А. Л. Кудяшев, Владимир Васильевич Хоминец, Андрей Васильевич Теремшонок, Е. Б. Нагорный, С. Ю. Стадниченко, А. В. Доль, Д. В. Иванов, И. В. Кириллова, Л. Ю. Коссович, А. Л. Ковтун
Objective. To assess the results of clinical approbation of individual finite-element biomechanical model of a patient’s spino-pelvic complex with subsequent modeling of the best option of surgical treatment. Material and Methods. A biomechanical modeling of changes in the sagittal profile of a patient with degenerative disease of the lumbosacral spine, bilateral spondylolysis, and unstable grade 2 spondylolisthesis of the L4 vertebra was performed. The developed biomechanical model made it possible to assess the characteristics of the stress-strain state of the spinal motion segments aroused due to development of the disease. Within the built biomechanical model of the patient’s spino-pelvic complex, a corrective operation was further modeled that assumed a preservation of harmonious profile of sagittal spino-pelvic relationships. Post-correction characteristics of the stress-strain state of spinal motion segments were studied and compared with preoperative parameters of the biomechanical model. Results. Using methods of biomechanics and computer modeling allowed to calculate the stress-strain state of the lumbosacral spine under static load for two options of fixation and intervertebral cage implantation at the L4–L5 level: four transpedicular screws (L4–L5 vertebrae) and six transpedicular screws (L3–L4–L5 vertebrae). The simulation results showed that neither metal implants, nor elements of the lumbosacral spine experienced critical stresses and deformations that could lead to the destruction and instability of the implant. Conclusion. The developed individual biomechanical finite-element solid model of the spine and pelvis allowed for biomechanical justification of prerequisites for the formation and further progression of degenerative changes in spinal motion segments associated with violations of the sagittal profile due to grade 2 spondylolisthesis of the L4 vertebra. The model built on the results of radiological examination biomechanically substantiated the best option of corrective spine surgery allowing to minimize stresses and deformations by choosing reasonable magnitude of correction of sagittal spino-pelvic parameters and configuration of transpedicular system.
{"title":"Biomechanical modeling in surgical treatment of a patient with true lumbar spondylolisthesis","authors":"А. Л. Кудяшев, Владимир Васильевич Хоминец, Андрей Васильевич Теремшонок, Е. Б. Нагорный, С. Ю. Стадниченко, А. В. Доль, Д. В. Иванов, И. В. Кириллова, Л. Ю. Коссович, А. Л. Ковтун","doi":"10.14531/2018.4.87-94","DOIUrl":"https://doi.org/10.14531/2018.4.87-94","url":null,"abstract":"Objective. To assess the results of clinical approbation of individual finite-element biomechanical model of a patient’s spino-pelvic complex with subsequent modeling of the best option of surgical treatment. Material and Methods. A biomechanical modeling of changes in the sagittal profile of a patient with degenerative disease of the lumbosacral spine, bilateral spondylolysis, and unstable grade 2 spondylolisthesis of the L4 vertebra was performed. The developed biomechanical model made it possible to assess the characteristics of the stress-strain state of the spinal motion segments aroused due to development of the disease. Within the built biomechanical model of the patient’s spino-pelvic complex, a corrective operation was further modeled that assumed a preservation of harmonious profile of sagittal spino-pelvic relationships. Post-correction characteristics of the stress-strain state of spinal motion segments were studied and compared with preoperative parameters of the biomechanical model. Results. Using methods of biomechanics and computer modeling allowed to calculate the stress-strain state of the lumbosacral spine under static load for two options of fixation and intervertebral cage implantation at the L4–L5 level: four transpedicular screws (L4–L5 vertebrae) and six transpedicular screws (L3–L4–L5 vertebrae). The simulation results showed that neither metal implants, nor elements of the lumbosacral spine experienced critical stresses and deformations that could lead to the destruction and instability of the implant. Conclusion. The developed individual biomechanical finite-element solid model of the spine and pelvis allowed for biomechanical justification of prerequisites for the formation and further progression of degenerative changes in spinal motion segments associated with violations of the sagittal profile due to grade 2 spondylolisthesis of the L4 vertebra. The model built on the results of radiological examination biomechanically substantiated the best option of corrective spine surgery allowing to minimize stresses and deformations by choosing reasonable magnitude of correction of sagittal spino-pelvic parameters and configuration of transpedicular system.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"15 1","pages":"87-94"},"PeriodicalIF":0.0,"publicationDate":"2018-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48767362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Likhachev, V. Zaretskov, A. Shulga, Svetlana Anfasovna Gramma, I. Shchanitsyn, S. Bazhanov, A. V. Zaretskov, A. M. Donnik
Objective. To analyze the 50 most cited articles related to the diagnosis, classification and surgical treatment of injuries of the thoracolumbar junction, which influenced the study of this problem. Material and Methods. The Web of Science database was searched for keywords to detect articles related to thoracolumbar junction surgery. Articles were selected taking into account the title, abstract and the used methods, and then evaluated by the total number of citations to identify the fifty most cited. Characteristics of publications were analyzed. Results. The United States of America, Thomas Jefferson University and A.R. Vaccaro were the most productive country, institution and author, respectively, dealing with the subject. The 2000s was the most active decade in terms of the number of publications. The greatest attention of scientists dealing with the problems of thoracolumbar injury was attracted by the article by McLain et al. analyzing the causes of the failures of short-segment transpedicular systems in the early postoperative period. The article by Laursen et al. presenting the results of using recombinant bone morphogenetic protein-7 in combination with metal fixation is at the top of the list in terms of average citation index. Most articles are well-designed randomized studies with the evidence level II. Conclusion. Citation analysis allowed to identify the most relevant articles, the authors of which have made a significant contribution to the problem of surgery of the thoracolumbar junction. Study of the information field through the prism of the most cited articles allows seeing the mainstream and future development of diagnostics, classification and treatment of the injuries of this localization.
客观的分析50篇被引用最多的关于胸腰椎交界处损伤的诊断、分类和外科治疗的文章，这些文章对该问题的研究产生了影响。材料和方法。在Web of Science数据库中搜索关键词，以检测与胸腰椎交界处手术相关的文章。文章的选择考虑了标题、摘要和使用的方法，然后根据引用总数进行评估，以确定被引用最多的50篇。分析了出版物的特点。后果美利坚合众国、托马斯·杰斐逊大学和A.R.Vaccaro分别是处理这一问题最富有成效的国家、机构和作者。就出版物数量而言，2000年代是最活跃的十年。研究胸腰椎损伤问题的科学家们最为关注的是McLain等人的文章。分析了短节段经椎弓根系统在术后早期失败的原因。Laursen等人的文章介绍了将重组骨形态发生蛋白-7与金属固定结合使用的结果，这篇文章在平均引用指数方面位居榜首。大多数文章都是精心设计的证据水平为II的随机研究。结论引文分析可以确定最相关的文章，这些文章的作者对胸腰椎交界处的手术问题做出了重大贡献。通过引用最多的文章来研究信息领域，可以看到这种定位损伤的诊断、分类和治疗的主流和未来发展。
{"title":"Injuries to the thoracolumbar junction: bibliometric analysis of English-language literature","authors":"S. Likhachev, V. Zaretskov, A. Shulga, Svetlana Anfasovna Gramma, I. Shchanitsyn, S. Bazhanov, A. V. Zaretskov, A. M. Donnik","doi":"10.14531/2018.4.52-69","DOIUrl":"https://doi.org/10.14531/2018.4.52-69","url":null,"abstract":"Objective. To analyze the 50 most cited articles related to the diagnosis, classification and surgical treatment of injuries of the thoracolumbar junction, which influenced the study of this problem. Material and Methods. The Web of Science database was searched for keywords to detect articles related to thoracolumbar junction surgery. Articles were selected taking into account the title, abstract and the used methods, and then evaluated by the total number of citations to identify the fifty most cited. Characteristics of publications were analyzed. Results. The United States of America, Thomas Jefferson University and A.R. Vaccaro were the most productive country, institution and author, respectively, dealing with the subject. The 2000s was the most active decade in terms of the number of publications. The greatest attention of scientists dealing with the problems of thoracolumbar injury was attracted by the article by McLain et al. analyzing the causes of the failures of short-segment transpedicular systems in the early postoperative period. The article by Laursen et al. presenting the results of using recombinant bone morphogenetic protein-7 in combination with metal fixation is at the top of the list in terms of average citation index. Most articles are well-designed randomized studies with the evidence level II. Conclusion. Citation analysis allowed to identify the most relevant articles, the authors of which have made a significant contribution to the problem of surgery of the thoracolumbar junction. Study of the information field through the prism of the most cited articles allows seeing the mainstream and future development of diagnostics, classification and treatment of the injuries of this localization.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48888020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Rerikh, Yu. A. Predein, A. Zaidman, A. Lastevsky, V.A. Bataev V.A. Bataev V.A. Bataev, A. Nikulina
Objective. To analyze the features of bone tissue formation during plasty of vertebral body defect or fracture with an allogeneic bone graft in an experiment in vitro. Material and Methods. Models of the vertebral body defect (fracture of the cranioventral part with penetration into the nucleus pulposus) were created in an experiment on 20 mini-pigs of the same age. Plasty of traumatic defects was performed with allogeneic bone graft or autologous bone. CT, histological, and spectrometric studies of microscopic specimens were carried out at 14, 30, 90, and 180 day. Reparative osteogenesis, X-ray density, Ca and P content, and microhardness were studied. Results. After implantation of allogeneic bone graft, an organ-specific bone similar to the recipient’s bone in morphological structure, X-ray density, mineral composition and microhardness, was formed on the 90th day (P = 0.01). After transplantation of autobone, the regenerate formed by this day in the central part was in a phase of resorption and restructuring with lower indices of X-ray density, content of Ca and P, and microhardness (P = 0.01). Conclusion. Аfter plasty of vertebral body traumatic defects with allogeneic bone graft, the organ-specific bone tissue is formed at an earlier time and reliably exhibits greater mineralization and strength.
{"title":"Experimental substantiation of osteotransplant application in traumatic vertebral defects","authors":"V. Rerikh, Yu. A. Predein, A. Zaidman, A. Lastevsky, V.A. Bataev V.A. Bataev V.A. Bataev, A. Nikulina","doi":"10.14531/2018.4.41-51","DOIUrl":"https://doi.org/10.14531/2018.4.41-51","url":null,"abstract":"Objective. To analyze the features of bone tissue formation during plasty of vertebral body defect or fracture with an allogeneic bone graft in an experiment in vitro. Material and Methods. Models of the vertebral body defect (fracture of the cranioventral part with penetration into the nucleus pulposus) were created in an experiment on 20 mini-pigs of the same age. Plasty of traumatic defects was performed with allogeneic bone graft or autologous bone. CT, histological, and spectrometric studies of microscopic specimens were carried out at 14, 30, 90, and 180 day. Reparative osteogenesis, X-ray density, Ca and P content, and microhardness were studied. Results. After implantation of allogeneic bone graft, an organ-specific bone similar to the recipient’s bone in morphological structure, X-ray density, mineral composition and microhardness, was formed on the 90th day (P = 0.01). After transplantation of autobone, the regenerate formed by this day in the central part was in a phase of resorption and restructuring with lower indices of X-ray density, content of Ca and P, and microhardness (P = 0.01). Conclusion. Аfter plasty of vertebral body traumatic defects with allogeneic bone graft, the organ-specific bone tissue is formed at an earlier time and reliably exhibits greater mineralization and strength.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49147663","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 describe the original technical surgical procedure simplifying the correction of kyphosis in children due to instrumental distraction of the anterior column of the spine, to analyze its effectiveness in the setting of clinical series. Level of evidence – IV. Material and Methods. The study included 9 patients aged 7 months to 14 years (median age: 4 years 8 months) with angular kyphosis (median magnitude 53°, min – 38°, max – 80°) associated with tuberculous (n = 4) and non-specific (n = 4) spondylitis and with a sequelae of spinal cord injury (n = 1). Deformity correction was achieved using temporary instrumental interbody distraction followed by anterior fusion with titanium mesh cage filled with autologous bone graft during a single-step two-stage reconstruction and stabilization surgery. Results. The duration of surgery was 3 hours 2 min ± 44 min, the volume of blood loss – 190 ml ± 39 ml. In all cases, the deformity was corrected by 75–85 % with restoration of physiological thoracic kyphosis and spinal profile. Conclusion. A safe and effective technique for intraoperative anterior instrumental distraction can be used to correct angular kyphosis in children, including infants.
{"title":"Anterior correction of angular kyphosis in children: description of the technique and analysis of clinical series","authors":"A. Mushkin, D. Naumov, V. Zorin, M. Serdobintsev","doi":"10.14531/2018.4.15-20","DOIUrl":"https://doi.org/10.14531/2018.4.15-20","url":null,"abstract":"Objective. To describe the original technical surgical procedure simplifying the correction of kyphosis in children due to instrumental distraction of the anterior column of the spine, to analyze its effectiveness in the setting of clinical series. Level of evidence – IV. Material and Methods. The study included 9 patients aged 7 months to 14 years (median age: 4 years 8 months) with angular kyphosis (median magnitude 53°, min – 38°, max – 80°) associated with tuberculous (n = 4) and non-specific (n = 4) spondylitis and with a sequelae of spinal cord injury (n = 1). Deformity correction was achieved using temporary instrumental interbody distraction followed by anterior fusion with titanium mesh cage filled with autologous bone graft during a single-step two-stage reconstruction and stabilization surgery. Results. The duration of surgery was 3 hours 2 min ± 44 min, the volume of blood loss – 190 ml ± 39 ml. In all cases, the deformity was corrected by 75–85 % with restoration of physiological thoracic kyphosis and spinal profile. Conclusion. A safe and effective technique for intraoperative anterior instrumental distraction can be used to correct angular kyphosis in children, including infants.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66675413","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}
Вячеслав Викторович Новиков, Александр Юрьевич Сергунин, Вадим Васильевич Белозеров, Майя Николаевна Лебедева, Александр Сергеевич Васюра, Михаил Витальевич Михайловский
The paper presents a clinical case of surgical treatment of an adult patient with severe rigid congenital kyphosis developed due to multiple anomalies in the thoracolumbar spine. Surgical intervention included vertebral column resection (VCR) and the deformity correction using segmental third-generation instrumentation with transpedicular fixation. The VCR made it possible to correct the relationship between vertebrae in the anomaly zone, to improve the shape of the spinal canal and increase its volume, and to achieve apparent mobility of the spine at the apex of the kyphosis. Preservation of the anterosuperior portion of the body of the resected vertebra allowed avoiding anterior mesh cage use to support and reconstruct the anterior supporting column of the resected segment. This enabled performing necessary correction of severe kyphotic deformity, reduced the risk of neurological complications, and favored the formation of solid bone block in the long-term period after surgery.
{"title":"Surgical treatment of severe congenital kyphosis in an adult patient: rare clinical observation and a brief literature review","authors":"Вячеслав Викторович Новиков, Александр Юрьевич Сергунин, Вадим Васильевич Белозеров, Майя Николаевна Лебедева, Александр Сергеевич Васюра, Михаил Витальевич Михайловский","doi":"10.14531/2018.4.21-26","DOIUrl":"https://doi.org/10.14531/2018.4.21-26","url":null,"abstract":"The paper presents a clinical case of surgical treatment of an adult patient with severe rigid congenital kyphosis developed due to multiple anomalies in the thoracolumbar spine. Surgical intervention included vertebral column resection (VCR) and the deformity correction using segmental third-generation instrumentation with transpedicular fixation. The VCR made it possible to correct the relationship between vertebrae in the anomaly zone, to improve the shape of the spinal canal and increase its volume, and to achieve apparent mobility of the spine at the apex of the kyphosis. Preservation of the anterosuperior portion of the body of the resected vertebra allowed avoiding anterior mesh cage use to support and reconstruct the anterior supporting column of the resected segment. This enabled performing necessary correction of severe kyphotic deformity, reduced the risk of neurological complications, and favored the formation of solid bone block in the long-term period after surgery.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48041797","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 guidelines for the evaluation and treatment of vertebral pathology in patients with the consequences of spina bifida are presented for discussion among professional groups before their adoption. The guidelines are based on the literature data and the authors’ own experience. The purpose of the study is algorithmization of treatment, the material is presented mainly in the form of tables
{"title":"Vertebral syndrome in consequences of spina bifida: clinical features and treatment","authors":"S. Ryabykh, A. Mushkin, D. Savin","doi":"10.14531/2018.4.107-114","DOIUrl":"https://doi.org/10.14531/2018.4.107-114","url":null,"abstract":"The guidelines for the evaluation and treatment of vertebral pathology in patients with the consequences of spina bifida are presented for discussion among professional groups before their adoption. The guidelines are based on the literature data and the authors’ own experience. The purpose of the study is algorithmization of treatment, the material is presented mainly in the form of tables","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66675258","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 main historical aspects of the evolution of transpedicular fixation of the spine were analyzed according to the literature. The main historical stages in the development of transpedicular fixation of the spine were identified: vertebral screw fixation (King, 1944), pedicle screw plate system (Roy-Camille, 1970), external transpedicular fixation – Fixateur Externe (Magerl, 1977), internal transpedicular fixation – Fixateur Interne (Dick, 1982), transpedicular titanium implants (1987). They played a significant role in the formation of modern surgical technologies for posterior metallic osteosynthesis and the creation of multifunctional transpedicular fixation devices, which are now considered to be the gold standard of posterior fixation for various pathologies of the thoracic, lumbar and lumbosacral spine.
{"title":"Historical aspects of transpedicular fixation of the spine: literature review","authors":"S. Makarevich","doi":"10.14531/2018.4.95-106","DOIUrl":"https://doi.org/10.14531/2018.4.95-106","url":null,"abstract":"The main historical aspects of the evolution of transpedicular fixation of the spine were analyzed according to the literature. The main historical stages in the development of transpedicular fixation of the spine were identified: vertebral screw fixation (King, 1944), pedicle screw plate system (Roy-Camille, 1970), external transpedicular fixation – Fixateur Externe (Magerl, 1977), internal transpedicular fixation – Fixateur Interne (Dick, 1982), transpedicular titanium implants (1987). They played a significant role in the formation of modern surgical technologies for posterior metallic osteosynthesis and the creation of multifunctional transpedicular fixation devices, which are now considered to be the gold standard of posterior fixation for various pathologies of the thoracic, lumbar and lumbosacral spine.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66675807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Byvaltsev, A. K. Okoneshnikova, A. Kalinin, S. S. Rabinovich
Objective. To clarify indications for dynamic and rigid stabilization based on the analysis of correlation between neuroimaging parameters of facet joints (FJ) and clinical outcomes of surgical treatment of patients with degenerative diseases of the lumbar spine. Material and Methods. A total of 141 patients with degenerative diseases of the lumbar spine were surgically treated. Patients were divided into three groups: patients of Group I (n = 48) underwent surgical intervention with artificial intervertebral disc prosthesis; those of Group II (n = 42) – with interbody fusion and combined transpedicular and transfacetal stabilization; and those of Group III (n = 51) – with interbody fusion and bilateral transpedicular stabilization. The correlation between long-term clinical outcomes (pain syndrome according to VAS, functional state according to ODI, and satisfaction with surgical result according to MacNab scale) and preoperative neuroimaging parameters of FJ (degenerative changes according to Fujiwara, facet angle magnitudes, and the presence of tropism) was analyzed. Results. A direct significant nonparametric correlation of neuroimaging parameters of facet angles and FJ tropism with long-term clinical outcomes of surgical treatment according to VAS and ODI was revealed. It was established that good clinical outcomes were achieved with the following preoperative parameters: in Group I, the facet angle was less than 60°, while the presence of tropism had no correlation dependence; in Group II, the facet angle – more than 60°, in the absence of FJ tropism; and in Group III, the facet angle – more than 60°, in the presence of FJ tropism. Conclusion. Objective neuroimaging parameters of the facet angle magnitude of less than 60°, regardless of the presence of tropism, allow performing total arthroplasty. If the facet angle is more than 60°, the rigid stabilization of the operated segment is indicated; in the absence of tropism, a contralateral transfacetal fixation is possible, and in its presence – a bilateral transpedicular stabilization is reasonable.
{"title":"Interrelation of tropism and angulation parameters of facet joints and results of stabilization surgeries for degenerative diseases of the lumbar spine","authors":"V. Byvaltsev, A. K. Okoneshnikova, A. Kalinin, S. S. Rabinovich","doi":"10.14531/2018.4.70-79","DOIUrl":"https://doi.org/10.14531/2018.4.70-79","url":null,"abstract":"Objective. To clarify indications for dynamic and rigid stabilization based on the analysis of correlation between neuroimaging parameters of facet joints (FJ) and clinical outcomes of surgical treatment of patients with degenerative diseases of the lumbar spine. Material and Methods. A total of 141 patients with degenerative diseases of the lumbar spine were surgically treated. Patients were divided into three groups: patients of Group I (n = 48) underwent surgical intervention with artificial intervertebral disc prosthesis; those of Group II (n = 42) – with interbody fusion and combined transpedicular and transfacetal stabilization; and those of Group III (n = 51) – with interbody fusion and bilateral transpedicular stabilization. The correlation between long-term clinical outcomes (pain syndrome according to VAS, functional state according to ODI, and satisfaction with surgical result according to MacNab scale) and preoperative neuroimaging parameters of FJ (degenerative changes according to Fujiwara, facet angle magnitudes, and the presence of tropism) was analyzed. Results. A direct significant nonparametric correlation of neuroimaging parameters of facet angles and FJ tropism with long-term clinical outcomes of surgical treatment according to VAS and ODI was revealed. It was established that good clinical outcomes were achieved with the following preoperative parameters: in Group I, the facet angle was less than 60°, while the presence of tropism had no correlation dependence; in Group II, the facet angle – more than 60°, in the absence of FJ tropism; and in Group III, the facet angle – more than 60°, in the presence of FJ tropism. Conclusion. Objective neuroimaging parameters of the facet angle magnitude of less than 60°, regardless of the presence of tropism, allow performing total arthroplasty. If the facet angle is more than 60°, the rigid stabilization of the operated segment is indicated; in the absence of tropism, a contralateral transfacetal fixation is possible, and in its presence – a bilateral transpedicular stabilization is reasonable.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66675656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Mironov, S. Kolesov, V. Pereverzev, D. A. Kolbovsky, A. A. Kuleshov, M. S. Vetrile, A. I. Kazmin
To analyze surgical treatment of craniovertebral stenosis in patients with mucopolysaccharidosis. Material and Methods. A total of 9 patients (4 men, 5 women) with mucopolysaccharidosis were operated on for craniovertebral stenosis in 2012–2017. All patients underwent clinical examination, standard radiography of the cervical spine with functional tests to assess atlantooccipital stability according to Rothman, and MRI to determine the degree of the spinal cord compression, stenosis of the spinal canal, and changes in soft tissues surrounding the spinal canal due to fibrosis and accumulation of glycosaminoglycans. Maximum stenosis at the C0–C2 level was noted in 5 patients, at C1–C2 in 2, at C2–C4 in 1, and at C0–C1 in 1. Myelopathy in the upper cervical spine was detected in five cases. The overall somatic and functional statuses, as well as neurological parameters were assessed. Follow-up examination and X-ray examination were performed at 3, 6 and 12 months after surgery, and further every 6 months. Results. The average follow-up period was 2.5 years. The age of the patients varied from 1.8 to 34 years. After 3, 6, and 12 months after surgery, instrumentation was radiologically stable in all cases, there were no bone resorption signs around the elements of instrumentation. Seven patients showed a regression of neurologic symptoms and positive dynamics in the somatic status according to the assessment scales. In one patient, the neurological status remained unchanged. In one case, a temporary deterioration in the condition was noted after a failed intubation attempt, which required emergency tracheostomy, and operation was postponed to a later date to stabilize the condition. Complications after surgical treatment were observed in five patients. In one case, pseudoarthrosis, rod fracture, and instrumentation instability developed 1.5 years after the intervention, and revision surgery was required. Wound healing problems were observed in three patients and a liquorrhea in the early postoperative period, which was stopped without revision intervention – in one case. Conclusion. Decompression and stabilization in patients with mucopolysaccharidosis should be performed in advance, before any neurological disorder development. Fixation is required to prevent the development of instability, post-laminectomy deformities, and progression of cicatricial stenosis. Timely initiation of enzyme-replacement therapy improves the results of mucopolysaccharidosis treatment.
{"title":"Surgical treatment of craniovertebral stenosis in patients with mucopolysaccharidosis type I, II, and VI","authors":"S. Mironov, S. Kolesov, V. Pereverzev, D. A. Kolbovsky, A. A. Kuleshov, M. S. Vetrile, A. I. Kazmin","doi":"10.14531/2018.4.32-40","DOIUrl":"https://doi.org/10.14531/2018.4.32-40","url":null,"abstract":"To analyze surgical treatment of craniovertebral stenosis in patients with mucopolysaccharidosis. Material and Methods. A total of 9 patients (4 men, 5 women) with mucopolysaccharidosis were operated on for craniovertebral stenosis in 2012–2017. All patients underwent clinical examination, standard radiography of the cervical spine with functional tests to assess atlantooccipital stability according to Rothman, and MRI to determine the degree of the spinal cord compression, stenosis of the spinal canal, and changes in soft tissues surrounding the spinal canal due to fibrosis and accumulation of glycosaminoglycans. Maximum stenosis at the C0–C2 level was noted in 5 patients, at C1–C2 in 2, at C2–C4 in 1, and at C0–C1 in 1. Myelopathy in the upper cervical spine was detected in five cases. The overall somatic and functional statuses, as well as neurological parameters were assessed. Follow-up examination and X-ray examination were performed at 3, 6 and 12 months after surgery, and further every 6 months. Results. The average follow-up period was 2.5 years. The age of the patients varied from 1.8 to 34 years. After 3, 6, and 12 months after surgery, instrumentation was radiologically stable in all cases, there were no bone resorption signs around the elements of instrumentation. Seven patients showed a regression of neurologic symptoms and positive dynamics in the somatic status according to the assessment scales. In one patient, the neurological status remained unchanged. In one case, a temporary deterioration in the condition was noted after a failed intubation attempt, which required emergency tracheostomy, and operation was postponed to a later date to stabilize the condition. Complications after surgical treatment were observed in five patients. In one case, pseudoarthrosis, rod fracture, and instrumentation instability developed 1.5 years after the intervention, and revision surgery was required. Wound healing problems were observed in three patients and a liquorrhea in the early postoperative period, which was stopped without revision intervention – in one case. Conclusion. Decompression and stabilization in patients with mucopolysaccharidosis should be performed in advance, before any neurological disorder development. Fixation is required to prevent the development of instability, post-laminectomy deformities, and progression of cicatricial stenosis. Timely initiation of enzyme-replacement therapy improves the results of mucopolysaccharidosis treatment.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66675839","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}
Two cases of surgical treatment for lesions of the craniovertebral junction in patients with ankylosing spondylitis accompanied by severe neurological symptoms are described. Patients underwent one-step combined interventions. The first stage included occipitospondylodesis using screw instrumentation, and the second – transoral removal of the C2 odontoid process. Surgical treatment resulted in elimination of the spinal cord compression, regression of neurological deficit existed in patients before surgery, and achievement of stable fixation in the intervention area.
{"title":"Lesion of the craniovertebral junction in ankylosing spondylitis: rare clinical observations","authors":"I. Lisitsky, А. М. Kiselev","doi":"10.14531/2018.4.27-31","DOIUrl":"https://doi.org/10.14531/2018.4.27-31","url":null,"abstract":"Two cases of surgical treatment for lesions of the craniovertebral junction in patients with ankylosing spondylitis accompanied by severe neurological symptoms are described. Patients underwent one-step combined interventions. The first stage included occipitospondylodesis using screw instrumentation, and the second – transoral removal of the C2 odontoid process. Surgical treatment resulted in elimination of the spinal cord compression, regression of neurological deficit existed in patients before surgery, and achievement of stable fixation in the intervention area.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66675460","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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