O. Prudnikova, A. Aranovich, Yu. A. Mushtaeva, A. Gubin
To review specific features of spinal sagittal balance in achondroplasia patients at stages of lower limb lengthening using the Ilizarov method. Material and Methods. Cross-sectional clinical and radiological study was performed in 29 achondroplasia patients prior to lower limb lengthening and at lengthening stages using the Ilizarov method. Parameters of sagittal balance of the spine and pelvis were evaluated radiologically. Clinical evaluation included examination, and assessment of neurological status and pain level. Results. Clinical manifestations of sagittal imbalance included hypokyphosis of the thoracic spine in 44.8 % of cases and increased lumbar lordosis in 55.2 %. No neurological disorders were diagnosed in patients. Pain scores 2 to 4 were observed in 17.2 % ofcases. After staged lower limb lengthening by 19.8 ± 3.3 cm, it was revealed that the values of the thoracic kyphosis, lumbar lordosis and the angle of the sacrum tilt improved and approached those of healthy peers. Vertical sagittal alignment measurements correlated with those of thoracic kyphosis. Thoracic kyphosis showed a correlation with lumbar lordosis. Pelvic indices had a moderate correlation with lumbar lordosis. Conclusion. Biomechanically substantiated transosseous compression-distraction osteosynthesis by Ilizarov technique used for lower limb lengthening in achondroplasia patients improves spinal sagittal balance parameters.
{"title":"Biomechanical aspects of spinal sagittal balance in achondroplasia patients during Ilizarov limb lengthening","authors":"O. Prudnikova, A. Aranovich, Yu. A. Mushtaeva, A. Gubin","doi":"10.14531/2018.4.7-14","DOIUrl":"https://doi.org/10.14531/2018.4.7-14","url":null,"abstract":"To review specific features of spinal sagittal balance in achondroplasia patients at stages of lower limb lengthening using the Ilizarov method. Material and Methods. Cross-sectional clinical and radiological study was performed in 29 achondroplasia patients prior to lower limb lengthening and at lengthening stages using the Ilizarov method. Parameters of sagittal balance of the spine and pelvis were evaluated radiologically. Clinical evaluation included examination, and assessment of neurological status and pain level. Results. Clinical manifestations of sagittal imbalance included hypokyphosis of the thoracic spine in 44.8 % of cases and increased lumbar lordosis in 55.2 %. No neurological disorders were diagnosed in patients. Pain scores 2 to 4 were observed in 17.2 % ofcases. After staged lower limb lengthening by 19.8 ± 3.3 cm, it was revealed that the values of the thoracic kyphosis, lumbar lordosis and the angle of the sacrum tilt improved and approached those of healthy peers. Vertical sagittal alignment measurements correlated with those of thoracic kyphosis. Thoracic kyphosis showed a correlation with lumbar lordosis. Pelvic indices had a moderate correlation with lumbar lordosis. Conclusion. Biomechanically substantiated transosseous compression-distraction osteosynthesis by Ilizarov technique used for lower limb lengthening in achondroplasia patients improves spinal sagittal balance parameters.","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":"47598738","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}
L. S. Shnaider, V. V. Pavlov, A. Krutko, V. A. Bazlov, T. Z. Mamuladze, A. V. Peleganchuk
Objective. To analyze the features of the sagittal spino-pelvic balance formation in patients with congenital hip dislocation and its changes after total hip replacement with restoration of the rotation center. Material and Methods. A retrospective analysis of medical documentation of 47 patients with congenital hip dislocation was performed, a total of 62 total hip replacements were performed. Patients were divided into two groups: Group I with unilateral congenital hip dislocation (n = 26) and Group II – with bilateral hip dislocation (n = 21). The processing and study of statistical correlation were carried out using the Spearman method at p ≤ 0.05. Results. Patients with congenital hip dislocation had average preoperative value of the global lumbar lordosis of 64.1°, and the excess value of the sacral slope angle of 46.4°, which led to hyperlordosis. After surgery, the average value of the global lumbar lordosis was 57.2°, the sacral slope – 41.5°. There was a close relationship between these parameters (r = 0.787). Conclusions. Restoration of the hip rotation center in patients with congenital hip dislocation contributes to a decrease in the sacrum incidence, pelvic anteversion, and lordosis.
{"title":"Changes in the spino-pelvic balance after hip replacement in patients with congenital hip dislocation","authors":"L. S. Shnaider, V. V. Pavlov, A. Krutko, V. A. Bazlov, T. Z. Mamuladze, A. V. Peleganchuk","doi":"10.14531/2018.4.80-86","DOIUrl":"https://doi.org/10.14531/2018.4.80-86","url":null,"abstract":"Objective. To analyze the features of the sagittal spino-pelvic balance formation in patients with congenital hip dislocation and its changes after total hip replacement with restoration of the rotation center. Material and Methods. A retrospective analysis of medical documentation of 47 patients with congenital hip dislocation was performed, a total of 62 total hip replacements were performed. Patients were divided into two groups: Group I with unilateral congenital hip dislocation (n = 26) and Group II – with bilateral hip dislocation (n = 21). The processing and study of statistical correlation were carried out using the Spearman method at p ≤ 0.05. Results. Patients with congenital hip dislocation had average preoperative value of the global lumbar lordosis of 64.1°, and the excess value of the sacral slope angle of 46.4°, which led to hyperlordosis. After surgery, the average value of the global lumbar lordosis was 57.2°, the sacral slope – 41.5°. There was a close relationship between these parameters (r = 0.787). Conclusions. Restoration of the hip rotation center in patients with congenital hip dislocation contributes to a decrease in the sacrum incidence, pelvic anteversion, and lordosis.","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":"48166037","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}
Вадим Анатольевич Бывальцев, Юрий Яковлевич Пестряков, Андрей Андреевич Калинин
Objective . To evaluate the relationship between the radiological and neuroimaging parameters of the spinal motion segment and the clinical outcome of surgical treatment of patients with degenerative diseases of the lumbosacral junction to clarify the indications for dynamic and rigid stabilization. Material and Methods . The study included 267 patients with degenerative diseases of the lumbosacral spine. Depending on the stabilization method, patients were divided into two groups: Group I (n = 83) with dynamic intervertebral disc (IVD) prosthesis; and Group II (n = 184) with interbody fusion and transpedicular fixation. Long-term clinical parameters and biomechanical characteristics before and after surgery were analyzed. Results . A significant nonparametric correlation of the long-term result of surgical treatment assessed by VAS and Oswestry Disability Index with radiological parameters and results of neuroimaging was revealed. It was determined that the use of artificial IVD allows achieving a minimum level of pain syndrome and good functional recovery with effective preservation of the volume of physiological movements in the operated segment and restoration of the total angle of lumbar lordosis. Conclusion . Objective neuroimaging data (grade II-IV of degeneration according to the measured diffusion coefficient) and radiological parameters (linear displacement of vertebrae not more than 4 mm, sagittal volume of movements in the spinal motion segment less than 6°, decrease in the height of intervertebral disc space no more than 2/3 of the superjacent one) make possible using total arthroplasty. It is advisable to perform interbody fusion and rigid stabilization in grade IV-V of degeneration, linear displacement of vertebrae more than 4 mm, sagittal volume of movements of at least 6°, and decrease in the interbody space height over 2/3 of the superjacent one.
{"title":"ВЗАИМОСВЯЗЬ СПОНДИЛОМЕТРИЧЕСКИХ ПАРАМЕТРОВ С ИСХОДОМ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ПАЦИЕНТОВ С ДЕГЕНЕРАТИВНЫМИ ЗАБОЛЕВАНИЯМИ ПОЯСНИЧНО-КРЕСТЦОВОГО ПЕРЕХОДА","authors":"Вадим Анатольевич Бывальцев, Юрий Яковлевич Пестряков, Андрей Андреевич Калинин","doi":"10.14531/SS2018.3.61-72","DOIUrl":"https://doi.org/10.14531/SS2018.3.61-72","url":null,"abstract":"Objective . To evaluate the relationship between the radiological and neuroimaging parameters of the spinal motion segment and the clinical outcome of surgical treatment of patients with degenerative diseases of the lumbosacral junction to clarify the indications for dynamic and rigid stabilization. Material and Methods . The study included 267 patients with degenerative diseases of the lumbosacral spine. Depending on the stabilization method, patients were divided into two groups: Group I (n = 83) with dynamic intervertebral disc (IVD) prosthesis; and Group II (n = 184) with interbody fusion and transpedicular fixation. Long-term clinical parameters and biomechanical characteristics before and after surgery were analyzed. Results . A significant nonparametric correlation of the long-term result of surgical treatment assessed by VAS and Oswestry Disability Index with radiological parameters and results of neuroimaging was revealed. It was determined that the use of artificial IVD allows achieving a minimum level of pain syndrome and good functional recovery with effective preservation of the volume of physiological movements in the operated segment and restoration of the total angle of lumbar lordosis. Conclusion . Objective neuroimaging data (grade II-IV of degeneration according to the measured diffusion coefficient) and radiological parameters (linear displacement of vertebrae not more than 4 mm, sagittal volume of movements in the spinal motion segment less than 6°, decrease in the height of intervertebral disc space no more than 2/3 of the superjacent one) make possible using total arthroplasty. It is advisable to perform interbody fusion and rigid stabilization in grade IV-V of degeneration, linear displacement of vertebrae more than 4 mm, sagittal volume of movements of at least 6°, and decrease in the interbody space height over 2/3 of the superjacent one.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"15 1","pages":"61-72"},"PeriodicalIF":0.0,"publicationDate":"2018-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66713164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective. To analyze the results of surgical treatment of patients with injuries and diseases of the cervical spine operated on using transpedicular fixation with free-hand technique. Matherial and Methods. A total of 97 patients with unstable injuries, congenital and acquired deformities, as well as with tumorous lesions of the cervical spine were examined. All patients were evaluated for the stability and reliability of transpedicular fixation in the long-term period, with the analysis of mistakes and complications that arose during treatment. Results. Positive results were obtained in 94.8 % of cases, and signs of fixation instability were absent in all patients. Despite 125 cases of pedicle wall perforation, only four patients required revision surgeries. A low rate of complications was noted, including no damage to the vertebral artery. The pain syndrome in patients decreased. Conclusion. The obtained results prove high efficiency and sufficient safety of the free-hand technique for the cervical spine fixation. At the same time, the technique requires careful preoperative preparation and examination of patients, thorough knowledge of anatomy of the operated area, and experience and qualification of the surgeon.
{"title":"ТРАНСПЕДИКУЛЯРНАЯ ФИКСАЦИЯ ШЕЙНОГО ОТДЕЛА ПОЗВОНОЧНИКА В СУБАКСИАЛЬНОЙ ЗОНЕ ПО МЕТОДИКЕ FREE-HAND","authors":"Ш. Ш. Магомедов, М. Ю. Докиш, А. П. Татаринцев","doi":"10.14531/SS2018.3.13-22","DOIUrl":"https://doi.org/10.14531/SS2018.3.13-22","url":null,"abstract":"Objective. To analyze the results of surgical treatment of patients with injuries and diseases of the cervical spine operated on using transpedicular fixation with free-hand technique. Matherial and Methods. A total of 97 patients with unstable injuries, congenital and acquired deformities, as well as with tumorous lesions of the cervical spine were examined. All patients were evaluated for the stability and reliability of transpedicular fixation in the long-term period, with the analysis of mistakes and complications that arose during treatment. Results. Positive results were obtained in 94.8 % of cases, and signs of fixation instability were absent in all patients. Despite 125 cases of pedicle wall perforation, only four patients required revision surgeries. A low rate of complications was noted, including no damage to the vertebral artery. The pain syndrome in patients decreased. Conclusion. The obtained results prove high efficiency and sufficient safety of the free-hand technique for the cervical spine fixation. At the same time, the technique requires careful preoperative preparation and examination of patients, thorough knowledge of anatomy of the operated area, and experience and qualification of the surgeon.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"15 1","pages":"13-22"},"PeriodicalIF":0.0,"publicationDate":"2018-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66712115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Krutko, A. Gladkov, V. Komissarov, Natalya Vasilyevna Komissarova
Objective. To analyze mathematical model of the efficiency of the compensatory mechanism of the deformed spine. Material and Methods. The developed basic kinematic model of the spine was used. The restoration of the position of the projection of the general center of mass (GCM) was mathematically modeled, and mechanogenesis of the spinal deformity and possibility of its compensation were evaluated. To assess the reliability of the mathematical model, spinal skiagrams taken from patients with clinically confirmed pathology and sagittal imbalance were used. Results. On the basis of quantitative characteristics of the primary spine deformity of a certain clinical case and using the developed algorithm, it is possible to create a model of both a primary deformity and a compensatory response from intact segments of the spine taking into account the influencing factors. This makes it possible to use the proposed kinematic model in scientific research on predicting the course of various types of spinal deformities. Conclusion. The proposed algorithms simulating the development of spinal deformities based on the restoration of the position of the GCM projection reflect their mechanogenesis and can be used to model various pathological conditions of the spine. A complete correction of the deformity does not mean a complete cure, since the required spinal fusion creates a new, prognostically less significant, but pathological situation.
{"title":"MODELING OF THE SPINE COMPENSATORY RESPONSE TO DEFORMITY","authors":"A. Krutko, A. Gladkov, V. Komissarov, Natalya Vasilyevna Komissarova","doi":"10.14531/SS2018.3.85-91","DOIUrl":"https://doi.org/10.14531/SS2018.3.85-91","url":null,"abstract":"Objective. To analyze mathematical model of the efficiency of the compensatory mechanism of the deformed spine. Material and Methods. The developed basic kinematic model of the spine was used. The restoration of the position of the projection of the general center of mass (GCM) was mathematically modeled, and mechanogenesis of the spinal deformity and possibility of its compensation were evaluated. To assess the reliability of the mathematical model, spinal skiagrams taken from patients with clinically confirmed pathology and sagittal imbalance were used. Results. On the basis of quantitative characteristics of the primary spine deformity of a certain clinical case and using the developed algorithm, it is possible to create a model of both a primary deformity and a compensatory response from intact segments of the spine taking into account the influencing factors. This makes it possible to use the proposed kinematic model in scientific research on predicting the course of various types of spinal deformities. Conclusion. The proposed algorithms simulating the development of spinal deformities based on the restoration of the position of the GCM projection reflect their mechanogenesis and can be used to model various pathological conditions of the spine. A complete correction of the deformity does not mean a complete cure, since the required spinal fusion creates a new, prognostically less significant, but pathological situation.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47158193","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 : 2018-09-19DOI: 10.14531/ss2018.3.100-105
I. Vasilyev, V. Stupak, S. B. Tsvetovsky, I. Pendyurin, M. Selyakova, E. Voronina, D. Dolzhenko
Dumb-bell schwannomas (neurinomas) account for 15 % of the total number of spinal neurinomas. Their surgical removal in the cervical spine is a technical challenge due to intricate anatomical relationships. The paper presents a clinical case of recurrence of the dumb-bell neurinoma at the cervicothoracic level 20 years after its total single-stage removal. The tumor recurrence was confirmed by the data of neuroimaging monitoring. Repeated removal was performed. The paper describes in details the course of the disease, clinical and radiological manifestations, and results of neurophysiological monitoring.
{"title":"LATE RECURRENCE OF SPINAL NEURINOMA AFTER ITS SINGLE-STAGE TOTAL REMOVAL","authors":"I. Vasilyev, V. Stupak, S. B. Tsvetovsky, I. Pendyurin, M. Selyakova, E. Voronina, D. Dolzhenko","doi":"10.14531/ss2018.3.100-105","DOIUrl":"https://doi.org/10.14531/ss2018.3.100-105","url":null,"abstract":"Dumb-bell schwannomas (neurinomas) account for 15 % of the total number of spinal neurinomas. Their surgical removal in the cervical spine is a technical challenge due to intricate anatomical relationships. The paper presents a clinical case of recurrence of the dumb-bell neurinoma at the cervicothoracic level 20 years after its total single-stage removal. The tumor recurrence was confirmed by the data of neuroimaging monitoring. Repeated removal was performed. The paper describes in details the course of the disease, clinical and radiological manifestations, and results of neurophysiological monitoring.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66711702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Panteleyev, M. Sazhnev, D. Gorbatyuk, A. I. Kazmin, V. Pereverzev, S. Kolesov
A clinical case of surgical treatment of a female adolescent patient with multiple malformations, congenital thoracolumbar kyphoscoliosis, severe lower paraparesis and impaired functions of pelvic organs is presented with a review of the literature on the problem under consideration. During the course of treatment over several years, the patient underwent repeated revision surgical interventions because of implant instability and infectious complications. The last stage of treatment included a three-column osteotomy of the spine at the deformity apex with posterior instrumented fixation. A significant correction of the deformity was achieved. Based on the results of 18-month follow-up, the correction is maintained, the implant is stable. The patient reports a significant improvement in the quality of life.
{"title":"THREE-COLUMN OSTEOTOMY OF THE SPINE DURING REVISION SURGERY IN A PATIENT WITH CONGENITAL ANGULAR THORACOLUMBAR KYPHOSCOLIOSIS","authors":"A. Panteleyev, M. Sazhnev, D. Gorbatyuk, A. I. Kazmin, V. Pereverzev, S. Kolesov","doi":"10.14531/ss2018.3.30-38","DOIUrl":"https://doi.org/10.14531/ss2018.3.30-38","url":null,"abstract":"A clinical case of surgical treatment of a female adolescent patient with multiple malformations, congenital thoracolumbar kyphoscoliosis, severe lower paraparesis and impaired functions of pelvic organs is presented with a review of the literature on the problem under consideration. During the course of treatment over several years, the patient underwent repeated revision surgical interventions because of implant instability and infectious complications. The last stage of treatment included a three-column osteotomy of the spine at the deformity apex with posterior instrumented fixation. A significant correction of the deformity was achieved. Based on the results of 18-month follow-up, the correction is maintained, the implant is stable. The patient reports a significant improvement in the quality of life.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66712141","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 present the features of clinical manifestations, diagnostic aspects and approaches to the treatment of neurogenic deformi- ties of the spine in adults based on the literature data.Material and Methods.The literature review was performed using PubMed, Medline, Web of Science, Scopus, CrossRef, AOSpine, Clini- cal Key, eLibrary databases and references of key articles published in the period from 06.02.2017 till 04.11.2017.Results.General trends in the treatment of adult patients with neurogenic deformities of the spine have been determined. Assessment of the risk from performing an intervention, taking into account possible complications and potential outcome, determines the approach to surgery in these patients. It is necessary to develop protocols of management with the definition of the main clinical symptoms, the ratio- nale for the use of non-invasive, minimally invasive or other options for care. Surgical treatment of patients with spinal deformities asso- ciated with neurodegenerative diseases (Parkinson’s disease) is accompanied by a high rate of complications and repeated interventions. Tactical algorithms for these patients should include the consistency of non-surgical and mini-invasive techniques and considering clinical manifestations of myopathy, mielo-, radiculopathy, which, in comparison with diagnostic tests, can determine the indications and volume of decompressive interventions, and the extent and levels of spinal fixation.Conclusion.The complexity of pathogenetic mechanisms and ambiguous results of non-surgical and surgical treatment determine the need for multidisciplinary approach and the development of protocols for the management of adult patients with neurogenic deformities of the spine.
目标。根据文献资料，介绍成人脊柱神经源性畸形的临床表现、诊断特点及治疗方法。材料和方法。使用PubMed、Medline、Web of Science、Scopus、CrossRef、AOSpine、Clini- cal Key、library数据库及2017年2月6日至2017年11月4日期间发表的关键文章的参考文献进行文献综述。神经源性脊柱畸形成人患者治疗的一般趋势已经确定。对实施干预的风险进行评估，考虑到可能的并发症和潜在的结果，决定了这些患者的手术方法。有必要制定管理方案，定义主要临床症状，使用非侵入性、微创性或其他治疗方案的比例。与神经退行性疾病(帕金森病)相关的脊柱畸形患者的外科治疗伴随着高发生率的并发症和反复干预。这些患者的战术算法应包括非手术和微创技术的一致性，并考虑肌病、脊髓、神经根病的临床表现，与诊断测试相比，这些临床表现可以确定减压干预的适应症和量。结论:成人脊柱神经源性畸形的发病机制复杂，非手术和手术治疗结果不明确，需要多学科联合治疗，并制定治疗方案。
{"title":"NEUROGENIC SPINAL DEFORMITIES IN ADULTS: MODERN PROBLEMS AND APPROACHES TO TREATMENT","authors":"O. Prudnikova, A. Gushcha, Ida Nikolaevna Shatina","doi":"10.14531/SS2018.3.39-51","DOIUrl":"https://doi.org/10.14531/SS2018.3.39-51","url":null,"abstract":"Objective.To present the features of clinical manifestations, diagnostic aspects and approaches to the treatment of neurogenic deformi- ties of the spine in adults based on the literature data.Material and Methods.The literature review was performed using PubMed, Medline, Web of Science, Scopus, CrossRef, AOSpine, Clini- cal Key, eLibrary databases and references of key articles published in the period from 06.02.2017 till 04.11.2017.Results.General trends in the treatment of adult patients with neurogenic deformities of the spine have been determined. Assessment of the risk from performing an intervention, taking into account possible complications and potential outcome, determines the approach to surgery in these patients. It is necessary to develop protocols of management with the definition of the main clinical symptoms, the ratio- nale for the use of non-invasive, minimally invasive or other options for care. Surgical treatment of patients with spinal deformities asso- ciated with neurodegenerative diseases (Parkinson’s disease) is accompanied by a high rate of complications and repeated interventions. Tactical algorithms for these patients should include the consistency of non-surgical and mini-invasive techniques and considering clinical manifestations of myopathy, mielo-, radiculopathy, which, in comparison with diagnostic tests, can determine the indications and volume of decompressive interventions, and the extent and levels of spinal fixation.Conclusion.The complexity of pathogenetic mechanisms and ambiguous results of non-surgical and surgical treatment determine the need for multidisciplinary approach and the development of protocols for the management of adult patients with neurogenic deformities of the spine. ","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66712517","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}
Роман Владимирович Халепа, Владимир Сергеевич Климов, Джамиль Афетович Рзаев, И.И. Василенко, Евгений Владимирович Конев, Евгения Валерьевна Амелина
Objective. To analyze the results of surgical treatment of patients of the older age group with central spinal stenosis at the lumbar level. Material and Methods. A total of 107 patients of elderly and senile age with clinically significant degenerative central stenosis of the spinal canal were treated. They were divided into two groups: patients in Group 1 underwent bilateral decompression of nerve roots through unilateral approach; those in Group 2 - nerve root decompression supplemented with interbody fusion and transpedicular fixation. Results. The surgery resulted in statistically significant reduction in pain, improvement of the quality of life, enlargement of spinal canal dimension parameters, and increase in the distance of walking. Statistical difference in the quality of life between Groups 1 and 2 was revealed for the indicator characterizing the psychological component of the SF-36 questionnaire (p = 0.03); there were no statistical differences for the remaining indicators. The key parameter for assessing central stenosis is the cross-sectional area of the dural sac. Conclusion. Preoperative examination of patients of the older age group should be comprehensive and include CT myelography with 3D reconstruction. The cause of nerve root compression in central stenosis is a combination of various factors in 41.9 % of cases. Differential surgical tactics provides an improvement in the quality of life in 80 % of cases. Excessive decompression does not improve the quality of life of patients. Instrumental fixation does not improve the outcome of surgical intervention and should be used only for clinically significant instability of the spinal motion segment.
{"title":"SURGICAL TREATMENT OF ELDERLY AND SENILE PATIENTS WITH DEGENERATIVE CENTRAL LUMBAR SPINAL STENOSIS","authors":"Роман Владимирович Халепа, Владимир Сергеевич Климов, Джамиль Афетович Рзаев, И.И. Василенко, Евгений Владимирович Конев, Евгения Валерьевна Амелина","doi":"10.14531/SS2018.3.73-84","DOIUrl":"https://doi.org/10.14531/SS2018.3.73-84","url":null,"abstract":"Objective. To analyze the results of surgical treatment of patients of the older age group with central spinal stenosis at the lumbar level. Material and Methods. A total of 107 patients of elderly and senile age with clinically significant degenerative central stenosis of the spinal canal were treated. They were divided into two groups: patients in Group 1 underwent bilateral decompression of nerve roots through unilateral approach; those in Group 2 - nerve root decompression supplemented with interbody fusion and transpedicular fixation. Results. The surgery resulted in statistically significant reduction in pain, improvement of the quality of life, enlargement of spinal canal dimension parameters, and increase in the distance of walking. Statistical difference in the quality of life between Groups 1 and 2 was revealed for the indicator characterizing the psychological component of the SF-36 questionnaire (p = 0.03); there were no statistical differences for the remaining indicators. The key parameter for assessing central stenosis is the cross-sectional area of the dural sac. Conclusion. Preoperative examination of patients of the older age group should be comprehensive and include CT myelography with 3D reconstruction. The cause of nerve root compression in central stenosis is a combination of various factors in 41.9 % of cases. Differential surgical tactics provides an improvement in the quality of life in 80 % of cases. Excessive decompression does not improve the quality of life of patients. Instrumental fixation does not improve the outcome of surgical intervention and should be used only for clinically significant instability of the spinal motion segment.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66713394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Mazurenko, V. T. Pustovoytenko, S. Makarevich, K. Krivorot, Irina Nikolayevna Somova
Objective. To assess radiological results of anterior spinal fusion using cylindrical titanium mesh implant for lumbar spine fracture.Material and Мethods. A total of 74 adult patients with unstable fractures of the L1-L5 vertebral bodies were selected. They underwent posterior instrumental fixation, anterior decompression of the spinal cord and its roots, and anterior interbody fusion with placement of titanium mesh implant. Radiological and CT control was performed immediately and 0.5-2 years after surgery.Results. The phenomenon of implant penetration into the body/bodies of the cranial and/or caudal fused vertebrae has been revealed. Depending on the nature of penetration, single-level (into one vertebra) and two-level (into two vertebrae) variants of the implant edge penetration were identified. A method for calculating the penetration rate was developed, which value determines three grades of the implant penetration: grade 1 with a rate less than 0.1; grade 2 - 0.1-0.29; and grade 3 - more than 0.3. On this basis, the results of anterior spinal fusion are evaluated as good, satisfactory or unsatisfactory, respectively. If the implant did not penetrate, the result is considered excellent.Conclusion. The proposed rate of implant penetration allows for objective evaluation of the interbody fusion results, both immediate and long-term.
{"title":"VARIANTS OF TITANIUM MESH IMPLANT PENETRATION INTO THE LUMBAR VERTEBRAL BODIES AFTER ANTERIOR FUSION","authors":"A. Mazurenko, V. T. Pustovoytenko, S. Makarevich, K. Krivorot, Irina Nikolayevna Somova","doi":"10.14531/ss2018.3.23-29","DOIUrl":"https://doi.org/10.14531/ss2018.3.23-29","url":null,"abstract":"Objective. To assess radiological results of anterior spinal fusion using cylindrical titanium mesh implant for lumbar spine fracture.Material and Мethods. A total of 74 adult patients with unstable fractures of the L1-L5 vertebral bodies were selected. They underwent posterior instrumental fixation, anterior decompression of the spinal cord and its roots, and anterior interbody fusion with placement of titanium mesh implant. Radiological and CT control was performed immediately and 0.5-2 years after surgery.Results. The phenomenon of implant penetration into the body/bodies of the cranial and/or caudal fused vertebrae has been revealed. Depending on the nature of penetration, single-level (into one vertebra) and two-level (into two vertebrae) variants of the implant edge penetration were identified. A method for calculating the penetration rate was developed, which value determines three grades of the implant penetration: grade 1 with a rate less than 0.1; grade 2 - 0.1-0.29; and grade 3 - more than 0.3. On this basis, the results of anterior spinal fusion are evaluated as good, satisfactory or unsatisfactory, respectively. If the implant did not penetrate, the result is considered excellent.Conclusion. The proposed rate of implant penetration allows for objective evaluation of the interbody fusion results, both immediate and long-term. ","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66711975","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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