Objective. To analyze the working classification of post-traumatic deformities of the thoracic and lumbar spine taking into account the main characteristics of pathological condition of the injured spinal motion segments, spinal cord and roots, affecting the choice of tactics and techniques of surgical treatment. Material and Methods. The clinical material for the classification development included 124 patients with post-traumatic deformities of the thoracic and lumbar spine operated on after 6 months to 14 years from the time of injury during 2003–2017. Results. The proposed working classification is based on the systematization of the three orthopedic features. It offers 120 variants of post-traumatic deformities of the thoracic and lumbar spine, each designated by three symbols: a digit, a letter, a digit (for example, 4.B.1 or 2.E.3). An additional option is the four surgical risk gradation of neurological status denoted by the Latin letter N with a digit from 1 to 4. Conclusion. The classification clearly systematizes numerous variants of post-traumatic deformities of the thoracic and lumbar spine based on the most clinically significant signs. Its application allows justifying the choice of a patient-specific tactical and technical option of surgical treatment.
{"title":"CLASSIFICATION OF POST-TRAUMATIC DEFORMITIES OF THE THORACIC AND LUMBAR SPINE","authors":"A. Afaunov, A. Kuzmenko, I. Basankin, M. Y. Ageev","doi":"10.14531/ss2018.2.23-32","DOIUrl":"https://doi.org/10.14531/ss2018.2.23-32","url":null,"abstract":"Objective. To analyze the working classification of post-traumatic deformities of the thoracic and lumbar spine taking into account the main characteristics of pathological condition of the injured spinal motion segments, spinal cord and roots, affecting the choice of tactics and techniques of surgical treatment. Material and Methods. The clinical material for the classification development included 124 patients with post-traumatic deformities of the thoracic and lumbar spine operated on after 6 months to 14 years from the time of injury during 2003–2017. Results. The proposed working classification is based on the systematization of the three orthopedic features. It offers 120 variants of post-traumatic deformities of the thoracic and lumbar spine, each designated by three symbols: a digit, a letter, a digit (for example, 4.B.1 or 2.E.3). An additional option is the four surgical risk gradation of neurological status denoted by the Latin letter N with a digit from 1 to 4. Conclusion. The classification clearly systematizes numerous variants of post-traumatic deformities of the thoracic and lumbar spine based on the most clinically significant signs. Its application allows justifying the choice of a patient-specific tactical and technical option of surgical treatment.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66711515","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. V. Shvets, S. Kolesov, I. N. Karpov, A. Panteleyev, I. V. Skorina, D. Gorbatyuk
{"title":"ADHESION BARRIER GEL ANTIADGEZIN FOR DEGENERATIVE LUMBAR SPINE DISEASE","authors":"V. V. Shvets, S. Kolesov, I. N. Karpov, A. Panteleyev, I. V. Skorina, D. Gorbatyuk","doi":"10.14531/ss2018.2.39-50","DOIUrl":"https://doi.org/10.14531/ss2018.2.39-50","url":null,"abstract":"","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47865798","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 complications developing during multistage correction of early severe spinal deformities of various etiologies using VEPTR instrumentation. Materials and Methods. The study included prospective group of 76 patients treated for early-onset scoliosis (EOS) with the VEPTR and VEPTR II instrumentation. Patients were classified using a randomized Classification of Early-Onset Scoliosis (C-EOS) system. In accordance with scoliosis etiology the cases were distributed as follows: 28 idiopathic, 26 congenital, 20 syndromic, and 2 neuromuscular scoliosis cases; and ratio of boys to girls was 32 : 44. The average age at the beginning of treatment was 5.4 ± 2.1 (1.6 to 9.8) years. The average follow-up period since the first stage was 2.2 (2 to 2.5) years. Results. Twenty three complications were revealed in 15 (19.7 %) patients. According to the C-EOS system, the patients with complications were referred to normoand hyperkyphotic groups. The most common complication was migration of the cranial point of implant fixation. Most complications were eliminated during the planned stage of deformity correction. In two cases, the complication resulted in cessation of the VEPTR technique using. Conclusions. The use of VEPTR instrumentation for the treatment of EOS is associated with a rather high risk of complications. This is most likely in patients with normokyphotic and hyperkyphotic deformities. Most complications are eliminated during stage correction. The need to abandon the further use of the VEPTR instrumentation is rare.
{"title":"COMPLICATIONS IN SURGERY OF EARLY-ONSET SCOLIOSIS WITH VEPTR INSTRUMENTATION: PRELIMINARY REPORT","authors":"D. N. Dolotin, V. A. Suzdalov","doi":"10.14531/ss2018.2.18-22","DOIUrl":"https://doi.org/10.14531/ss2018.2.18-22","url":null,"abstract":"Objective. To analyze complications developing during multistage correction of early severe spinal deformities of various etiologies using VEPTR instrumentation. Materials and Methods. The study included prospective group of 76 patients treated for early-onset scoliosis (EOS) with the VEPTR and VEPTR II instrumentation. Patients were classified using a randomized Classification of Early-Onset Scoliosis (C-EOS) system. In accordance with scoliosis etiology the cases were distributed as follows: 28 idiopathic, 26 congenital, 20 syndromic, and 2 neuromuscular scoliosis cases; and ratio of boys to girls was 32 : 44. The average age at the beginning of treatment was 5.4 ± 2.1 (1.6 to 9.8) years. The average follow-up period since the first stage was 2.2 (2 to 2.5) years. Results. Twenty three complications were revealed in 15 (19.7 %) patients. According to the C-EOS system, the patients with complications were referred to normoand hyperkyphotic groups. The most common complication was migration of the cranial point of implant fixation. Most complications were eliminated during the planned stage of deformity correction. In two cases, the complication resulted in cessation of the VEPTR technique using. Conclusions. The use of VEPTR instrumentation for the treatment of EOS is associated with a rather high risk of complications. This is most likely in patients with normokyphotic and hyperkyphotic deformities. Most complications are eliminated during stage correction. The need to abandon the further use of the VEPTR instrumentation is rare.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66711301","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}
{"title":"COMPUTER 3D-MODELING OF PATIENT-SPECIFIC NAVIGATIONAL TEMPLATE FOR CERVICAL SCREW INSERTION","authors":"A. Burtsev, O. M. Pavlova, S. Ryabykh, A. Gubin","doi":"10.14531/ss2018.2.33-38","DOIUrl":"https://doi.org/10.14531/ss2018.2.33-38","url":null,"abstract":"","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66711617","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}
Михаил Витальевич Михайловский, Вадим Васильевич Белозеров
Objective. To evaluate the results of surgical correction of scoliotic deformities in patients with spondylolisthesis. Material and Methods. A total of 51 patients with scoliosis and spondylolisthesis were observed in 1998–2016. Spondylolisthesis was asymptomatic in 49 cases. Most patients had grade I spondylolisthesis. Surgical correction of scoliotic deformity of the spine with segmental instrumentation was performed in 31 cases. Results. The average magnitude of the initial scoliotic curve before surgery was 67.2°, after surgery – 33.4°, and correction was 50.3 %. The magnitude of countercurve before surgery was 28.1°, after surgery – 11.1°, and correction was 35.5 %. In all cases, the L 5 vertebra was not included in the spinal fusion zone. Progression of the degree of the L 5 vertebra displacement in the postoperative period was not revealed. Neurological deficit was not observed. The average follow-up period was 5.4 ± 3.3 years. Conclusion. Correction of idiopathic scoliosis in the presence of L 5 spondylolisthesis can be carried out with good and satisfactory results and minimal risk of listhesis progression, and with preservation of the achieved result in the long-term period.
{"title":"СКОЛИОЗ И СПОНДИЛОЛИСТЕЗ: ВАРИАНТ РЕШЕНИЯ ПРОБЛЕМЫ","authors":"Михаил Витальевич Михайловский, Вадим Васильевич Белозеров","doi":"10.14531/SS2018.1.18-25","DOIUrl":"https://doi.org/10.14531/SS2018.1.18-25","url":null,"abstract":"Objective. To evaluate the results of surgical correction of scoliotic deformities in patients with spondylolisthesis. Material and Methods. A total of 51 patients with scoliosis and spondylolisthesis were observed in 1998–2016. Spondylolisthesis was asymptomatic in 49 cases. Most patients had grade I spondylolisthesis. Surgical correction of scoliotic deformity of the spine with segmental instrumentation was performed in 31 cases. Results. The average magnitude of the initial scoliotic curve before surgery was 67.2°, after surgery – 33.4°, and correction was 50.3 %. The magnitude of countercurve before surgery was 28.1°, after surgery – 11.1°, and correction was 35.5 %. In all cases, the L 5 vertebra was not included in the spinal fusion zone. Progression of the degree of the L 5 vertebra displacement in the postoperative period was not revealed. Neurological deficit was not observed. The average follow-up period was 5.4 ± 3.3 years. Conclusion. Correction of idiopathic scoliosis in the presence of L 5 spondylolisthesis can be carried out with good and satisfactory results and minimal risk of listhesis progression, and with preservation of the achieved result in the long-term period.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"15 1","pages":"18-25"},"PeriodicalIF":0.0,"publicationDate":"2018-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66710458","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}
Марк Микаелович Алексанян, Алексей Леонидович Хейло, К П Микаелян, Эдуард Гемджян Gemdzhian, Александр Георгиевич Аганесов
Objective. To analyze the effectiveness and features of microsurgical discectomy of herniated intervertebral discs in patients with excessive body weight. Material and Methods . A total of 104 patients (37 men and 67 women) aged 24–58 years with intervertebral disc hernias in the lumbar spine accompanied by compression of neural structures and radicular pain syndrome were operated on. The study group consisted of 48 obese patients who underwent microdiscectomy at the lumbar level. The control group included 56 non-obese patients operated in the same way. The level of the pain syndrome was assessed using the VAS and Oswestry’s functional activity questionnaire. Results. Preoperative pain intensity was slightly higher in patients with obesity than in those with normal body weight. Six weeks after the microdiscectomy, the radicular pain syndrome was arrested. The clinical effect of microdiscectomy persisted after 6 and 12 months. By the end of the follow-up period, some patients with excessive body weight had a tendency to have pain in the back and lower extremities. Also, patients with obesity had slightly greater intraoperative blood loss, the incidence of superficial infectious complications, the duration of the operation, and the length of hospital stay. Conclusion. The overweight factor should be considered when planning anesthesia and microsurgical discectomy in the lumbar spine.
{"title":"Микрохирургическая дискэктомия в поясничном отделе позвоночника: эффективность, болевой синдром, фактор ожирения","authors":"Марк Микаелович Алексанян, Алексей Леонидович Хейло, К П Микаелян, Эдуард Гемджян Gemdzhian, Александр Георгиевич Аганесов","doi":"10.14531/ss2018.1.42-48","DOIUrl":"https://doi.org/10.14531/ss2018.1.42-48","url":null,"abstract":"Objective. To analyze the effectiveness and features of microsurgical discectomy of herniated intervertebral discs in patients with excessive body weight. Material and Methods . A total of 104 patients (37 men and 67 women) aged 24–58 years with intervertebral disc hernias in the lumbar spine accompanied by compression of neural structures and radicular pain syndrome were operated on. The study group consisted of 48 obese patients who underwent microdiscectomy at the lumbar level. The control group included 56 non-obese patients operated in the same way. The level of the pain syndrome was assessed using the VAS and Oswestry’s functional activity questionnaire. Results. Preoperative pain intensity was slightly higher in patients with obesity than in those with normal body weight. Six weeks after the microdiscectomy, the radicular pain syndrome was arrested. The clinical effect of microdiscectomy persisted after 6 and 12 months. By the end of the follow-up period, some patients with excessive body weight had a tendency to have pain in the back and lower extremities. Also, patients with obesity had slightly greater intraoperative blood loss, the incidence of superficial infectious complications, the duration of the operation, and the length of hospital stay. Conclusion. The overweight factor should be considered when planning anesthesia and microsurgical discectomy in the lumbar spine.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"15 1","pages":"42-48"},"PeriodicalIF":0.0,"publicationDate":"2018-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66710686","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}
Сергей Валентинович Виссарионов, Кирилл Александрович Картавенко, Дмитрий Николаевич Кокушин
Objective. To assess the natural history of the lumbar spine deformity progression in children with isolated vertebral body malformation. Material and Methods . The natural course of spinal deformity associated with disrupted lumbar vertebra formation was analyzed in 40 patients aged 1 year 7 months to 17 years 11 months who received conservative treatment and dynamic follow-up during four years. Spondylography was performed in frontal and lateral projections in lying position every 6 months. Spondylograms were used to measure the magnitude of the angle of the local scoliotic and kyphotic components of deformity in the process of child’s growth and the magnitude of the angle of general lumbar lordosis. Results. The study showed that two components of deformity (scoliosis and kyphosis) were characterized by a progressive and stable course. Against the background of local curvature in the sagittal plane, the results of the study of general lordosis were distributed according to the age norm and to a flattening relative to the norm at the time of the last observation. Conclusion. At the primary examination of a patient, the initial magnitude of scoliotic curvature according to Cobb plays a predictive role in determining the further course of spinal deformity. When the magnitude of the primary curve is less than 30°, conservative therapy provides a stable course of congenital curvature, and in some children, a tendency to self-correction. Children with initial magnitude of the primary scoliotic curve of more than 30° have steady progression of congenital deformity in the lumbar spine of more than 6° during 4 years, which is an indication for surgical treatment at an early age.
{"title":"ЕСТЕСТВЕННОЕ ТЕЧЕНИЕ ВРОЖДЕННОЙ ДЕФОРМАЦИИ ПОЗВОНОЧНИКА У ДЕТЕЙ С ИЗОЛИРОВАННЫМ НАРУШЕНИЕМ ФОРМИРОВАНИЯ ПОЗВОНКА В ПОЯСНИЧНОМ ОТДЕЛЕ","authors":"Сергей Валентинович Виссарионов, Кирилл Александрович Картавенко, Дмитрий Николаевич Кокушин","doi":"10.14531/SS2018.1.6-17","DOIUrl":"https://doi.org/10.14531/SS2018.1.6-17","url":null,"abstract":"Objective. To assess the natural history of the lumbar spine deformity progression in children with isolated vertebral body malformation. Material and Methods . The natural course of spinal deformity associated with disrupted lumbar vertebra formation was analyzed in 40 patients aged 1 year 7 months to 17 years 11 months who received conservative treatment and dynamic follow-up during four years. Spondylography was performed in frontal and lateral projections in lying position every 6 months. Spondylograms were used to measure the magnitude of the angle of the local scoliotic and kyphotic components of deformity in the process of child’s growth and the magnitude of the angle of general lumbar lordosis. Results. The study showed that two components of deformity (scoliosis and kyphosis) were characterized by a progressive and stable course. Against the background of local curvature in the sagittal plane, the results of the study of general lordosis were distributed according to the age norm and to a flattening relative to the norm at the time of the last observation. Conclusion. At the primary examination of a patient, the initial magnitude of scoliotic curvature according to Cobb plays a predictive role in determining the further course of spinal deformity. When the magnitude of the primary curve is less than 30°, conservative therapy provides a stable course of congenital curvature, and in some children, a tendency to self-correction. Children with initial magnitude of the primary scoliotic curve of more than 30° have steady progression of congenital deformity in the lumbar spine of more than 6° during 4 years, which is an indication for surgical treatment at an early age.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"15 1","pages":"6-17"},"PeriodicalIF":0.0,"publicationDate":"2018-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48577870","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}
Алексей Леонидович Кудяшев, Владимир Васильевич Хоминец, Владимир Михайлович Шаповалов, П. А. Метленко, Филипп Владиславович Мироевский, Михаил Владимирович Резванцев, Андрей Васильевич Теремшонок, Константин Евгеньевич Коростелев, Владимир Дмитриевич Беседин, В. В. Скворцов
Objective. To present comparative analysis of mid- and long-term results of surgical treatment in patients with hip-spine syndrome operated on using conventional approaches and the developed algorithm. Material and Methods. The study included 175 patients aged 54.4 ± 12.7 years with grade III coxarthrosis combined with degenerative disease of the spine and vertebrogenic pain syndrome, who were admitted at the clinic for hip replacement. The study (n = 94) and comparison (n = 81) groups were identified. In the study group, the developed algorithm of rational surgical tactics was applied, and in the comparison group, standard approaches to the choice of surgical tactics were used. Results of surgical treatment in 134 patients were achieved, on average, in 9 months after surgery. Long-term results were evaluated in 55 patients, on average, in 61 months after hip replacement. Results. Using the developed algorithm allowed to increase the number of patients with good clinical and functional results, and to achieve better performance of the hip joint. The analysis of changes in patients’ satisfaction with the results of treatment demonstrated significantly higher rating of long-term outcomes as compared to mid-term. Analysis of pelvis-spine relationships confirmed the effect of hip replacement on the sagittal and frontal trunk balance. Conclusion. The developed approaches to the choice of rational surgical tactics in patients with hip-spine syndrome allows reliable improving of mid- and long-term results of surgical treatment.
{"title":"РЕЗУЛЬТАТЫ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ПАЦИЕНТОВ С КОКСОВЕРТЕБРАЛЬНЫМ СИНДРОМОМ: АПРОБАЦИЯ АЛГОРИТМА РАЦИОНАЛЬНОЙ ХИРУРГИЧЕСКОЙ ТАКТИКИ","authors":"Алексей Леонидович Кудяшев, Владимир Васильевич Хоминец, Владимир Михайлович Шаповалов, П. А. Метленко, Филипп Владиславович Мироевский, Михаил Владимирович Резванцев, Андрей Васильевич Теремшонок, Константин Евгеньевич Коростелев, Владимир Дмитриевич Беседин, В. В. Скворцов","doi":"10.14531/SS2018.1.55-64","DOIUrl":"https://doi.org/10.14531/SS2018.1.55-64","url":null,"abstract":"Objective. To present comparative analysis of mid- and long-term results of surgical treatment in patients with hip-spine syndrome operated on using conventional approaches and the developed algorithm. Material and Methods. The study included 175 patients aged 54.4 ± 12.7 years with grade III coxarthrosis combined with degenerative disease of the spine and vertebrogenic pain syndrome, who were admitted at the clinic for hip replacement. The study (n = 94) and comparison (n = 81) groups were identified. In the study group, the developed algorithm of rational surgical tactics was applied, and in the comparison group, standard approaches to the choice of surgical tactics were used. Results of surgical treatment in 134 patients were achieved, on average, in 9 months after surgery. Long-term results were evaluated in 55 patients, on average, in 61 months after hip replacement. Results. Using the developed algorithm allowed to increase the number of patients with good clinical and functional results, and to achieve better performance of the hip joint. The analysis of changes in patients’ satisfaction with the results of treatment demonstrated significantly higher rating of long-term outcomes as compared to mid-term. Analysis of pelvis-spine relationships confirmed the effect of hip replacement on the sagittal and frontal trunk balance. Conclusion. The developed approaches to the choice of rational surgical tactics in patients with hip-spine syndrome allows reliable improving of mid- and long-term results of surgical treatment.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"15 1","pages":"55-64"},"PeriodicalIF":0.0,"publicationDate":"2018-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66710759","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, М. А. Косимшоев, Алексей Владимирович Евсюков, В. С. Киселев, Е. Ю. Воронина
Objective. To evaluate the outcomes of the differentiated surgical treatment in patients with aggressive vertebral hemangiomas. Material and Methods . The study included 127 patients with aggressive vertebral hemangiomas operated on in 2013–2016. The tumor localization was cervical in 9.5% of cases, thoracic in 59.8 % and lumbar in 30.7 %. Patients were divided into two groups: Group I (n = 110) with type IIIA aggressive hemangiomas, and Group II (n = 17) with type IIIB aggressive hemangiomas. Preoperative assessment included clinical and neurological examination, VAS, ODI, JOA, Weinstein-Boriani-Biagini classification, and radiography; MSCT and MRI studies of the spine were performed before treatment and in 12 months after surgery. Results. Patients in Group I underwent puncture vertebroplasty. Back pain was 6 VAS, after 12 months – 2 VAS. The average preoperative ODI score was 32 and decreased to 9 in 12 months after surgery. In Group II, patients underwent decompression and stabilization with intraoperative open vertebroplasty of the affected vertebra. Preoperative embolization of tumor vessels was performed in two of 17 patients to reduce intraoperative blood loss. Preoperative back pain was 6 VAS, in 12 months after surgery – 2 VAS. The ODI score showed the improvement in all patients as compared to preoperative values. Conclusion . Puncture vertebroplasty ensures the achievement of good functional result in 95.4 % of cases of type IIIA aggressive hemangioma. Decompression and stabilization surgery with intraoperative open vertebroplasty provides good functional result in 93.4 % of cases of type IIIB aggressive hemangioma. The use of vertebroplasty in type IIIB aggressive hemangiomas allows for vertebral segment stabilization with a low risk of the tumor recurrence.
{"title":"Результаты дифференцированного хирургического лечения агрессивных гемангиом позвонков","authors":"Владимир Сергеевич Климов, М. А. Косимшоев, Алексей Владимирович Евсюков, В. С. Киселев, Е. Ю. Воронина","doi":"10.14531/SS2018.1.79-90","DOIUrl":"https://doi.org/10.14531/SS2018.1.79-90","url":null,"abstract":"Objective. To evaluate the outcomes of the differentiated surgical treatment in patients with aggressive vertebral hemangiomas. Material and Methods . The study included 127 patients with aggressive vertebral hemangiomas operated on in 2013–2016. The tumor localization was cervical in 9.5% of cases, thoracic in 59.8 % and lumbar in 30.7 %. Patients were divided into two groups: Group I (n = 110) with type IIIA aggressive hemangiomas, and Group II (n = 17) with type IIIB aggressive hemangiomas. Preoperative assessment included clinical and neurological examination, VAS, ODI, JOA, Weinstein-Boriani-Biagini classification, and radiography; MSCT and MRI studies of the spine were performed before treatment and in 12 months after surgery. Results. Patients in Group I underwent puncture vertebroplasty. Back pain was 6 VAS, after 12 months – 2 VAS. The average preoperative ODI score was 32 and decreased to 9 in 12 months after surgery. In Group II, patients underwent decompression and stabilization with intraoperative open vertebroplasty of the affected vertebra. Preoperative embolization of tumor vessels was performed in two of 17 patients to reduce intraoperative blood loss. Preoperative back pain was 6 VAS, in 12 months after surgery – 2 VAS. The ODI score showed the improvement in all patients as compared to preoperative values. Conclusion . Puncture vertebroplasty ensures the achievement of good functional result in 95.4 % of cases of type IIIA aggressive hemangioma. Decompression and stabilization surgery with intraoperative open vertebroplasty provides good functional result in 93.4 % of cases of type IIIB aggressive hemangioma. The use of vertebroplasty in type IIIB aggressive hemangiomas allows for vertebral segment stabilization with a low risk of the tumor recurrence.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"15 1","pages":"79-90"},"PeriodicalIF":0.0,"publicationDate":"2018-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48891516","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}
Александр Юрьевич Сергунин, Александр Сергеевич Васюра, Артем Николаевич Сорокин
Objective. To analyze the incidence of adding-on phenomenon in the surgery of Lenke type 1 idiopathic scoliosis. Material and Methods. The study included prospective analysis of radiographs of 89 patients (82 females and 7 males) with idiopathic scoliosis who met the criteria for inclusion. The age of patients at the time of surgery ranged from 12 to 25 years (mean: 16.3 ± 4.4 years). The average follow-up period was 2.3 ± 0.4 years. Scoliotic deformity corresponded to grade III according to V.D. Chaklin’s classification in 24 patients, and to grade IV in 65. The magnitude of the primary thoracic curve varied from 30° to 103° of Cobb angle (mean: 61.1° ± 17.1°). In all cases, segmental third generation instrumentation (hybrid or laminar) was used in combination with intraoperative skeletal traction with an afford equal to 50 % of the patient’s body weight. Laminar fixation was used in 6 patients, and hybrid fixation with different extent of screw installation in 83. Results. The following parameters showed significant increase: the magnitude of thoracic curve according to Cobb – 16.0° ± 4.3°, the distance from the center of the vertebra located one level distal to the lowest instrumented vertebra, to the central sacral vertical line (LIV+1-CSVL) – 3.6 ± 2.5 mm, the tilt of the lower instrumented vertebra in the coronal plane (LIV tilt angle) – 3.6° ± 2.8°, the tilt of the vertebra located one level distal to the lowest instrumented vertebra (LIV+1 tilt angle) – 4.6° ± 2.5°, and the distance from the center of the apical vertebra of the primary curve to the central sacral vertical line (AV-CSVL) – 17.2 ± 12.0 mm. A significant correlation was found between postoperative magnitude of the scoliotic curve and AV-CSVL distance, postoperative LIV+1-CSVL distance and postoperative LIV+1 tilt angle. An increase in LIV+1 tilt angle in combination with an increase in LIV+1-CSVL distance by more than 4 mm (or degrees) could be a parameter for measuring the adding-on phenomenon. Conclusion. The indication for reoperation may probably be a significant tilt of the vertebra located below the lowest instrumented vertebra, accompanied by pain syndrome and coronal imbalance.
{"title":"ФЕНОМЕН ADDING-ON ПРИ ИДИОПАТИЧЕСКИХ СКОЛИОЗАХ ПОДРОСТКОВ ТИПА LENKE I","authors":"Александр Юрьевич Сергунин, Александр Сергеевич Васюра, Артем Николаевич Сорокин","doi":"10.14531/SS2018.1.26-31","DOIUrl":"https://doi.org/10.14531/SS2018.1.26-31","url":null,"abstract":"Objective. To analyze the incidence of adding-on phenomenon in the surgery of Lenke type 1 idiopathic scoliosis. Material and Methods. The study included prospective analysis of radiographs of 89 patients (82 females and 7 males) with idiopathic scoliosis who met the criteria for inclusion. The age of patients at the time of surgery ranged from 12 to 25 years (mean: 16.3 ± 4.4 years). The average follow-up period was 2.3 ± 0.4 years. Scoliotic deformity corresponded to grade III according to V.D. Chaklin’s classification in 24 patients, and to grade IV in 65. The magnitude of the primary thoracic curve varied from 30° to 103° of Cobb angle (mean: 61.1° ± 17.1°). In all cases, segmental third generation instrumentation (hybrid or laminar) was used in combination with intraoperative skeletal traction with an afford equal to 50 % of the patient’s body weight. Laminar fixation was used in 6 patients, and hybrid fixation with different extent of screw installation in 83. Results. The following parameters showed significant increase: the magnitude of thoracic curve according to Cobb – 16.0° ± 4.3°, the distance from the center of the vertebra located one level distal to the lowest instrumented vertebra, to the central sacral vertical line (LIV+1-CSVL) – 3.6 ± 2.5 mm, the tilt of the lower instrumented vertebra in the coronal plane (LIV tilt angle) – 3.6° ± 2.8°, the tilt of the vertebra located one level distal to the lowest instrumented vertebra (LIV+1 tilt angle) – 4.6° ± 2.5°, and the distance from the center of the apical vertebra of the primary curve to the central sacral vertical line (AV-CSVL) – 17.2 ± 12.0 mm. A significant correlation was found between postoperative magnitude of the scoliotic curve and AV-CSVL distance, postoperative LIV+1-CSVL distance and postoperative LIV+1 tilt angle. An increase in LIV+1 tilt angle in combination with an increase in LIV+1-CSVL distance by more than 4 mm (or degrees) could be a parameter for measuring the adding-on phenomenon. Conclusion. The indication for reoperation may probably be a significant tilt of the vertebra located below the lowest instrumented vertebra, accompanied by pain syndrome and coronal imbalance.","PeriodicalId":37253,"journal":{"name":"Hirurgia Pozvonochnika","volume":"15 1","pages":"26-31"},"PeriodicalIF":0.0,"publicationDate":"2018-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66710535","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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