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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 脊柱感染性和炎症性疾病的下尿路神经源性功能障碍:是否与脊髓病的临床和放射学变异相关?单中心队列分析的初步结果
Q3 Medicine Pub Date : 2023-10-05 DOI: 10.14531/ss2023.3.79-85
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.
目标。目的探讨感染性脊柱炎患者脊髓病的临床和放射变异与下尿路神经源性功能障碍类型的关系。材料和方法。本文对20例感染性脊柱炎合并下尿路神经源性功能障碍患者进行了单中心队列观察性研究,分析了医疗记录并进行了前瞻性检查。结果。感染性脊柱炎可并发各种尿动力障碍,包括神经源性逼尿肌亢进(30%),其合并逼尿肌-括约肌无力(30%)和逼尿肌收缩力下降(40%)。在50%的患者中,尿动力学检查显示逼尿肌压力增加超过40厘米水。根据Vendatam,任何类型的下尿路功能障碍的发展与脊髓病的MRI类型之间没有联系,根据AIS,脊髓压迫程度与神经系统疾病的严重程度之间也没有联系。结论。本研究结果未证实感染性脊柱炎脊髓病变的各种特征与尿动力学检查结果之间存在关系。结果可靠性的限制是观测数量少。需要更大样本的研究来评估感染性脊柱炎患者脊髓病的临床和放射特征与下尿路神经源性功能障碍变异之间的关系。
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引用次数: 0
Osteoplasty of vertebral bone defects caused by pedicle screw loosening using orthobiological approaches: a pilot study of case series 骨成形术治疗椎弓根螺钉松动引起的椎体骨缺损:病例系列的初步研究
Q3 Medicine Pub Date : 2023-10-05 DOI: 10.14531/ss2023.3.86-95
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.
目标。目的:分析同种生物制品在椎体骨缺损成形术中的有效性和安全性。材料和方法。在一项回顾性、单中心、非随机研究中,研究了使用富含血栓凝胶的异体骨的螺钉增强技术的结果,该研究包括17例患者(10名女性,7名男性),这些患者的硬件不稳定表现为螺钉松动和螺钉周围的骨溶解。结果12个月内随访17例(100%)。我们比较了术前和术后的仪器数据、动力学的临床参数。结果。患者平均年龄59岁(43 ~ 75岁)。根据原发病理,患者的分布如下:11例(64.7%)为脊柱退行性营养不良病理,4例(23.5%)为外伤性损伤,2例(11.8%)为贝希特鲁病背景下的脊柱后凸畸形。从初次手术到翻修手术的平均时间为7.06个月(3.1-12.1),平均CRP为4.48(0.5-15.0)。观察患者12个月后,根据VAS评分从7.0分(6.0分;7.3)到1.0 (0.0;1.0)点(χ 2 = 47.9, df 3, * * <0.0001)。ODI指标的下降和患者生活质量的改善也显示出积极的趋势,从63.8分(57.1分;69.1)到3.0 (2.0;12个月时7.5)。在比较参数(VAS和ODI)时,获得的术前/术后差异有统计学意义,而这些变化具有明显的相关性。术后CT检查(3,6,12个月)显示螺钉无不稳定。结论。椎体骨缺损成形术和螺钉增强采用骨科入路已证明其主要的有效性和安全性。需要进一步的大样本量研究来证实所获得的结果。
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引用次数: 0
Degenerative changes in the intervertebral joints of the cervical spine after anterior interbody fusion and intervertebral disc arthroplasty 前路椎间融合术和椎间盘置换术后颈椎椎间关节的退行性改变
Q3 Medicine Pub Date : 2023-10-05 DOI: 10.14531/ss2023.3.72-78
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.
目标。目的探讨颈椎关节置换术和前路椎间融合术对相邻椎间关节退行性改变的影响。材料和方法。一项回顾性队列研究纳入了46例伴有颈椎病压迫性脊髓病和/或神经根病症状的患者(22例颈椎全椎间盘置换术- CTDA, 24例颈椎前路椎间盘切除术和融合- ACDF)。手术治疗12个月后评估手术节段附近的小关节退变程度。颈椎退行性改变采用CT根据Okamoto分类进行评估。使用Vidar Dicom Viewer 3.2软件查看图像并评估椎间关节。采用IBM SPSS Statistics 23进行统计学处理。数据以中位数、第25百分位和第75百分位表示- Me [Q1;第三季度)。结果。两组患者平均年龄为47岁[39;[52]年(Mann - Whitney u检验,p = 0.047)。ACDF组为48 [42];55岁,CTDA组42岁[36;52年。ACDF组治疗前后的退行性改变比较(Wilcoxon分析)显示,随着退行性程度的进展,颅骨关节(p = 0.023)和尾侧关节(p = 0.001)的差异有统计学意义。在CTDA组中,颅关节(p = 0.157)和尾关节(p = 0.161)的退变程度在治疗前和治疗后均无差异(Wilcoxon分析)。结论。在退行性疾病中稳定脊柱节段的手术不可否认地影响邻近节段综合征的发展。然而,使用内假体技术可以在较小程度上加重相邻节段椎间关节退行性改变的程度。
{"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}
引用次数: 0
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 经前外侧小入路腰椎融合术:前椎间(OLIF-AF)和经皮椎弓根(OLIF-PF)固定术治疗单节段狭窄的比较
Q3 Medicine Pub Date : 2023-10-04 DOI: 10.14531/ss2023.3.50-62
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}
引用次数: 0
Thoracoscopic microdiscectomy for disc herniation in the thoracic spine: surgical technique and analysis of early results 胸腔镜下显微椎间盘切除术治疗胸椎椎间盘突出症:手术技术及早期结果分析
Q3 Medicine Pub Date : 2023-10-04 DOI: 10.14531/ss2023.3.63-71
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.
目标。目的介绍胸腔镜下显微椎间盘切除术治疗胸椎椎间盘突出症的技术及早期结果分析。材料和方法。一项回顾性单中心研究纳入了2018-2020年接受胸腔镜显微椎间盘切除术的19例患者(15名女性和4名男性)。患者的中位年龄为45岁(21-75岁);从出现症状到首次就诊神经外科医生的中位时间为12个月(范围1-152个月)。入院前,所有患者均主诉胸椎和/或胸壁外侧有不同程度的疼痛。9例(47%)患者有腿部感觉运动神经功能障碍。采用改良MacNub评分法评估手术效果,并根据Clavien - Dindo评分法对术后并发症进行分类。在第一次随访检查时(平均干预后2个月)评估早期治疗结果。使用SPSS统计程序(IBM SPSS Statistics, version 27)进行数据分析。结果。15例(79%)患者术后初期基本平安无事。4例(21%)Clavien - Dindo 1级并发症:化脓性椎间盘炎1例(5%),肺炎1例(5%),腿部感觉障碍恶化1例(5%),下肢深静脉血栓形成1例(5%)。平均住院时间为3天。16例(84%)患者在术后2个月内获得了改良MacNub评分的良好结果(极好、改善或满意)。在3例(16%)病例中,症状保持不变(根据MacNub量表不满意)。所有病例均未见病情恶化。数据统计分析(Fischer方法,Mann - Whitney u检验)显示,影响手术结果的唯一预后因素是疝位于胸椎下部T8和T12椎体之间(p = 0.007)。因此,9例中胸区(T4-T8)疝患者手术效果良好,其中6例(67%)无主诉。在10例胸椎下段疝患者中,有3例(30%)没有完全治愈。其他因素(性别、年龄、疝大小等)与结果无统计学意义相关。结论。胸腔镜显微椎间盘切除术可用于胸椎突出症的外科治疗。需要进一步的研究来证实该技术的长期有效性和安全性。
{"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}
引用次数: 0
Repeat discectomy and spinal fusion in the treatment of recurrent lumbar disc herniation: systematic review of the literature 重复椎间盘切除术和脊柱融合术治疗复发性腰椎间盘突出症:文献的系统回顾
Q3 Medicine Pub Date : 2023-10-03 DOI: 10.14531/ss2023.3.43-49
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.
目标。对比较椎间盘切除术和脊柱融合术治疗复发性腰椎间盘突出症的研究进行文献综述。材料和方法。对四个电子数据库(PubMed、Google Scholar、Science Direct和Cochrane)进行了全面的搜索。比较椎间盘切除术和脊柱融合术治疗复发性腰椎间盘突出症的结果的研究进行了分析。比较术后并发症、手术费用、手术时间、住院时间、疼痛评分和复发率。结果。10项包含1066例患者数据的研究符合纳入标准。其中620例行椎间盘切除术,446例行脊柱融合术。椎间盘切除术在腿部和背部疼痛的VAS评分上取得了良好的效果,但在3-6个月后,与脊柱融合术相比没有显著差异。椎间盘切除术的复发率从7.27%到22.91%不等,而融合术的复发率为0%。融合手术并发症较少:1.72 - 28.00%(平均11.6%),而椎间盘切除术为5.25 - 32.73%(平均15.7%)。然而,与椎间盘切除术相比,脊柱融合术的手术时间更长,出血量更大,住院时间更长。结论。椎间盘切除术和脊柱融合术是治疗复发性腰椎间盘突出症的有效选择。与此同时,椎间盘切除术显示出高水平的初步症状缓解,更具成本效益。然而,复发的风险是显著的,退变和不稳定的进展可能导致疼痛在一年内复发。融合手术提供了稳定性并消除了复发的风险,但主要的挑战是手术的成本。技术的选择应基于患者的个体因素,并应仔细考虑每种入路的优缺点。
{"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}
引用次数: 0
The effect of surgical correction of Lenke types I and III scoliotic deformities on the spinal balance in patients aged 15–35 years Lenke I型和III型脊柱侧凸畸形手术矫正对15-35岁患者脊柱平衡的影响
Q3 Medicine Pub Date : 2023-10-03 DOI: 10.14531/ss2023.3.16-25
Vadim Vasilyevich Belozerov, Aleksey Vladimirovich Peleganchuk, Mikhail Vitalyevich Mikhaylovskiy
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.
目标。分析脊柱畸形矫正对15-35岁Lenke I型和III型特发性脊柱侧凸患者额矢状面平衡参数的影响。材料和方法。对268例15 ~ 35岁的Lenke I型和III型特发性脊柱侧凸患者手术前后的脊柱平衡矢状面和额面参数动态进行了评估。根据失衡程度评估患者的生活质量和术后并发症数量。结果。超过一半(55.6%)的Lenke I型和III型特发性脊柱侧凸患者有初始平衡障碍,其中14.6%有明显异常。严重的脊柱侧凸(85.3°±30.3°)、较大的L5倾斜(10.3±7.9°)预示着明显的平衡障碍;术后矢状面失衡(32.75±27.7),侧凸残留曲线大(43.3°±23.1°),胸后凸残留角大(32.3°±15.9°),腰椎前凸残留角小(52.3°±14.1°);p & lt;0.05. 除了PT和SS外,主要的代偿因素是L5在额平面的倾斜角度和L5 - s1在矢状面的角度。在15-35岁的年轻患者中,L5-S1水平的椎间盘活动度足以实现更平衡的体位,即使PI-LL比发生了显著变化。结论。在术后长期内,脊柱明显的不平衡使术后机械并发症的风险增加高达50%,而患者的生活质量并未下降,个别病例需要重复手术干预。脊柱侧凸畸形的矫正使无平衡障碍的患者数量增加了6%,使总偏差的数量减少了2倍。
{"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}
引用次数: 0
Evaluation of Patient Expectations for Surgical Treatment of Degenerative Disease of the Lumbosacral Spine 腰骶椎退行性疾病手术治疗患者期望的评估
Q3 Medicine Pub Date : 2023-10-03 DOI: 10.14531/ss2023.3.34-42
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
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.
目标。目的探讨影响腰骶椎退行性疾病患者术前预期的主要人口学因素。材料和方法。对103例计划于2019年至2021年进行手术的腰骶骨退行性疾病患者进行了横断面研究。一般人口统计数据,患者的教育水平和既往手术的存在被考虑在内。使用翻译和改编的俄文版特殊外科医院-腰椎手术期望调查(hss - lses)问卷评估手术治疗结果的期望。采用一般问卷:欧洲生活质量5维度(EQ-5D-5L)和36项简短健康调查(SF-36),以及疾病特异性Oswestry残疾指数(ODI)评估患者的生活质量。结果。研究发现,根据hss - lses,患者对即将进行的手术干预的期望越高,患者年龄越大,总体和情绪健康状态、活力、ODI评分以及疼痛综合征严重程度评分越高,心理健康评分越低。高教育水平和既往脊柱手术的患者对后续手术的期望较低。结论。腰骶椎退行性疾病患者对手术治疗的期望取决于患者的年龄、受教育程度、记忆力和生活质量下降的严重程度。
{"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}
引用次数: 0
Risk factors of proximal junctional kyphosis after surgical correction of spinal deformities caused by Scheuermann’s disease 索伊尔曼氏病所致脊柱畸形手术矫治后近端关节后凸的危险因素分析
Q3 Medicine Pub Date : 2023-10-03 DOI: 10.14531/ss2023.3.6-15
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.
目标。目的:探讨采用节段内固定术的Scheuermann后凸患者发生近端交界性后凸(PJK)的危险因素。材料和方法。研究组共纳入43例患者,其中女性13例,男性30例,平均年龄17岁,术后平均随访6年。分析术前、术后一周及随访结束时患者站立姿势的脊椎图。研究影像学参数:颈椎前凸、绝对旋转角、胸椎入骨角、T1椎体倾斜、颈部倾斜、颅骨倾斜、胸椎后凸、胸腰椎后凸、腰椎前凸、椎体和骨盆参数(骨盆发生率、骨盆倾斜、骶骨坡度)、矢状垂直轴、近端接合角(PJA)、脊柱后融合长度。结果。术前平均PJA为7°[3°;8°],术后立即- 10°[8°];13°],随访期结束时- 25°[19°;32°)。随访期结束时PJK的发生率为79.1%(43例患者中有34例)。胸后凸初始值为77°[72°;86°],术后- 41°[31°;46°],最后一次检查- 43°[35°];53°)。术前T1椎体矢状面倾角为39°[30°;45°],随访阶段- 33°[22°;37°]和39°[27°];45°)。确定了一些重要的预测因子。T1椎体倾斜度(p = 0.005)每增加k°,PJK的风险增加1.19k [1.08k;1.37k]倍,胸后凸增加了k°(p = 0.023) - 1.12k (1.03k;1.27 k)倍。术前预测该并发症发生可能性的公式为:P(PJK) = 1 - 1/(1 + exp (-23.14 + 0.26 × T1 + 0.21 × TK)),其中P(PJK)为近端关节后凸的发生概率;Exp (z)是指数函数的z次方;T1 (T1椎体倾斜)和TK(胸椎后凸)为术前变量值。通过ROC分析,确定PJK预测的阈值为74.2%,即预测PJK发生的概率大于模型公式计算的阈值。在已知最终结果的基础上,对多元模型的预测能力进行了测试。这一预测在43个案例中有41个是正确的。结论。采用多变量logistic回归方法,确定了两个相互独立的乘法指标,T1椎体倾斜度和胸椎后凸是预测PJK的高精度指标(灵敏度94.1%,特异性100.0%)。
{"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}
引用次数: 0
Comparative radiological analysis of hybrid and circular stabilization methods for the treatment of osteoporotic vertebral burst fractures 混合与圆形固定方法治疗骨质疏松性椎体爆裂骨折的放射学比较分析
Q3 Medicine Pub Date : 2023-10-03 DOI: 10.14531/ss2023.3.26-33
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.
目标。对混合稳定(后路固定联合水泥椎体成形术和去蛋白同种异体骨成形术)和环形稳定(后路固定联合前路融合)治疗合并骨质疏松症的椎体无并发症爆裂骨折的方法进行比较放射学分析。材料和方法。这项研究是回顾性的。形成两组患者,确定纳入和排除标准。评估后凸矫正程度(根据Cobb)、术后残留后凸畸形程度及其术后长期复发率、矢状平衡(Barrey指数)。随访期为12个月。不考虑对患者病情的主观评估。结果。初始后凸畸形大小(>20°),术后后凸矫正不完全(>5°)、密度t评分值、矢状面失衡是局部后凸复发、畸形矫正不全、失代偿性矢状面失衡的主要预测因素,且术前、术后差异有统计学意义。结论。当比较混合稳定和圆形稳定方法时,放射学结果没有统计学差异。
{"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 (&gt;20°), incomplete achievement of kyphosis correction after surgery (&gt; 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}
引用次数: 0
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Hirurgia Pozvonochnika
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