Ольга Михайловна Павлова, Александр Владимирович Бурцев, Александр Вадимович Губин, Сергей Олегович Рябых
Objective. To prove the safety and technical and mechanical validity of posterior screw fixation of the cervical spine in children and to compare different types of the cervical spine fixation based on our own treatment experience and literature data. Material and Methods . A retrospective analysis of 47 patients under the age of 18 years who underwent various types of posterior instrumental fixation of the cervical spine was performed. Level of Evidence – III. Results . The duration of postoperative follow-up varied from 2 months to 6.6 years (mean, 2.1 ± 1.6 years). A total of 186 screws were placed, the number of screws inserted in one patient reached 10 (mean, 3.9 ± 2.4). Postoperative complications were observed in 5 (10.6 %) patients. Conclusion . Posterior screw fixation of the cervical spine provides biomechanically reliable stabilization of the segment, helps to achieve good correction of deformity and reduction of dislocations, shortens the period of rehabilitation, and is a safe method of surgical treatment in children.
{"title":"ЗАДНЯЯ ИНСТРУМЕНТАЛЬНАЯ ФИКСАЦИЯ ШЕЙНОГО ОТДЕЛА ПОЗВОНОЧНИКА У ДЕТЕЙ: ОПЫТ ЛЕЧЕНИЯ","authors":"Ольга Михайловна Павлова, Александр Владимирович Бурцев, Александр Вадимович Губин, Сергей Олегович Рябых","doi":"10.14531/SS2017.4.27-31","DOIUrl":"https://doi.org/10.14531/SS2017.4.27-31","url":null,"abstract":"Objective. To prove the safety and technical and mechanical validity of posterior screw fixation of the cervical spine in children and to compare different types of the cervical spine fixation based on our own treatment experience and literature data. Material and Methods . A retrospective analysis of 47 patients under the age of 18 years who underwent various types of posterior instrumental fixation of the cervical spine was performed. Level of Evidence – III. Results . The duration of postoperative follow-up varied from 2 months to 6.6 years (mean, 2.1 ± 1.6 years). A total of 186 screws were placed, the number of screws inserted in one patient reached 10 (mean, 3.9 ± 2.4). Postoperative complications were observed in 5 (10.6 %) patients. Conclusion . Posterior screw fixation of the cervical spine provides biomechanically reliable stabilization of the segment, helps to achieve good correction of deformity and reduction of dislocations, shortens the period of rehabilitation, and is a safe method of surgical treatment in children.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"14 1","pages":"27-31"},"PeriodicalIF":0.0,"publicationDate":"2017-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66710001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-12-30DOI: 10.14531/SS2017.4.110-116
Н. С. Заборовский, С. В. Кострицкий, Дмитрий Пташников, В. И. Широкорад
Objective. To evaluate the impact of surgical intervention and targeted therapy on the results of treatment and survival of patients with metastases of renal cell carcinoma to the spine. Material and Methods . Retrospective analysis of 100 patients (76 men, 24 women, mean age 58.4 years) with renal cell carcinoma metastases to the spine was carried out. Metastasectomy (en block resection) was performed in 39 patients, palliative decompression and stabilization — in 61. Twenty six patients received adjuvant targeted therapy (7 with metastasectomy, 19 with palliative decompression). The pain syndrome (VAS), neurological status (Frankel scale), and survival time (from the moment of surgery till the lethal outcome or the last follow-up examination) were assessed. The Kaplan – Meier survival analysis and Log-rank test were performed. A p-value < 0.05 was considered significant. Results . All patients demonstrated restoration of neurologic function and reduction of pain syndrome. There was no significant difference in survival time in patients with metastasectomy and palliative decompression (p = 0.47). Statistically significant survival benefit was observed in patients who underwent targeted therapy (p = 0.0019). Conclusion . Targeted therapy increases survival time in patients with renal cell carcinoma metastases to the spine. Metastasectomy is advisable with additional targeted therapy.
{"title":"МЕТАСТАТИЧЕСКОЕ ПОРАЖЕНИЕ ПОЗВОНОЧНИКА НА ФОНЕ ПОЧЕЧНО-КЛЕТОЧНОГО РАКА: РЕЗУЛЬТАТЫ ЛЕЧЕНИЯ И ВЫЖИВАЕМОСТЬ ПОСЛЕ УДАЛЕНИЯ ОПУХОЛИ","authors":"Н. С. Заборовский, С. В. Кострицкий, Дмитрий Пташников, В. И. Широкорад","doi":"10.14531/SS2017.4.110-116","DOIUrl":"https://doi.org/10.14531/SS2017.4.110-116","url":null,"abstract":"Objective. To evaluate the impact of surgical intervention and targeted therapy on the results of treatment and survival of patients with metastases of renal cell carcinoma to the spine. Material and Methods . Retrospective analysis of 100 patients (76 men, 24 women, mean age 58.4 years) with renal cell carcinoma metastases to the spine was carried out. Metastasectomy (en block resection) was performed in 39 patients, palliative decompression and stabilization — in 61. Twenty six patients received adjuvant targeted therapy (7 with metastasectomy, 19 with palliative decompression). The pain syndrome (VAS), neurological status (Frankel scale), and survival time (from the moment of surgery till the lethal outcome or the last follow-up examination) were assessed. The Kaplan – Meier survival analysis and Log-rank test were performed. A p-value < 0.05 was considered significant. Results . All patients demonstrated restoration of neurologic function and reduction of pain syndrome. There was no significant difference in survival time in patients with metastasectomy and palliative decompression (p = 0.47). Statistically significant survival benefit was observed in patients who underwent targeted therapy (p = 0.0019). Conclusion . Targeted therapy increases survival time in patients with renal cell carcinoma metastases to the spine. Metastasectomy is advisable with additional targeted therapy.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"14 1","pages":"110-116"},"PeriodicalIF":0.0,"publicationDate":"2017-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66709984","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}
Евгений Сергеевич Байков, Андрей Александрович Байкалов
Objective. To identify natural radiological parameters of degenerative spinal motion segments and biochemical changes in intervertebral disc tissues, which have a significant connection with the hernia recurrence after microdiscectomy. Material and Methods . The MRI, radiography and biochemical parameters of the nucleus pulpous and annulus fibrosus tissues from patients operated for L4–L5 and L5–S1 herniation were assessed and statistically analyzed. Two groups of patients were examined: Group I (n = 50) – with recurrent hernias, Group II (n = 50) – without recurrence during three years. Results . Significant correlation was observed between recurrent lumbar disc herniation after microdiscectomy and the following biomechanical parameters: height of the intervertebral disc (p = 0.001; r = 0.69), segmental sagittal range of motion (p = 0.001; r = 0.61), lumbar lordosis (p = 0.001, r = 0.78), stage of the intervertebral disc degeneration (p = 0.001; r = 0.46), and type of hernia (p = 0.001, r = 0.45). The quantitative and qualitative characteristics of proteoglycans/glycosaminoglycans of the nucleus pulposus and annulus fibrosus differed significantly in patients of the studied groups, but significant correlation with recurrent hernias was not found (r < 0.3). Conclusion . The preserved intervertebral disc height, hypermobility of the spinal motion segment, the smoothness of the lumbar lordosis, moderate intervertebral disc degeneration, and the disc protrusion have significant connection with the recurrence of lumbar intervertebral disc herniation after microdiscectomy.
{"title":"СВЯЗЬ БИОМЕХАНИЧЕСКИХ И БИОХИМИЧЕСКИХ ПАРАМЕТРОВ ПОЗВОНОЧНО-ДВИГАТЕЛЬНЫХ СЕГМЕНТОВ С РЕЦИДИВОМ ГРЫЖ ПОЯСНИЧНЫХ МЕЖПОЗВОНКОВЫХ ДИСКОВ","authors":"Евгений Сергеевич Байков, Андрей Александрович Байкалов","doi":"10.14531/SS2017.4.61-68","DOIUrl":"https://doi.org/10.14531/SS2017.4.61-68","url":null,"abstract":"Objective. To identify natural radiological parameters of degenerative spinal motion segments and biochemical changes in intervertebral disc tissues, which have a significant connection with the hernia recurrence after microdiscectomy. Material and Methods . The MRI, radiography and biochemical parameters of the nucleus pulpous and annulus fibrosus tissues from patients operated for L4–L5 and L5–S1 herniation were assessed and statistically analyzed. Two groups of patients were examined: Group I (n = 50) – with recurrent hernias, Group II (n = 50) – without recurrence during three years. Results . Significant correlation was observed between recurrent lumbar disc herniation after microdiscectomy and the following biomechanical parameters: height of the intervertebral disc (p = 0.001; r = 0.69), segmental sagittal range of motion (p = 0.001; r = 0.61), lumbar lordosis (p = 0.001, r = 0.78), stage of the intervertebral disc degeneration (p = 0.001; r = 0.46), and type of hernia (p = 0.001, r = 0.45). The quantitative and qualitative characteristics of proteoglycans/glycosaminoglycans of the nucleus pulposus and annulus fibrosus differed significantly in patients of the studied groups, but significant correlation with recurrent hernias was not found (r < 0.3). Conclusion . The preserved intervertebral disc height, hypermobility of the spinal motion segment, the smoothness of the lumbar lordosis, moderate intervertebral disc degeneration, and the disc protrusion have significant connection with the recurrence of lumbar intervertebral disc herniation after microdiscectomy.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"14 1","pages":"61-68"},"PeriodicalIF":0.0,"publicationDate":"2017-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49106730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-12-30DOI: 10.14531/SS2017.4.95-102
Татьяна Васильевна Русова, Анастасия Александровна Воропаева
The endplate is crucial for maintaining normal functioning of a healthy intervertebral disc. It provides structural support of the spine and regulates the flow of nutrients and the metabolic processes in the disc. With age and in the pathogenesis of diseases, the cartilage undergoes degeneration and calcification thus disrupting the access of nutrients to the cells and altering the biochemical and morphological structure of the endplate and metabolic processes throughout the disc. A number of evidences points to the existence of the endplate innervation, so its damage can be a source of chronic low back pain. The presented literature review highlights the questions of anatomy and physiology of vertebral endplates and describes relationships between changes in their morphological and molecular structures and degenerative lesion of intervertebral discs and chronic back pain syndrome. The material of the study included abstracts of articles from the PubMed database, articles published in The Journal of Bone and Joint Surgery, Spine, European Spine Journal and in other journals over the past 15 years. If necessary, books and articles of previous years were used.
{"title":"строение, функции и роль Замыкательных пластинок в развитии дегенеративных заболеваний позвоночника: обзор литературы","authors":"Татьяна Васильевна Русова, Анастасия Александровна Воропаева","doi":"10.14531/SS2017.4.95-102","DOIUrl":"https://doi.org/10.14531/SS2017.4.95-102","url":null,"abstract":"The endplate is crucial for maintaining normal functioning of a healthy intervertebral disc. It provides structural support of the spine and regulates the flow of nutrients and the metabolic processes in the disc. With age and in the pathogenesis of diseases, the cartilage undergoes degeneration and calcification thus disrupting the access of nutrients to the cells and altering the biochemical and morphological structure of the endplate and metabolic processes throughout the disc. A number of evidences points to the existence of the endplate innervation, so its damage can be a source of chronic low back pain. The presented literature review highlights the questions of anatomy and physiology of vertebral endplates and describes relationships between changes in their morphological and molecular structures and degenerative lesion of intervertebral discs and chronic back pain syndrome. The material of the study included abstracts of articles from the PubMed database, articles published in The Journal of Bone and Joint Surgery, Spine, European Spine Journal and in other journals over the past 15 years. If necessary, books and articles of previous years were used.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"14 1","pages":"95-102"},"PeriodicalIF":0.0,"publicationDate":"2017-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66710855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-12-30DOI: 10.14531/ss2017.4.117-124
Роман Игоревич Голиков, Майя Николаевна Лебедева, Александр Михайлович Агеенко, А. В. Пальмаш, И. А. Стаценко
Objective . To evaluate the effectiveness of dalargin and polyoxidonium as neurovegetative protection components, when performing decompression and stabilization operations in patients in the late period of spine and spinal cord injury. Material and Methods . Perioperative parameters of central hemodynamics and stress hormone levels were analyzed in 68 patients operated on using technology of multi-stage treatment in one surgical session under three variants of general anesthesia with mechanical ventilation: sevoflurane, fentanyl, and rocuronium bromide in Group I (n = 23); sevoflurane, fentanyl, dalargin, and rocuronium bromide – in Group II (n = 21); and sevoflurane, fentanyl, polyoxidonium, and rocuronium bromide – in Group III (n = 24). Results . The duration of operation was: 385.7 ± 54.8 min in Group I, 391.5 ± 43.5 min in Group II, 399.2 ± 51.2 min in Group III, and blood loss was 1008.7 ± 89.2 ml, 968.3 ± 71.8 ml, 1001.4 ± 80.3 ml, respectively. Statistically significant differences in cardiac output parameter from initial values were recorded during anterior spinal fusion procedure and at the stage of spinal deformity correction. There were no significant differences in hemodynamics between the groups. The greatest deviations in stress hormone levels were recorded in Group I at stages of anterior spinal fusion, deformity correction, and on the first day after surgery. The level of endogenous intoxication in Group I corresponded to high severity, in Groups II and III – to moderate severity. The need for opioid analgesics was significantly lower in Groups II and III (p < 0.05). Conclusion . Inclusion of dalargin and polyoxidonium into the anesthesia program allows achieving a required level of anesthetic protection of patients during operation, while maintaining adequate reactivity of the patient’s body defenses.
{"title":"ФАРМАКОЛОГИЧЕСКИЕ СПОСОБЫ ПРОФИЛАКТИКИ ХИРУРГИЧЕСКОГО СТРЕССА У ПАЦИЕНТОВ С ТРАВМОЙ ПОЗВОНОЧНИКА","authors":"Роман Игоревич Голиков, Майя Николаевна Лебедева, Александр Михайлович Агеенко, А. В. Пальмаш, И. А. Стаценко","doi":"10.14531/ss2017.4.117-124","DOIUrl":"https://doi.org/10.14531/ss2017.4.117-124","url":null,"abstract":"Objective . To evaluate the effectiveness of dalargin and polyoxidonium as neurovegetative protection components, when performing decompression and stabilization operations in patients in the late period of spine and spinal cord injury. Material and Methods . Perioperative parameters of central hemodynamics and stress hormone levels were analyzed in 68 patients operated on using technology of multi-stage treatment in one surgical session under three variants of general anesthesia with mechanical ventilation: sevoflurane, fentanyl, and rocuronium bromide in Group I (n = 23); sevoflurane, fentanyl, dalargin, and rocuronium bromide – in Group II (n = 21); and sevoflurane, fentanyl, polyoxidonium, and rocuronium bromide – in Group III (n = 24). Results . The duration of operation was: 385.7 ± 54.8 min in Group I, 391.5 ± 43.5 min in Group II, 399.2 ± 51.2 min in Group III, and blood loss was 1008.7 ± 89.2 ml, 968.3 ± 71.8 ml, 1001.4 ± 80.3 ml, respectively. Statistically significant differences in cardiac output parameter from initial values were recorded during anterior spinal fusion procedure and at the stage of spinal deformity correction. There were no significant differences in hemodynamics between the groups. The greatest deviations in stress hormone levels were recorded in Group I at stages of anterior spinal fusion, deformity correction, and on the first day after surgery. The level of endogenous intoxication in Group I corresponded to high severity, in Groups II and III – to moderate severity. The need for opioid analgesics was significantly lower in Groups II and III (p < 0.05). Conclusion . Inclusion of dalargin and polyoxidonium into the anesthesia program allows achieving a required level of anesthetic protection of patients during operation, while maintaining adequate reactivity of the patient’s body defenses.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"14 1","pages":"117-124"},"PeriodicalIF":0.0,"publicationDate":"2017-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47279921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Kokushin, Sergey Belyanchikov, V. V. Murashko, Kirill A. Kartavenko, Nikita O. Khusainov
Objective. To perform comparative analysis of the accuracy of pedicle screw placement in spinal deformity correction in children with idiopathic scoliosis using 3D-CT navigation. Material and Methods . Surgical treatment of 96 patients aged 14–18 years with Lenke type I and V idiopathic scoliosis was performed. In the study group (n = 66), pedicle screws were inserted using the navigation station, in the control group (n = 30) – by the freehand method. The accuracy of pedicle screw position was assessed using postoperative CT images of the spine based on the Gertzbein scale. Results . The total number of pedicle screws inserted in the study group was 1166, in the control group – 546. In the study group, position of screws was correct in 96 % (1119 screws) of observations and incorrect in 4 % (47 screws). In the control group, the correct position was noted only in 78 % (426 screws) of cases, and the number of incorrectly inserted screws was significantly larger – 22 % (120 screws). In the study group, incorrectly inserted screws in the thoracic spine were detected in 4.8 % of cases, in the lumbar spine – in 2.5 %; in the control group, pedicle screws were incorrectly inserted in the thoracic spine in 35.1 % of cases, in the lumbar spine – in 10.1 %. Conclusion . Using the navigation station during surgical intervention aimed at correcting the deformity of the spine in children with idiopathic scoliosis of various locations allows a significant increase in the number of correctly inserted pedicle screws used for instrumentation.
{"title":"СРАВНИТЕЛЬНЫЙ АНАЛИЗ КОРРЕКТНОСТИ УСТАНОВКИ ТРАНСПЕДИКУЛЯРНЫХ ВИНТОВ ПРИ ХИРУРГИЧЕСКОМ ЛЕЧЕНИИ ДЕТЕЙ С ИДИОПАТИЧЕСКИМ СКОЛИОЗОМ","authors":"D. Kokushin, Sergey Belyanchikov, V. V. Murashko, Kirill A. Kartavenko, Nikita O. Khusainov","doi":"10.14531/SS2017.4.8-17","DOIUrl":"https://doi.org/10.14531/SS2017.4.8-17","url":null,"abstract":"Objective. To perform comparative analysis of the accuracy of pedicle screw placement in spinal deformity correction in children with idiopathic scoliosis using 3D-CT navigation. Material and Methods . Surgical treatment of 96 patients aged 14–18 years with Lenke type I and V idiopathic scoliosis was performed. In the study group (n = 66), pedicle screws were inserted using the navigation station, in the control group (n = 30) – by the freehand method. The accuracy of pedicle screw position was assessed using postoperative CT images of the spine based on the Gertzbein scale. Results . The total number of pedicle screws inserted in the study group was 1166, in the control group – 546. In the study group, position of screws was correct in 96 % (1119 screws) of observations and incorrect in 4 % (47 screws). In the control group, the correct position was noted only in 78 % (426 screws) of cases, and the number of incorrectly inserted screws was significantly larger – 22 % (120 screws). In the study group, incorrectly inserted screws in the thoracic spine were detected in 4.8 % of cases, in the lumbar spine – in 2.5 %; in the control group, pedicle screws were incorrectly inserted in the thoracic spine in 35.1 % of cases, in the lumbar spine – in 10.1 %. Conclusion . Using the navigation station during surgical intervention aimed at correcting the deformity of the spine in children with idiopathic scoliosis of various locations allows a significant increase in the number of correctly inserted pedicle screws used for instrumentation.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"14 1","pages":"8-17"},"PeriodicalIF":0.0,"publicationDate":"2017-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48330981","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}
Владимир Сергеевич Климов, Роман Владимирович Халепа, И.И. Василенко, Евгений Владимирович Конев, Евгения Валерьевна Амелина
Objective. To analyze the results of differentiated surgical treatment of elderly and senile patients with lateral stenosis of the lumbar spinal canal. Material and Methods . A total of 95 patients with nerve root compression and back pain were operated on. The analysis and complex evaluation of treatment results were carried out in two groups: Group 1 included 79 (84.15 %) patients with nerve root compression associated with lateral spinal canal stenosis without instability of the spinal motion segment; Group 2 – 16 (15.85 %) patients with clinically significant lateral lumbar spinal canal stenosis with one root compression and severe back pain syndrome caused by the spinal motion segment instability. The clinical and neurological status of patients was evaluated using VAS, ODI, and SF-36 questionnaires. Changes in the angle and depth of the lateral radicular recess and the instability of the spinal motion segment were assessed using CT and functional radiographic findings. Results . Lateral stenosis in elderly and senile patients is presented as a combination of compressing factors in 47.2 % of cases. The increase in the angle of the lateral radicular recess up to 30–40° and in its depth up to 5 mm resulted in reduction of the pain syndrome in the leg and back, and improvement of the quality of life. Conclusion . The use of differentiated surgical treatment tactics based on identification of the dominant clinical neurological syndrome provides good and excellent results in patients of the older age group in 83 % of cases.
{"title":"Результаты дифференцированного хирургического лечения пациентов пожилого и старческого возраста c латеральным стенозом позвоночного канала на поясничном уровне","authors":"Владимир Сергеевич Климов, Роман Владимирович Халепа, И.И. Василенко, Евгений Владимирович Конев, Евгения Валерьевна Амелина","doi":"10.14531/SS2017.4.76-84","DOIUrl":"https://doi.org/10.14531/SS2017.4.76-84","url":null,"abstract":"Objective. To analyze the results of differentiated surgical treatment of elderly and senile patients with lateral stenosis of the lumbar spinal canal. Material and Methods . A total of 95 patients with nerve root compression and back pain were operated on. The analysis and complex evaluation of treatment results were carried out in two groups: Group 1 included 79 (84.15 %) patients with nerve root compression associated with lateral spinal canal stenosis without instability of the spinal motion segment; Group 2 – 16 (15.85 %) patients with clinically significant lateral lumbar spinal canal stenosis with one root compression and severe back pain syndrome caused by the spinal motion segment instability. The clinical and neurological status of patients was evaluated using VAS, ODI, and SF-36 questionnaires. Changes in the angle and depth of the lateral radicular recess and the instability of the spinal motion segment were assessed using CT and functional radiographic findings. Results . Lateral stenosis in elderly and senile patients is presented as a combination of compressing factors in 47.2 % of cases. The increase in the angle of the lateral radicular recess up to 30–40° and in its depth up to 5 mm resulted in reduction of the pain syndrome in the leg and back, and improvement of the quality of life. Conclusion . The use of differentiated surgical treatment tactics based on identification of the dominant clinical neurological syndrome provides good and excellent results in patients of the older age group in 83 % of cases.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"14 1","pages":"76-84"},"PeriodicalIF":0.0,"publicationDate":"2017-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66710134","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}
The paper presents a review of the current literature devoted to estimation of outcomes of surgical treatment for degenerative changes in the spine using scales, tests and questionnaires. The literature search in domestic and foreign bibliographic databases has been carried out, and the use of scales, tests and questionnaires in spinal surgery was analyzed. The review presents requirements for scales, tests and questionnaires, examines the evaluation of clinical and patient-reported outcomes, and describes the advantages of multifactorial outcome evaluation. The multifactorial evaluation of outcomes is illustrated by the example of degenerative changes in the cervical spine, and includes a clinical case of surgical treatment for cervical myelopathy. The limitations of scales, tests and questionnaires are also discussed.
{"title":"ОЦЕНКА ИСХОДОВ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ДЕГЕНЕРАТИВНО-ДИСТРОФИЧЕСКИХ ЗАБОЛЕВАНИЙ ПОЗВОНОЧНИКА","authors":"А. О. Гуща, А. Р. Юсупова","doi":"10.14531/SS2017.4.85-94","DOIUrl":"https://doi.org/10.14531/SS2017.4.85-94","url":null,"abstract":"The paper presents a review of the current literature devoted to estimation of outcomes of surgical treatment for degenerative changes in the spine using scales, tests and questionnaires. The literature search in domestic and foreign bibliographic databases has been carried out, and the use of scales, tests and questionnaires in spinal surgery was analyzed. The review presents requirements for scales, tests and questionnaires, examines the evaluation of clinical and patient-reported outcomes, and describes the advantages of multifactorial outcome evaluation. The multifactorial evaluation of outcomes is illustrated by the example of degenerative changes in the cervical spine, and includes a clinical case of surgical treatment for cervical myelopathy. The limitations of scales, tests and questionnaires are also discussed.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"14 1","pages":"85-94"},"PeriodicalIF":0.0,"publicationDate":"2017-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66710304","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}
А. В. Залетина, Сергей Валентинович Виссарионов, Алексей Георгиевич Баиндурашвили, Михаил Анатольевич Садовой, К. С. Соловьева, Ольга Анатольевна Купцова
Objective. To analyze statistical data on children with isolated spinal fractures and those combined with spinal cord injury, and to study the structure of injuries. Material and Methods . Data on the number of children from 55 regions of the Russian Federation were studied, and the structure of spinal fractures and spinal column injuries combined with injuries of spinal cord and its elements was analyzed. Results . The absolute number of spinal injuries varies between regions of the Russian Federation from 2075.20 ± 166.64 cases in the Novosibirsk region to the total absence of injuries in the Republic of Tyva. The average number of superficial injuries to the spine is 10.34 ± 11.55 cases, and of injuries of the spinal column – 6.05 ± 5.51 cases per 10 thousand children. On the average, 4.30 ± 3.90 compression fractures, and 0.20 ± 0.20 unstable and complicated spinal column injuries per 10 thousand children are observed. Conclusion . On the territory of the Russian Federation, there is significant variation in the number of children with superficial injuries and spinal column injuries. The variety of data obtained indicates the difficulties in diagnosing and registration of patients with this type of traumatic injury.
{"title":"Структура повреждений позвоночника у детей в регионах Российской Федерации","authors":"А. В. Залетина, Сергей Валентинович Виссарионов, Алексей Георгиевич Баиндурашвили, Михаил Анатольевич Садовой, К. С. Соловьева, Ольга Анатольевна Купцова","doi":"10.14531/SS2017.4.52-60","DOIUrl":"https://doi.org/10.14531/SS2017.4.52-60","url":null,"abstract":"Objective. To analyze statistical data on children with isolated spinal fractures and those combined with spinal cord injury, and to study the structure of injuries. Material and Methods . Data on the number of children from 55 regions of the Russian Federation were studied, and the structure of spinal fractures and spinal column injuries combined with injuries of spinal cord and its elements was analyzed. Results . The absolute number of spinal injuries varies between regions of the Russian Federation from 2075.20 ± 166.64 cases in the Novosibirsk region to the total absence of injuries in the Republic of Tyva. The average number of superficial injuries to the spine is 10.34 ± 11.55 cases, and of injuries of the spinal column – 6.05 ± 5.51 cases per 10 thousand children. On the average, 4.30 ± 3.90 compression fractures, and 0.20 ± 0.20 unstable and complicated spinal column injuries per 10 thousand children are observed. Conclusion . On the territory of the Russian Federation, there is significant variation in the number of children with superficial injuries and spinal column injuries. The variety of data obtained indicates the difficulties in diagnosing and registration of patients with this type of traumatic injury.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"14 1","pages":"52-60"},"PeriodicalIF":0.0,"publicationDate":"2017-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49193373","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}
Андрей Александрович Зуев, Валерий Борисович Лебедев, Дмитрий Сергеевич Епифанов, Ренат Мадехатович Нурмухаметов, Глеб Владимирович Костенко, Никита Витальевич Педяш
A clinical case of surgical treatment of a female patient with posttraumatic syringomyelia which led to tetraparesis and dissociated sensory loss in the trunk and upper and lower limbs is presented. Clinical manifestations of these spinal cord changes occurred 21 years after complicated fracture of the L1 vertebra associated with complex posttraumatic spinal deformity. Multistage surgical intervention made it possible to restore liquorodynamics, perform the necessary correction of severe kyphotic deformity of the spine, and reduce the risk of torso imbalance. As a result, the syrinx practically disappeared at all levels of the study.
{"title":"Хирургическое лечение пациента с посттравматической сирингомиелией, ассоциированной со сложной посттравматической деформацией позвоночника","authors":"Андрей Александрович Зуев, Валерий Борисович Лебедев, Дмитрий Сергеевич Епифанов, Ренат Мадехатович Нурмухаметов, Глеб Владимирович Костенко, Никита Витальевич Педяш","doi":"10.14531/SS2017.4.39-44","DOIUrl":"https://doi.org/10.14531/SS2017.4.39-44","url":null,"abstract":"A clinical case of surgical treatment of a female patient with posttraumatic syringomyelia which led to tetraparesis and dissociated sensory loss in the trunk and upper and lower limbs is presented. Clinical manifestations of these spinal cord changes occurred 21 years after complicated fracture of the L1 vertebra associated with complex posttraumatic spinal deformity. Multistage surgical intervention made it possible to restore liquorodynamics, perform the necessary correction of severe kyphotic deformity of the spine, and reduce the risk of torso imbalance. As a result, the syrinx practically disappeared at all levels of the study.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"14 1","pages":"39-44"},"PeriodicalIF":0.0,"publicationDate":"2017-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66710013","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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