicated by neurogenic dysfunction of the lower urinary tract. Results. Infectious spondylitis can be complicated by the development of various urodynamic disorders, including neurogenic detrusor hyperactivity (30 %), its combination with detrusor-sphincter dissinergia (30 %) and a decrease in detrusor contractility (40 %). In 50 % of patients, an urodynamic examination revealed an increase in detrusor pressure of more than 40 cm water. There was no connection between the development of any type of lower urinary tract dysfunction and MRI types of myelopathy according to Vendatam, as well as between the level of spinal cord compression and the severity of neurological disorders according to AIS. Conclusion. The results of the study do not confirm the existence of a relationship between the various characteristics of myelopathy in infectious spondylitis and the results of urodynamic examination. The limitation of the reliability of the results is the small number of observations. Studies with a larger sample are required to assess the relationship between the clinical and radiation characteristics of myelopathy and variants of neurogenic dysfunction of the lower urinary tract in patients with infectious spondylitis.
{"title":"Neurogenic dysfunction of the lower urinary tract in infectious and inflammatory diseases of the spine: is there a correlation with clinical and radiological variants of myelopathy? Preliminary result of the analysis of a single-center cohort","authors":"Aleksandr Igorevich Gorbunov, Mikhail Aleksandrovich Mushkin, Diana Airatovna Kaumova, Alexandr Nikolaevich Muraviev, Andrey Igorevich Gorelov, Nadezhda Valerievna Orlova, Anna Andreevna Gorelova","doi":"10.14531/ss2023.3.79-85","DOIUrl":"https://doi.org/10.14531/ss2023.3.79-85","url":null,"abstract":"Objective. To study the relationship between clinical and radiation variants of myelopathy and types of the neurogenic dysfunction of the lower urinary tract in patients with infectious spondylitis. Material and Methods. A single-center cohort observational study was conducted with the analysis of medical records and a prospective examination of 20 patients with infectious spondylitis complicated by neurogenic dysfunction of the lower urinary tract. Results. Infectious spondylitis can be complicated by the development of various urodynamic disorders, including neurogenic detrusor hyperactivity (30 %), its combination with detrusor-sphincter dissinergia (30 %) and a decrease in detrusor contractility (40 %). In 50 % of patients, an urodynamic examination revealed an increase in detrusor pressure of more than 40 cm water. There was no connection between the development of any type of lower urinary tract dysfunction and MRI types of myelopathy according to Vendatam, as well as between the level of spinal cord compression and the severity of neurological disorders according to AIS. Conclusion. The results of the study do not confirm the existence of a relationship between the various characteristics of myelopathy in infectious spondylitis and the results of urodynamic examination. The limitation of the reliability of the results is the small number of observations. Studies with a larger sample are required to assess the relationship between the clinical and radiation characteristics of myelopathy and variants of neurogenic dysfunction of the lower urinary tract in patients with infectious spondylitis.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135546512","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}
Igor Vadimovich Basankin, Abram Akopovich Giulzatyan, Irina Valeryevna Gilevich, Ivan Evgenyevich Gritsaev, David Aleksandrovich Tayurski, Vladimir Alekseyevich Porkhanov
Objective. To analyze the effectiveness and safety of using an orthobiological product in osteoplasty of bone defects of the vertebrae with simultaneous reosteosynthesis. Material and Methods. The results of screw augmentation technology using thrombogel-enriched allogeneic bone were studied in a retrospective, single-center, non-randomized study, which included 17 patients (10 women, 7 men) with instability of the hardware in the form of screw loosening and osteolysis around screws. Results within 12 months were followed up in 17 patients (100 %). We compared preoperative and postoperative instrumental data, clinical parameters in dynamics. Results. The mean age of the patients was 59 (43–75) years. The distribution of patients, according to the primary pathology, was as follows: 11 patients (64.7 %) had a degenerative-dystrophic pathology of the spine, 4 patients (23.5 %) had a traumatic injury, and 2 patients had a kyphotic deformity on the background of Bechterew’s disease (11.8 %). The mean time from primary to revision surgery was 7.06 months (3.1–12.1), mean CRP was 4.48 (0.5–15.0). When observing patients for 12 months, all patients showed a positive trend in the form of a statistically significant regression of back pain according to VAS from 7.0 (6.0; 7.3) to 1.0 (0.0; 1.0) points (χ 2 = 47.9, df 3, р < 0.0001). A positive trend was also noted in the form of a decrease in ODI indicators and an improvement in the quality of life of patients from 63.8 (57.1; 69.1) to 3.0 (2.0; 7.5) at 12 months. When comparing the parameters (VAS and ODI), the obtained differences before/after the operation were statistically significant, while these changes have a pronounced correlation. Postoperative CT studies (3, 6, 12 months) showed no instability of the screws. Conclusion. Osteoplasty of vertebral bone defects and screw augmentation using orthobiological approaches have demonstrated their primary efficacy and safety. Further studies with a large sample size are needed to confirm the obtained results.
{"title":"Osteoplasty of vertebral bone defects caused by pedicle screw loosening using orthobiological approaches: a pilot study of case series","authors":"Igor Vadimovich Basankin, Abram Akopovich Giulzatyan, Irina Valeryevna Gilevich, Ivan Evgenyevich Gritsaev, David Aleksandrovich Tayurski, Vladimir Alekseyevich Porkhanov","doi":"10.14531/ss2023.3.86-95","DOIUrl":"https://doi.org/10.14531/ss2023.3.86-95","url":null,"abstract":"Objective. To analyze the effectiveness and safety of using an orthobiological product in osteoplasty of bone defects of the vertebrae with simultaneous reosteosynthesis. Material and Methods. The results of screw augmentation technology using thrombogel-enriched allogeneic bone were studied in a retrospective, single-center, non-randomized study, which included 17 patients (10 women, 7 men) with instability of the hardware in the form of screw loosening and osteolysis around screws. Results within 12 months were followed up in 17 patients (100 %). We compared preoperative and postoperative instrumental data, clinical parameters in dynamics. Results. The mean age of the patients was 59 (43–75) years. The distribution of patients, according to the primary pathology, was as follows: 11 patients (64.7 %) had a degenerative-dystrophic pathology of the spine, 4 patients (23.5 %) had a traumatic injury, and 2 patients had a kyphotic deformity on the background of Bechterew’s disease (11.8 %). The mean time from primary to revision surgery was 7.06 months (3.1–12.1), mean CRP was 4.48 (0.5–15.0). When observing patients for 12 months, all patients showed a positive trend in the form of a statistically significant regression of back pain according to VAS from 7.0 (6.0; 7.3) to 1.0 (0.0; 1.0) points (χ 2 = 47.9, df 3, р < 0.0001). A positive trend was also noted in the form of a decrease in ODI indicators and an improvement in the quality of life of patients from 63.8 (57.1; 69.1) to 3.0 (2.0; 7.5) at 12 months. When comparing the parameters (VAS and ODI), the obtained differences before/after the operation were statistically significant, while these changes have a pronounced correlation. Postoperative CT studies (3, 6, 12 months) showed no instability of the screws. Conclusion. Osteoplasty of vertebral bone defects and screw augmentation using orthobiological approaches have demonstrated their primary efficacy and safety. Further studies with a large sample size are needed to confirm the obtained results.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"2 1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135546661","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}
Aleksandr Sergeyevich Eliseev, Andrey Evgenyevich Bokov, Sergey Gennadyevich Mlyavykh
Objective. To study the effect of arthroplasty and anterior interbody fusion in the cervical spine on degenerative changes in the adjacent intervertebral joints. Material and Methods. A retrospective cohort study included 46 patients (22 with cervical total disc arthroplasy – CTDA, and 24 with anterior cervical discectomy and fusion – ACDF) with symptoms of cervical spondylogenic compression myelopathy and/or radiculopathy. The degree of degeneration of facet joints adjacent to the operated segments was evaluated 12 months after surgical treatment. Degenerative changes in the cervical spine were assessed using CT according to the Okamoto classification. Vidar Dicom Viewer 3.2 software was used to view images and evaluate intervertebral joints. Statistical processing was performed using IBM SPSS Statistics 23. Data were presented as median and 25th and 75th percentiles – Me [Q1; Q3]. Results. The mean age of patients in both groups was 47 [39; 52] years (Mann – Whitney U-test, p = 0.047). In the ACDF group it was 48 [42; 55] years and in the CTDA group – 42 [36; 52] years. Comparison of degenerative changes in the ACDF group before and after treatment (Wilcoxon analysis) showed a statistically significant difference in the cranial (p = 0.023), and caudal (p = 0.001) joints, with the progression of degeneration degree. In the CTDA group, no difference between pre- and post-treatment degeneration degree (Wilcoxon analysis) was found in either cranial joints (p = 0.157) or caudal joints (p = 0.161). Conclusion. Surgeries to stabilize spinal segments in degenerative diseases undeniably affect the development of the adjacent level syndrome. However, the use of endoprosthetic technology makes it possible to aggravate the degree of degenerative changes in the intervertebral joints of adjacent segments to a lesser extent.
{"title":"Degenerative changes in the intervertebral joints of the cervical spine after anterior interbody fusion and intervertebral disc arthroplasty","authors":"Aleksandr Sergeyevich Eliseev, Andrey Evgenyevich Bokov, Sergey Gennadyevich Mlyavykh","doi":"10.14531/ss2023.3.72-78","DOIUrl":"https://doi.org/10.14531/ss2023.3.72-78","url":null,"abstract":"Objective. To study the effect of arthroplasty and anterior interbody fusion in the cervical spine on degenerative changes in the adjacent intervertebral joints. Material and Methods. A retrospective cohort study included 46 patients (22 with cervical total disc arthroplasy – CTDA, and 24 with anterior cervical discectomy and fusion – ACDF) with symptoms of cervical spondylogenic compression myelopathy and/or radiculopathy. The degree of degeneration of facet joints adjacent to the operated segments was evaluated 12 months after surgical treatment. Degenerative changes in the cervical spine were assessed using CT according to the Okamoto classification. Vidar Dicom Viewer 3.2 software was used to view images and evaluate intervertebral joints. Statistical processing was performed using IBM SPSS Statistics 23. Data were presented as median and 25th and 75th percentiles – Me [Q1; Q3]. Results. The mean age of patients in both groups was 47 [39; 52] years (Mann – Whitney U-test, p = 0.047). In the ACDF group it was 48 [42; 55] years and in the CTDA group – 42 [36; 52] years. Comparison of degenerative changes in the ACDF group before and after treatment (Wilcoxon analysis) showed a statistically significant difference in the cranial (p = 0.023), and caudal (p = 0.001) joints, with the progression of degeneration degree. In the CTDA group, no difference between pre- and post-treatment degeneration degree (Wilcoxon analysis) was found in either cranial joints (p = 0.157) or caudal joints (p = 0.161). Conclusion. Surgeries to stabilize spinal segments in degenerative diseases undeniably affect the development of the adjacent level syndrome. However, the use of endoprosthetic technology makes it possible to aggravate the degree of degenerative changes in the intervertebral joints of adjacent segments to a lesser extent.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"107 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135546511","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}
Aleksandr Petrovich Saifullin, Alexandr Yakovlevich Aleynik, Andrei Evgenyevich Bokov, Sergey Gennadyevich Mlyavykh
Objective. To perform comparative analysis of the clinical efficacy and safety of indirect decompression of the spinal roots and interbody fusion through the lateral pre-psoas approach (OLIF) with anterolateral (OLIF-AF) and posterior percutaneous (OLIF-PF) screw fixations in the surgical treatment of single-segment lumbar stenosis. Material and Methods. A retrospective comparative analysis of treatment of 88 patients aged 29 to 72 years with single-level lumbar stenosis was carried out. Posterior instrumental fixation (OLIF-PF) was performed in 60 cases, and anterolateral (OLIF-AF) – in 28. Results. The compared groups did not statistically significantly differ from each other in terms of age, gender, body mass index, clinical picture and duration of symptoms before surgery, assessment of neurological status according to the Zurich Claudication Questionnaire (ZCQ), preoperative diagnosis, localization of stenosis, pain assessment in the back and leg before surgery according to a digital rating scale, physical status (ASA), health assessment (SF-12, ODI), follow-up period, as well as smoking and the presence of comorbidities (p > 0.05). In the OLIF-AF group, compared to the OLIF-PF group, a statistically significant advantage was found in terms of blood loss, duration of surgery and anesthesia, the level of radiological exposure, duration of patient’s hospitalization and hospital stay in the postoperative period, as well as the duration of antibiotic prophylaxis and intraoperative volume of infusions (p < 0.05). Despite earlier discharge and less use of local anesthesia (35.7 % vs 73.3 %; p = 0.001), patients in the OLIF-AF group had statistically significantly lower level of back pain on the day of discharge (3.0 vs 3.5; p = 0.034) and were less likely to need opioids (3.6 % vs 31.7 %; p = 0.003). With regard to complications and adverse events, there were no statistically significant differences during dynamic follow-up period from 3 to 50 months in both groups (17.9 % vs 28.3 %; p = 0.290), including depending on the timing of complications (early or late). In addition, no statistically significant differences were found for neurological, infectious, gastrointestinal, urological, or implant-related complications (p > 0.05). Conclusions. Indirect decompression of the spinal roots and interbody fusion through the lateral pre-psoas approach in combination with OLIF-AF is an effective and safe technique for the surgical treatment of single-segment lumbar stenosis. This method allows to reduce the invasiveness of surgery and severity of the pain syndrome and to create conditions for enhanced recovery after surgery. Further multicenter randomized trials are needed to comprehensively evaluate long-term outcomes.
目标。比较分析经腰肌前外侧入路(OLIF)椎体间融合术联合前外侧(OLIF- af)和后路经皮(OLIF- pf)螺钉固定治疗单节段腰椎管狭窄症的临床疗效和安全性。材料和方法。回顾性比较分析88例29 ~ 72岁单节段腰椎管狭窄患者的治疗方法。后路固定术(OLIF-PF) 60例，前外侧固定术(OLIF-AF) 28例。结果。比较组在年龄、性别、体重指数、术前临床表现及症状持续时间、苏黎世跛行问卷(ZCQ)神经系统状态评估、术前诊断、狭窄定位、术前背部和腿部疼痛评估(数字评定量表)、身体状况(ASA)、健康评估(SF-12、ODI)、随访时间、以及吸烟和存在合并症(p >0.05)。在OLIF-AF组中，与OLIF-PF组相比，出血量、手术和麻醉时间、放射暴露水平、术后患者住院和住院时间、抗生素预防持续时间和术中输注量均有统计学意义上的优势(p <0.05)。尽管较早出院且较少使用局麻(35.7% vs 73.3%;p = 0.001)， OLIF-AF组患者在出院当天的背痛水平有统计学意义显著降低(3.0 vs 3.5;P = 0.034)，并且不太可能需要阿片类药物(3.6% vs 31.7%;P = 0.003)。在3 ~ 50个月的动态随访期间，两组的并发症和不良事件发生率比较，差异无统计学意义(17.9% vs 28.3%;P = 0.290)，包括取决于并发症发生的时间(早期或晚期)。此外，在神经系统、感染性、胃肠道、泌尿系统或植入物相关并发症方面，没有发现统计学上的显著差异(p >0.05)。结论。经腰肌前外侧入路间接椎根减压和椎间融合术联合OLIF-AF是一种有效且安全的手术治疗单节段腰椎管狭窄的技术。这种方法可以减少手术的侵入性和疼痛综合征的严重程度，并为增强术后恢复创造条件。需要进一步的多中心随机试验来全面评估长期结果。
{"title":"Lumbar fusion through the anterolateral mini-approach: comparison of anterior interbody (OLIF-AF) and percutaneous pedicle (OLIF-PF) fixations in the surgical treatment of single-level stenosis","authors":"Aleksandr Petrovich Saifullin, Alexandr Yakovlevich Aleynik, Andrei Evgenyevich Bokov, Sergey Gennadyevich Mlyavykh","doi":"10.14531/ss2023.3.50-62","DOIUrl":"https://doi.org/10.14531/ss2023.3.50-62","url":null,"abstract":"Objective. To perform comparative analysis of the clinical efficacy and safety of indirect decompression of the spinal roots and interbody fusion through the lateral pre-psoas approach (OLIF) with anterolateral (OLIF-AF) and posterior percutaneous (OLIF-PF) screw fixations in the surgical treatment of single-segment lumbar stenosis. Material and Methods. A retrospective comparative analysis of treatment of 88 patients aged 29 to 72 years with single-level lumbar stenosis was carried out. Posterior instrumental fixation (OLIF-PF) was performed in 60 cases, and anterolateral (OLIF-AF) – in 28. Results. The compared groups did not statistically significantly differ from each other in terms of age, gender, body mass index, clinical picture and duration of symptoms before surgery, assessment of neurological status according to the Zurich Claudication Questionnaire (ZCQ), preoperative diagnosis, localization of stenosis, pain assessment in the back and leg before surgery according to a digital rating scale, physical status (ASA), health assessment (SF-12, ODI), follow-up period, as well as smoking and the presence of comorbidities (p > 0.05). In the OLIF-AF group, compared to the OLIF-PF group, a statistically significant advantage was found in terms of blood loss, duration of surgery and anesthesia, the level of radiological exposure, duration of patient’s hospitalization and hospital stay in the postoperative period, as well as the duration of antibiotic prophylaxis and intraoperative volume of infusions (p < 0.05). Despite earlier discharge and less use of local anesthesia (35.7 % vs 73.3 %; p = 0.001), patients in the OLIF-AF group had statistically significantly lower level of back pain on the day of discharge (3.0 vs 3.5; p = 0.034) and were less likely to need opioids (3.6 % vs 31.7 %; p = 0.003). With regard to complications and adverse events, there were no statistically significant differences during dynamic follow-up period from 3 to 50 months in both groups (17.9 % vs 28.3 %; p = 0.290), including depending on the timing of complications (early or late). In addition, no statistically significant differences were found for neurological, infectious, gastrointestinal, urological, or implant-related complications (p > 0.05). Conclusions. Indirect decompression of the spinal roots and interbody fusion through the lateral pre-psoas approach in combination with OLIF-AF is an effective and safe technique for the surgical treatment of single-segment lumbar stenosis. This method allows to reduce the invasiveness of surgery and severity of the pain syndrome and to create conditions for enhanced recovery after surgery. Further multicenter randomized trials are needed to comprehensively evaluate long-term outcomes.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"84 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135647192","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}
Juri Vladimirovich Kivelev, Alexey Sergeyevich Gaitan, Alexey Leonidovich Krivoshapkin
Objective. To describe the technique and analysis of early results of thoracoscopic microdiscectomy for disc herniation in the thoracic spine. Material and Methods. A retrospective single-center study included 19 patients (15 women and 4 men) who underwent thoracoscopic microdiscectomy in 2018–2020. The median age of patients was 45 years (range 21–75 years); the median time from the onset of symptoms to the first visit to a neurosurgeon was 12 months (range 1–152 months). Before admission to the hospital, all patients complained of pain of varying intensity in the thoracic spine and/or along the lateral surface of the chest. Nine (47 %) patients had sensorimotor neurological deficit in the legs. The outcomes of operations were assessed using the modified MacNub scale, and postoperative complications were classified according to the Clavien – Dindo scale. Early results of treatment were evaluated at the first follow-up examination (on average, 2 months after the intervention). Data analysis was performed using the SPSS statistical program (IBM SPSS Statistics, version 27). Results. The immediate postoperative period was mostly uneventful in 15 (79 %) patients. Four (21 %) Clavien – Dindo grade 1 complications were registered: 1 (5 %) case of purulent discitis, 1 (5 %) pneumonia, 1 (5 %) worsening of sensory disturbances in the leg, and 1 (5 %) deep vein thrombosis of the leg. The average length of hospital stay was three days. Favorable results (excellent, improvement or satisfactory) according to the modified MacNub scale were registered in 16 (84 %) patients in two months after surgery. In three (16 %) cases, the symptoms remained unchanged (unsatisfactory according to the MacNub scale). No deterioration was recorded in any of the cases. Statistical analysis of the data (Fischer’s method, Mann – Whitney U-test) showed that the only prognostic factor affecting the outcome of the operation was the localization of the hernia in the lower thoracic region between the T8 and T12 vertebrae (p = 0.007). Thus, all nine patients with a hernia in the midthoracic region (T4–T8) had a favorable outcome of the operation, in 6 (67 %) of them there were no complaints. In three (30 %) out of 10 patients with a hernia in the lower thoracic region, there was no complete cure. All other factors (gender, age, hernia size, etc.) did not have a statistically significant correlation with the outcome. Conclusion. Thoracoscopic microdiscectomy can be used in the surgical treatment of herniations of the thoracic spine. Additional studies are needed to confirm the effectiveness and safety of the technique in the long term.
{"title":"Thoracoscopic microdiscectomy for disc herniation in the thoracic spine: surgical technique and analysis of early results","authors":"Juri Vladimirovich Kivelev, Alexey Sergeyevich Gaitan, Alexey Leonidovich Krivoshapkin","doi":"10.14531/ss2023.3.63-71","DOIUrl":"https://doi.org/10.14531/ss2023.3.63-71","url":null,"abstract":"Objective. To describe the technique and analysis of early results of thoracoscopic microdiscectomy for disc herniation in the thoracic spine. Material and Methods. A retrospective single-center study included 19 patients (15 women and 4 men) who underwent thoracoscopic microdiscectomy in 2018–2020. The median age of patients was 45 years (range 21–75 years); the median time from the onset of symptoms to the first visit to a neurosurgeon was 12 months (range 1–152 months). Before admission to the hospital, all patients complained of pain of varying intensity in the thoracic spine and/or along the lateral surface of the chest. Nine (47 %) patients had sensorimotor neurological deficit in the legs. The outcomes of operations were assessed using the modified MacNub scale, and postoperative complications were classified according to the Clavien – Dindo scale. Early results of treatment were evaluated at the first follow-up examination (on average, 2 months after the intervention). Data analysis was performed using the SPSS statistical program (IBM SPSS Statistics, version 27). Results. The immediate postoperative period was mostly uneventful in 15 (79 %) patients. Four (21 %) Clavien – Dindo grade 1 complications were registered: 1 (5 %) case of purulent discitis, 1 (5 %) pneumonia, 1 (5 %) worsening of sensory disturbances in the leg, and 1 (5 %) deep vein thrombosis of the leg. The average length of hospital stay was three days. Favorable results (excellent, improvement or satisfactory) according to the modified MacNub scale were registered in 16 (84 %) patients in two months after surgery. In three (16 %) cases, the symptoms remained unchanged (unsatisfactory according to the MacNub scale). No deterioration was recorded in any of the cases. Statistical analysis of the data (Fischer’s method, Mann – Whitney U-test) showed that the only prognostic factor affecting the outcome of the operation was the localization of the hernia in the lower thoracic region between the T8 and T12 vertebrae (p = 0.007). Thus, all nine patients with a hernia in the midthoracic region (T4–T8) had a favorable outcome of the operation, in 6 (67 %) of them there were no complaints. In three (30 %) out of 10 patients with a hernia in the lower thoracic region, there was no complete cure. All other factors (gender, age, hernia size, etc.) did not have a statistically significant correlation with the outcome. Conclusion. Thoracoscopic microdiscectomy can be used in the surgical treatment of herniations of the thoracic spine. Additional studies are needed to confirm the effectiveness and safety of the technique in the long term.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135647194","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}
Serik Kaliulovich Makirov, Gerald Musa, Dimitri T. Keri Ndandja, Gennady Egorovich Chmutin, Alexander Valeryevich Kim, Dmitri Vladimirovich Hovrin, Olzhas Bekenovich Otarov
Objective. To conduct a literature review of studies comparing the treatment of recurrent lumbar disc herniation using discectomy and spinal fusion. Material and Methods. A comprehensive search across four electronic databases (PubMed, Google Scholar, Science Direct, and Cochrane) was conducted. Studies comparing the outcomes of discectomy and spinal fusion for recurrent lumbar disc herniation were analyzed. Postoperative complications, cost and duration of surgery, length of hospital stay, pain score, and recurrence rate were compared. Results. Ten studies comprising data of 1066 patients met the inclusion criteria. Discectomy was performed in 620 of them, while 446 patients underwent spinal fusion surgery. Discectomy yielded good results in VAS scores for leg and back pain, but after 3–6 months, there was no significant difference compared to spinal fusion. The recurrence rate for discectomy varied from 7.27 % to 22.91 %, while fusion had 0 % same-level recurrence. Fusion surgery had fewer complications: 1.72–28.00 % (average 11.6 %) vs 5.25–32.73 % (average 15.7 %) for discectomy. However, spinal fusion had longer operation time, greater blood loss and longer hospital stay compared to discectomy. Conclusion. Discectomy and spinal fusion are effective treatment options for recurrent lumbar disc herniation. At the same time, discectomy demonstrates a high level of initial relief of symptoms and is more cost-effective. However, the risk of recurrence is significant, and the progression of degeneration and instability may result in pain recurrence within a year. Fusion surgery provides stability and eliminates the risk of recurrence, but the main challenge is the cost of surgery. The choice of technique should be based on individual patient factors, and the advantages and disadvantages of each approach should be carefully considered.
{"title":"Repeat discectomy and spinal fusion in the treatment of recurrent lumbar disc herniation: systematic review of the literature","authors":"Serik Kaliulovich Makirov, Gerald Musa, Dimitri T. Keri Ndandja, Gennady Egorovich Chmutin, Alexander Valeryevich Kim, Dmitri Vladimirovich Hovrin, Olzhas Bekenovich Otarov","doi":"10.14531/ss2023.3.43-49","DOIUrl":"https://doi.org/10.14531/ss2023.3.43-49","url":null,"abstract":"Objective. To conduct a literature review of studies comparing the treatment of recurrent lumbar disc herniation using discectomy and spinal fusion. Material and Methods. A comprehensive search across four electronic databases (PubMed, Google Scholar, Science Direct, and Cochrane) was conducted. Studies comparing the outcomes of discectomy and spinal fusion for recurrent lumbar disc herniation were analyzed. Postoperative complications, cost and duration of surgery, length of hospital stay, pain score, and recurrence rate were compared. Results. Ten studies comprising data of 1066 patients met the inclusion criteria. Discectomy was performed in 620 of them, while 446 patients underwent spinal fusion surgery. Discectomy yielded good results in VAS scores for leg and back pain, but after 3–6 months, there was no significant difference compared to spinal fusion. The recurrence rate for discectomy varied from 7.27 % to 22.91 %, while fusion had 0 % same-level recurrence. Fusion surgery had fewer complications: 1.72–28.00 % (average 11.6 %) vs 5.25–32.73 % (average 15.7 %) for discectomy. However, spinal fusion had longer operation time, greater blood loss and longer hospital stay compared to discectomy. Conclusion. Discectomy and spinal fusion are effective treatment options for recurrent lumbar disc herniation. At the same time, discectomy demonstrates a high level of initial relief of symptoms and is more cost-effective. However, the risk of recurrence is significant, and the progression of degeneration and instability may result in pain recurrence within a year. Fusion surgery provides stability and eliminates the risk of recurrence, but the main challenge is the cost of surgery. The choice of technique should be based on individual patient factors, and the advantages and disadvantages of each approach should be carefully considered.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"113 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135789228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective. To analyze the effect of spinal deformity correction on the parameters of the frontal and sagittal balance in patients aged 15-35 years with Lenke types I and III idiopathic scoliosis. Material and Methods. The dynamics of sagittal and frontal parameters of the spinal balance was assessed in 268 patients aged 15 to 35 years with Lenke type I and III idiopathic scoliosis before and after surgical treatment. The patients’ quality of life and the number of postoperative complications were assessed depending on the imbalance severity. Results. More than half of patients (55.6 %) with Lenke types I and III idiopathic scoliosis have initial balance disorders, and 14.6 % of them have pronounced abnormalities. Significant balance disorders are predicted by severe scoliosis (85.3° ± 30.3°), greater L5 tilt (10.3 ± 7.9 before surgery; 5.3 ± 4.8 after surgery) and initial sagittal imbalance (32.75 ± 27.7), large residual scoliotic curve (43.3° ± 23.1°), large angle of residual thoracic kyphosis (32.3° ± 15.9°), and smaller angle of lumbar lordosis after surgery (52.3° ± 14.1°); p < 0.05. The main compensatory elements, in addition to PT and SS, are the angle of L5 tilt in the frontal plane and the L5–S1 angle in the sagittal plane. In young patients aged 15-35 years, disc mobility at the L5–S1 level is sufficient to achieve a more balanced body position, even with a significant change in the PI-LL ratio. Conclusion. In the long-term postoperative period, a pronounced imbalance of the spine increases the risk of mechanical postoperative complications up to 50 %, while the quality of life of patients does not decrease, and repeated surgical interventions are required in singular cases. Correction of scoliotic deformity allows increasing the number of patients without balance disorders by 6 %, and reducing the number of gross deviations by 2 times.
{"title":"The effect of surgical correction of Lenke types I and III scoliotic deformities on the spinal balance in patients aged 15–35 years","authors":"Vadim Vasilyevich Belozerov, Aleksey Vladimirovich Peleganchuk, Mikhail Vitalyevich Mikhaylovskiy","doi":"10.14531/ss2023.3.16-25","DOIUrl":"https://doi.org/10.14531/ss2023.3.16-25","url":null,"abstract":"Objective. To analyze the effect of spinal deformity correction on the parameters of the frontal and sagittal balance in patients aged 15-35 years with Lenke types I and III idiopathic scoliosis. Material and Methods. The dynamics of sagittal and frontal parameters of the spinal balance was assessed in 268 patients aged 15 to 35 years with Lenke type I and III idiopathic scoliosis before and after surgical treatment. The patients’ quality of life and the number of postoperative complications were assessed depending on the imbalance severity. Results. More than half of patients (55.6 %) with Lenke types I and III idiopathic scoliosis have initial balance disorders, and 14.6 % of them have pronounced abnormalities. Significant balance disorders are predicted by severe scoliosis (85.3° ± 30.3°), greater L5 tilt (10.3 ± 7.9 before surgery; 5.3 ± 4.8 after surgery) and initial sagittal imbalance (32.75 ± 27.7), large residual scoliotic curve (43.3° ± 23.1°), large angle of residual thoracic kyphosis (32.3° ± 15.9°), and smaller angle of lumbar lordosis after surgery (52.3° ± 14.1°); p < 0.05. The main compensatory elements, in addition to PT and SS, are the angle of L5 tilt in the frontal plane and the L5–S1 angle in the sagittal plane. In young patients aged 15-35 years, disc mobility at the L5–S1 level is sufficient to achieve a more balanced body position, even with a significant change in the PI-LL ratio. Conclusion. In the long-term postoperative period, a pronounced imbalance of the spine increases the risk of mechanical postoperative complications up to 50 %, while the quality of life of patients does not decrease, and repeated surgical interventions are required in singular cases. Correction of scoliotic deformity allows increasing the number of patients without balance disorders by 6 %, and reducing the number of gross deviations by 2 times.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"94 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135789024","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 determine the main demographic factors that influence preoperative expectations of patients with degenerative diseases of the lumbosacral spine. Material and Methods. A cross-sectional study was performed for 103 patients with degenerative diseases of the lumbosacral spine who were scheduled for surgery in the period from 2019 to 2021. General demographic data, level of patient’s education and the presence of previous surgeries were taken into account. Expectations for surgical treatment outcome were assessed using a translated and adapted Russian version of the Hospital for Special Surgery – Lumbar Spine Surgery Expectations Survey (HSS-LSSES) questionnaire. The quality of life of patients was assessed using the general questionnaires: European Quality of Life-5 Dimensions (EQ-5D-5L) and the 36-item Short-Form Health Survey (SF-36), as well as the disease-specific Oswestry Disability Index (ODI). Results. It was found that, according to HSS-LSSES, patients’ expectations for the upcoming surgical intervention are the higher, the older the patient’s age, the higher the general and emotional state of health, vitality, ODI scores, as well as the severity of pain syndrome, and the lower the mental health score. Patients with a high level of education and prior spinal surgery have lower expectations for subsequent surgery. Conclusion. The expectations of patients for the surgical treatment for degenerative disease of the lumbosacral spine depend on the patient’s age, level of education, anamnesis and severity of decline in the quality of life.
{"title":"Evaluation of Patient Expectations for Surgical Treatment of Degenerative Disease of the Lumbosacral Spine","authors":"Nikita Sergeevich Zaborovskii, Anton Aleksandrovich Denisov, Dmitrii Arkadyevich Mikhaylov, Oleg Anatolyevich Smekalenkov, Sergey Vladimirovich Masevnin, Vladislav Sergeyevich Murakhovsky, Shamil Shamsudinovich Magomedov, Mikhail Yuryevich Dokish, Aleksandr Pavlovich Tatarintsev, Yuriy Yurievich Polyakov, Dmitrii Aleksandrovich Ptashnikov","doi":"10.14531/ss2023.3.34-42","DOIUrl":"https://doi.org/10.14531/ss2023.3.34-42","url":null,"abstract":"Objective. To determine the main demographic factors that influence preoperative expectations of patients with degenerative diseases of the lumbosacral spine. Material and Methods. A cross-sectional study was performed for 103 patients with degenerative diseases of the lumbosacral spine who were scheduled for surgery in the period from 2019 to 2021. General demographic data, level of patient’s education and the presence of previous surgeries were taken into account. Expectations for surgical treatment outcome were assessed using a translated and adapted Russian version of the Hospital for Special Surgery – Lumbar Spine Surgery Expectations Survey (HSS-LSSES) questionnaire. The quality of life of patients was assessed using the general questionnaires: European Quality of Life-5 Dimensions (EQ-5D-5L) and the 36-item Short-Form Health Survey (SF-36), as well as the disease-specific Oswestry Disability Index (ODI). Results. It was found that, according to HSS-LSSES, patients’ expectations for the upcoming surgical intervention are the higher, the older the patient’s age, the higher the general and emotional state of health, vitality, ODI scores, as well as the severity of pain syndrome, and the lower the mental health score. Patients with a high level of education and prior spinal surgery have lower expectations for subsequent surgery. Conclusion. The expectations of patients for the surgical treatment for degenerative disease of the lumbosacral spine depend on the patient’s age, level of education, anamnesis and severity of decline in the quality of life.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"100 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135789031","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}
Aleksandr Yuryevich Sergunin, Mikhail Vitalyevich Mikhaylovskiy
Objective. To identify risk factors for the development of Proximal Junctional Kyphosis (PJK) in patients with Scheuermann’s kyphosis operated on using segmental instrumentation. Material and Methods . The study group consisted of 43 patients (13 females, 30 males), mean age was 17 years, and mean postoperative follow-up was 6 years. Spondylograms with a patient in a standing position performed before surgery, a week after surgery, and at the end of the follow-up period were analyzed. Radiological parameters were studied: cervical lordosis, absolute rotation angle, thoracic entry angle, T1 vertebral body tilt, neck tilt, skull tilt, thoracic kyphosis, thoracolumbar kyphosis, lumbar lordosis, vertebral and pelvic parameters (Pelvic Incidence, Pelvic Tilt, Sacral Slope), sagittal vertical axis, proximal junctional angle (PJA), and length of the posterior spinal fusion. Results. The mean PJA before surgery was 7° [3°; 8°], immediately after surgery – 10° [8°; 13°], by the end of the follow-up period – 25°[19°; 32°]. The incidence of PJK by the end of the follow-up period was 79.1 % (in 34 out of 43 patients). The initial value of thoracic kyphosis was 77° [72°; 86°], after surgery – 41° [31°; 46°], at the last examination – 43° [35°; 53°]. The inclination of the T1 vertebral body in the sagittal plane before surgery was 39° [30°; 45°], at the stages of follow-up – 33° [22°; 37°] and 39° [27°; 45°]. Some significant predictors were identified. An increase in the inclination of the T1 vertebral body (p = 0.005) by k° is associated with an increase in the risk of PJK by 1.19k [1.08k; 1.37k] times, and an increase of thoracic kyphosis by k° (p = 0.023) – by 1.12k (1.03k; 1.27k) times. The formula for preoperative predicting the likelihood of this complication is: P (PJK) = 1 - 1/(1 + exp (-23.14 + 0.26 × T1 + 0.21 × TK)), where P(PJK) is the probability of proximal junctional kyphosis; exp(z) is the exponential function to the power of z; T1 (T1 vertebral body tilt) and TK (thoracic kyphosis) are preoperative values of variables. Using ROC analysis, the threshold value for predicting PJK was determined to be 74.2 %, that is, the development of PJK was predicted in patients with a PJK probability greater than the threshold value calculated by the model formula. The predictive ability of the multivariate model was tested on the basis of the available initial data with a known final result. The prediction was correct in 41 cases out of 43. Conclusion. Using the multivariate logistic regression method, two mutually independent multiplicative indicators were determined for predicting PJK with high accuracy (sensitivity 94.1 %, specificity 100.0 %) – inclination of the T1 vertebral body and thoracic kyphosis.
{"title":"Risk factors of proximal junctional kyphosis after surgical correction of spinal deformities caused by Scheuermann’s disease","authors":"Aleksandr Yuryevich Sergunin, Mikhail Vitalyevich Mikhaylovskiy","doi":"10.14531/ss2023.3.6-15","DOIUrl":"https://doi.org/10.14531/ss2023.3.6-15","url":null,"abstract":"Objective. To identify risk factors for the development of Proximal Junctional Kyphosis (PJK) in patients with Scheuermann’s kyphosis operated on using segmental instrumentation. Material and Methods . The study group consisted of 43 patients (13 females, 30 males), mean age was 17 years, and mean postoperative follow-up was 6 years. Spondylograms with a patient in a standing position performed before surgery, a week after surgery, and at the end of the follow-up period were analyzed. Radiological parameters were studied: cervical lordosis, absolute rotation angle, thoracic entry angle, T1 vertebral body tilt, neck tilt, skull tilt, thoracic kyphosis, thoracolumbar kyphosis, lumbar lordosis, vertebral and pelvic parameters (Pelvic Incidence, Pelvic Tilt, Sacral Slope), sagittal vertical axis, proximal junctional angle (PJA), and length of the posterior spinal fusion. Results. The mean PJA before surgery was 7° [3°; 8°], immediately after surgery – 10° [8°; 13°], by the end of the follow-up period – 25°[19°; 32°]. The incidence of PJK by the end of the follow-up period was 79.1 % (in 34 out of 43 patients). The initial value of thoracic kyphosis was 77° [72°; 86°], after surgery – 41° [31°; 46°], at the last examination – 43° [35°; 53°]. The inclination of the T1 vertebral body in the sagittal plane before surgery was 39° [30°; 45°], at the stages of follow-up – 33° [22°; 37°] and 39° [27°; 45°]. Some significant predictors were identified. An increase in the inclination of the T1 vertebral body (p = 0.005) by k° is associated with an increase in the risk of PJK by 1.19k [1.08k; 1.37k] times, and an increase of thoracic kyphosis by k° (p = 0.023) – by 1.12k (1.03k; 1.27k) times. The formula for preoperative predicting the likelihood of this complication is: P (PJK) = 1 - 1/(1 + exp (-23.14 + 0.26 × T1 + 0.21 × TK)), where P(PJK) is the probability of proximal junctional kyphosis; exp(z) is the exponential function to the power of z; T1 (T1 vertebral body tilt) and TK (thoracic kyphosis) are preoperative values of variables. Using ROC analysis, the threshold value for predicting PJK was determined to be 74.2 %, that is, the development of PJK was predicted in patients with a PJK probability greater than the threshold value calculated by the model formula. The predictive ability of the multivariate model was tested on the basis of the available initial data with a known final result. The prediction was correct in 41 cases out of 43. Conclusion. Using the multivariate logistic regression method, two mutually independent multiplicative indicators were determined for predicting PJK with high accuracy (sensitivity 94.1 %, specificity 100.0 %) – inclination of the T1 vertebral body and thoracic kyphosis.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"100 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135789242","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}
Viktor Viktorovich Rerikh, Vladimir Dmitryevich Sinyavin
Objective. To perform a comparative radiological analysis of the methods of hybrid stabilization (posterior fixation in combination with cement vertebroplasty and osteoplasty with deproteinized allobone) and circular stabilization (posterior fixation in combination with anterior fusion) used in the treatment of uncomplicated burst fractures of the vertebral bodies associated with osteoporosis. Material and Methods. The study is retrospective. Two groups of patients were formed, and inclusion and exclusion criteria were determined. The magnitude of kyphosis correction (according to Cobb), the magnitude of residual postoperative kyphotic deformity, as well as its recurrence in the long-term postoperative period, and the sagittal balance (Barrey index) were assessed. The follow-up period was 12 months. Subjective assessments of the patient’s condition were not considered. Results. The magnitude of initial kyphotic deformity (>20°), incomplete achievement of kyphosis correction after surgery (> 5°), the value of densitometry T-score, and sagittal imbalance before and after surgical intervention are, with a statistically significant difference, the main predictors of local kyphosis recurrence, incomplete correction of deformity and decompensated sagittal imbalance. Conclusions. When comparing the methods of hybrid and circular stabilization, there was no statistical difference in radiological outcomes.
{"title":"Comparative radiological analysis of hybrid and circular stabilization methods for the treatment of osteoporotic vertebral burst fractures","authors":"Viktor Viktorovich Rerikh, Vladimir Dmitryevich Sinyavin","doi":"10.14531/ss2023.3.26-33","DOIUrl":"https://doi.org/10.14531/ss2023.3.26-33","url":null,"abstract":"Objective. To perform a comparative radiological analysis of the methods of hybrid stabilization (posterior fixation in combination with cement vertebroplasty and osteoplasty with deproteinized allobone) and circular stabilization (posterior fixation in combination with anterior fusion) used in the treatment of uncomplicated burst fractures of the vertebral bodies associated with osteoporosis. Material and Methods. The study is retrospective. Two groups of patients were formed, and inclusion and exclusion criteria were determined. The magnitude of kyphosis correction (according to Cobb), the magnitude of residual postoperative kyphotic deformity, as well as its recurrence in the long-term postoperative period, and the sagittal balance (Barrey index) were assessed. The follow-up period was 12 months. Subjective assessments of the patient’s condition were not considered. Results. The magnitude of initial kyphotic deformity (>20°), incomplete achievement of kyphosis correction after surgery (> 5°), the value of densitometry T-score, and sagittal imbalance before and after surgical intervention are, with a statistically significant difference, the main predictors of local kyphosis recurrence, incomplete correction of deformity and decompensated sagittal imbalance. Conclusions. When comparing the methods of hybrid and circular stabilization, there was no statistical difference in radiological outcomes.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135789029","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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