An analysis of key publications devoted to transpedicular fixation of the cervical spine has been carried out. The installation of transpedicular screws in the cervical spine is a technically challenging procedure, the frequency of screw deviation from the optimal trajectory remains high even with the use of modern intraoperative technologies, and there is a risk of serious lifethreatening complications. The use of this technique allows achieving reliable three-column stabilization of the cervical spine through only posterior approach, which is the preferred or only possible option for a limited group of patients. According to literature data, screw displacement beyond the pedicle borders occurs, on average, in 15-20 % of cases, while clinically significant complications occur in 4-5 % of cases. Among 32 operated patients, one severe neurologic complication caused by vertebral artery compression by the screw was noted. Of the 79 installed screws, 18 (22.79 %) cases of lateral pedicle wall perforation were observed. There were no cases of the fixator instability, infection and radiculopathy due to compression by the screw.
Malignant neoplasms remain the leading cause of death worldwide. The spine is a target for metastasis more often than other skeletal bones. This article details the principles of diagnosis, treatment, and the clinical picture of secondarylesions of the spinal column. The causes of pain syndrome in cancerous lesions of the spine are reviewed: compression of nerve structures, pathological fractures, spinal instability, lytic foci and paraneoplastic pain syndrome. The causes and patterns of each type of pain syndrome are described in detail. The article presents the scales used to predict the life expectancy of these patients: Tokuhashi, Tomita and Bauer. The effectiveness of these scales is compared. The selection criteria for surgical treatment of patients with metastatic lesions of the spine are described in detail. Modern methods of surgical treatment of secondary lesions of the spinal column are presented: palliative, subtotal, total (enblock resections). The indications and contraindications for each type of surgical treatment are described. Methods of intraoperative hemostasis are described, with the special attention given to preoperative tumor embolization. The errors and complications of this technique are described in detail. The correlation dependence of intraoperative blood loss volume on the embolization terms is presented. Modern trends in the development of surgical methods in metastatic spinal tumors are described in conclusion.
Objective: to compare the results of minimally invasive and open surgery in the treatment of the patients with combined symptomatic degenerative stenosis and scoliotic deformity of the lumbar spine. Patients and methods. A retrospective comparative analysis of the long-term results of 54 patients was performed. The patients were devided in two groups: open surgery (group 1, n=39) and minimally invasive surgery (group 2, n=15). Different approaches were used based on the type of deformity (according to Berzhano and Lamartine), localization and extent of lumbar stenosis. The evaluation of volume of decompression, blood loss, time of surgery and postoperative treatment, intraoperative complications, pain and patients condition were measured using clinical scales ODI, ZCQ, SF-12 was performed. Results. No differences in the type of deformity, the severity of stenosis and clinical manifestations between groups were discovered before treatment. All characteristics of the surgery (except the intraoperative complications) - blood loss, duration of surgery, and hospital stay - were significantly less in the minimally invasive group. Postoperative assessment has shown in group 1 greater regression of axial pain syndrome (p=0.03), in group 2 greater regression of radicular syndrome (p=0.03). Assessment of quality of life based on questionnaires after 2 years has revealed no differences between groups. Conclusion. Using of minimally-invasive decompression and decompression-stabilizing surgical technologies in patients with combined stenosis and deformity of the lumbar spine allow to eliminate the syndromes of neural compression, provide sufficient correction of segmental relationships and improve the quality of life.
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