The aim of the study was to evaluate the effectiveness of the accelerated recovery program for patients with polysegmental degenerative diseases of the lumbar spine.Materials and Methods. This prospective study included 53 patients who underwent two-level transforaminal interbody fusion in the L II -S I segments. Two groups were identified: in group 1 (n=24), operations were performed using the accelerated recovery program; in group 2 (n=29), open rigid stabilization was used under traditional intravenous anesthesia. The end-point parameters were the number of bed-days spent in the hospital after the operation, the number of perioperative surgical complications and adverse effects of anesthesia, and the number of re-hospitalizations within 90 days. We also recorded the time of patient activation, the level of pain around the operated zone (using a visual analogue scale), and the quality of life in the long-term postoperative period (median 18 months); the latter was assessed using the SF-36 questionnaire (physical and psychological components of health).Results. Patients under the accelerated recovery program were found to have a shorter duration of surgery and anesthesia, less blood loss, lower amounts of injected opioids, faster verticalization, and a reduced period of inpatient treatment (p<0.05 for all parameters). As compared to group 2, patients in group 1 had a lower level of pain in the surgery zone (p<0.05), better long-term indicators of the physical and psychological components of health (p<0.05), a lower number of anesthesia-associated adverse events (p<0.05), and a lower rate of postoperative complications (p<0.05). During the 90-day postoperative observation, four patients of group 2 (13.8%) were urgently referred to a medical institution for additional medical care.Conclusion. The accelerated recovery program for two-level interbody fusion showed its safety and high clinical efficiency in the treatment of patients with polysegmental degenerative diseases of the lumbar spine. The program can be used in any center for spine surgery where effective interaction between polyvalent medical and nursing teams is maintained.
The aim of the study was to assess clinical decision support system (CDSS) in spinal surgery for personalized minimally invasive technologies on lumbar spine. Materials and Methods The prospective study involved 59 patients operated on using CDSS based on a personalized surgical algorithm considering patient-specific parameters of lumbar segments. Among them, 11 patients underwent total disk replacement (TDR), 25 and 23 patients had minimally invasive (MI-TLIF) and open (O-TLIF) dorsal rigid stabilization, respectively, according to an original technology. The comparative analysis was carried out using retrospective findings of 196 patients operated on involving TDR (n=42), MI-TLIF (n=79), and O-TLIF (n=75). The efficiency of CDSS medical algorithms was assessed by pain syndrome in the lumbar spine and lower limbs, as well as by patients’ functional status on discharge according to ODI, 3 and 6 months after the operation. Results The comparison by gender characteristics and anthropometric data revealed no significant intergroup differences among the groups under study (p>0.05). Intergroup analysis of functional status by ODI, pain intensity in lower limbs and lumbar spine showed better clinical outcomes in patients operated using CDSS compared to a retrospective group (p<0.05): 6 months after TDR and O-TLIF, and 3 months after MI-TLIF. Conclusion The study findings demonstrated high efficiency of CDSS developed for personalized surgical treatment of patients with degenerative lumbar spine diseases taking into consideration individual biometric parameters of lumbar segments.
2 ЧУЗ «Клиническая больница РЖД-Медицина» г. Иркутск, Иркутск; 3 ФГБНУ «Иркутский научный центр хирургии и травматологии», Иркутск; 4 ГБОУ ДПО «Иркутская государственная медицинская академия последипломного образования», Иркутск Цель исследования: провести анализ факторов риска развития неудовлетворительных отдаленных клинических исходов после выполнения двухуровневой дорзальной ригидной стабилизации при лечении пациентов с дегенеративными заболеваниями поясничного отдела позвоночника. Ретроспективно проанализированы результаты хирургического лечения 469 пациентов, оперированных в период с 2009 по 2014 г. в Центре нейрохирургии Дорожной клинической больницы г. Иркутска. Выполнен анализ характеристик оперативного вмешательства, течения анестезиологического пособия, уровня болевого синдрома по визуально-аналоговой шкале (ВАШ), функционального состояния по индексу ODI, удовлетворенности исходом операции по шкале Macnab в раннем и отдаленном послеоперационном периодах. Для выявления и оценки влияния различных факторов риска на развитие неудовлетворительных отдаленных клинических исходов после выполнения двухуровневой дорзальной ригидной стабилизации и анестезиологического пособия построена модель логистической регрессии фиксированных эффектов. Среди факторов риска статистически значимое влияние на развитие неудовлетворительных отдаленных клинических послеоперационных исходов оказывают: женский пол (отношение шансов (ОШ) 3,8, р=0,01), возраст пациента старше 65 лет (ОШ 20,6, р<0,001), индекс массы тела более 25 кг/м2 (ОШ 6, р=0,005), степень операционно-анестезиологического риска по шкале ASA ≥ III (ОШ 18,5, р=0,006), курение (ОШ 4,2, р=0,03), объем кровопотери более 500 мл (ОШ 25,7, р<0,001), наличие сопутствующих заболеваний (ОШ 5,5, р=0,002), продолжительность наркоза более 180 мин. (ОШ 17,2, р<0,001), вид оперативного вмешательства (ОШ 2,6, р=0,004). Выявленные факторы риска оказывают значительное влияние на развитие неудовлетворительных отдаленных клинических исходов после выполнения двухуровневой дорзальной ригидной стабилизации, модифицирование которых потенциально оптимизирует результаты хирургического лечения и снизит количество неблагоприятных последствий при лечении пациентов с дегенеративными заболеваниями поясничного отдела позвоночника. Ключевые слова: поясничный отдел позвоночника, дегенеративные заболевания, задняя ригидная стабилизация, многоуровневые вмешательства, послеоперационные исходы, осложнения, факторы риска. 4 SBIAGE "Irkutsk state medical academy of postgraduate education", Irkutsk To analyze the risk factors for the development of unsatisfactory long-term clinical outcomes after performing two-level dorsal rigid stabilization in the treatment of patients with degenerative diseases of the lumbar spine. The results of surgical treatment of 469 patients operated on from 2009 to 2014 at the Neurosurgery Center of the Road Clinical Hospital in Irkutsk were retrospectively analyzed. The analysis of the characteristics of the surgical intervention, the course of the anesthetic aid, the level of p...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.