Lumbar intervertebral disc degeneration (DD) disease is one of the main risk factors for low back pain and a leading cause of population absenteeism and disability worldwide. Despite a variety of biological studies, lumbar DD is not yet fully understood, partially because there are only few studies that use systematic and integrative approaches. This urges the need for studies that integrate different omics (including genomics and transcriptomics) measured on samples within a single cohort. This protocol describes a disease-oriented Russian disc degeneration study (RuDDS) biobank recruitment and analyses aimed to facilitate further omics studies of lumbar DD integrating genomic, transcriptomic and glycomic data. A total of 1,100 participants aged over 18 with available lumbar MRI scans, medical histories and biological material (whole blood, plasma and intervertebral disc tissue samples from surgically treated patients) will be enrolled during the three-year period from two Russian clinical centers. Whole blood, plasma and disc tissue specimens will be used for genotyping with genome-wide SNP-arrays, glycome profiling and RNA sequencing, respectively. Omics data will be further used for a genome-wide association study of lumbar DD with in silico functional annotation, analysis of plasma glycome and lumbar DD disease interactions and transcriptomic data analysis including an investigation of differential expression patterns associated with lumbar DD disease. Statistical tests applied in each of the analyses will meet the standard criteria specific to the attributed study field. In a long term, the results of the study will expand fundamental knowledge about lumbar DD development and contribute to the elaboration of novel personalized approaches for disease prediction and therapy. Additionally to the lumbar disc degeneration study, a RuDDS cohort could be used for other genetic studies, as it will have unique omics data. Trial registration number NCT04600544.
Results of randomized prospective study with participation of 94 patients aged from 20 to 70 years with monosegmental lumbar spine lesions are presented. Minimum invasive surgical interventions were performed in 55 patients from the main group. Control group consisted of 39 patients in whom decompressive-stabilizing operations via conventional posteromedian approach with skeletization of posterior segments of vertebral column were performed. Average size of operative wound in open interventions more than 10 times exceeded that size in minimum invasive interventions and made up 484 ± 56 and 36 ± 12 sq.cm, respectively. Mean blood loss was 326.6 ± 278.0 ml in the main group and 855.1 ± 512.0 ml in the comparative one. In the main group no one patient required substitution hemotransfusion, while in 13 patients from the comparative group donor erythrocytic mass and/or fresh-frozen plasma were used to eliminate the deficit of blood components. Intensity of pain syndrome in the zone of surgical intervention by visual analog scale in the main group was lower than in comparative group. In the main and comparative groups the duration of hospitalization made up 6.1 ± 2.7 and 9.7 ± 3.7 bed days, respectively. In no one patient from the main group complications in the zone of operative wound were noted. Three patients from the comparative group required secondary debridement and in 1 patient early deep operative wound suppuration was observed. Application of low invasive surgical techniques for the treatment of patients with degenerative lumbar spine lesions enabled to perform radical surgical treatment with minimal iatrogenic injury. The method possessed indubitable advantages over the conventional open operations especially intraoperatively and in early postoperative period.
Objective. To analyze the early clinical and radiological outcomes of lumbar spine fusion in patients with degenerative sagittal imbalance.Material and Methods. The data of 45 patients who were operated on sequentially using a combination of surgical methods for vertebrogenic pain syndrome and (or) neurological deficit and who had a violation of the sagittal balance of degenerative origin were analyzed. All patients underwent anterior spinal fusion at the L4–L5, L5–S1 levels to correct and restore lower lumbar lordosis. The next stage was decompression through posterior approach, if necessary supplemented by interbody fusion at clinically significant lumbar levels above the L4–L5 segment. In all patients, surgical treatment was completed with screw transpedicular fixation at the levels of interbody fusion. Demographic, clinical and surgical data, and radiological parameters were evaluated.Results. The study included data from 6 men and 39 women with an average age of 58.9 ± 7.8 years. Duration of hospital stay was 27.1 ± 7.4 days. The primary surgery was performed in 33 (73.3 %) patients, and the reoperation for pain recurrence after previous surgery at the same lumbar level – in 12 (26.7 %) patients. The duration of surgery was 529.8 ± 117.8 min, the blood loss was 1130.4 ± 560.1 ml. Back and leg pain VAS score decreased after surgery from 6.7 ± 0.9 and 4.7 ± 1.4 to 3.3 ± 0.9 and 0.5 ± 0.6, respectively (p < 0.001). The ideal sagittal type according the Russoly’s classification was restored in 27 (60 %) cases, that below the ideal – in 9 (20 %), and hypercorrection was in 9 (20 %). PT decreased from 26.1° ± 5.7° to 17.4° ± 3.9° (p < 0.001) and SVA – from 6.7 ± 3.5 to 2.7 ± 2.3 cm (p < 0.001). LL increased from 36.3° ± 18.5° to 55.1° ± 11.8° (p < 0.001) and Low LL – from 13.5° ± 9.8° to 37.9° ± 8.2° (p < 0.001). According to GAP, the number of patients with severe and moderate imbalance was reduced (p < 0.001). Surgical complications were observed in 26 (57.7 %) patients.Conclusion. The multi-stage surgical treatment of patients with degenerative spinal deformities using corrective fusion in the lumbar spine significantly improves parameters of the spinopelvic and global sagittal balances in the early postoperative period.
Purpose. Compare the clinical and radiological results of treatment of patients with spinal deformities operated on using the PSO method and corrective fusion in the lumbar spine. Materials and methods. Retrospective monocenter cohort study. The data of 42 patients were analyzed. PSO (group I) was performed in 12 patients; 30 patients had a combination of surgical methods (group II) with mandatory ventral corrective spinal fusion at levels L4-L5, L5-S1. Clinical and radiological parameters were evaluated during hospitalization and at least 1 year later. Results. Postoperative hospitalization in group I 32.5 7.4 days, 27.1 7.4 in group II (p = 0.558758). The duration of the operation in group I was 402.5 55.6 minutes, in group II 526.0 116.2 minutes (p = 0.001124); blood loss 1862.5 454.3 ml versus 1096.0 543.3 ml (p = 0.000171). In both groups, significantly improved clinical and radiological parameters after surgery and after 1 year (p 0.05). In group II, as compared with group I after surgery and more than 1 year: lower back pain according to VAS (p = 0.015424 and p = 0.015424); below ODI after 1 year was (p = 0.000001). In group I, compared with group II after surgery and after 1 year, SVA is less (p = 0.029879 and p = 0.000014), lumbar lordosis is higher (p = 0.045002 and p = 0.024120), LDI is restored more optimally (p = 0.000001 and p = 0.000002), the GAP is lower (p = 0.005845 and p = 0.002639). The ideal Russoly type is restored more often in patients of group II (p = 0,00032). Complications in group I were noted in 12 (100%) patients, in group II in 13 (43.3%) patients (p = 0.001). Conclusions. In multistep surgical treatment compared with PSO, the anterior corrective interbody fusion L4-L5, L5-S1 reliably better and more harmoniously restores the sagittal balance parameters, has significantly lower volume of intraoperative blood loss, fewer perioperative complications and significantly improves the quality of life of patients.
Objective. To analyze clinical and radiological results of corrective fusion in the lumbar spine in the treatment of patients with sagittal imbalance after previous surgical interventions.Material and Methods. A retrospective monocentric study, clinical case series. The data of 18 patients operated on using a combination of surgical methods with obligatory anterior corrective fusion at the L4–L5 and/or L5–S1 levels to achieve optimal parameters of the sagittal balance disturbed or developed after previous interventions were analyzed. Clinical and radiological parameters were assessed during hospital stay and at least 10 months later.Results. The study presents data from 3 (16.7 %) men and 15 (83.3 %) women with an average age of 57.5 ± 9.1 years. Average length of hospital stay was 26.9 ± 10.1 days. In 7 (38.9 %) cases, the deformity occurred at the previously operated level and in 11 (61.1 %) – at the adjacent one. The duration of surgery was 481.4 ± 101.7 minutes, and blood loss was 1028.9 ± 594.9 ml. Back and leg pain VAS scores decreased in 10–19 months after surgery from 6.4 ± 0.9 and 4.8 ± 1.3 to 3.2 ± 1.2 and 0.9 ± 0.8, respectively (p < 0.001). The ODI score decreased from 59.6 ± 5.9 to 39.9 ± 7.7 (p < 0.001). The ideal Roussouly type was restored in 11 (61.1 %) cases, below ideal – in 3 (16.7 %), and overcorrection – in 4 (22.2 %). LL increased from 48.1 ± 13.6 ° to 56.9 ± 11.6 ° (p < 0.001), and LDI – from 40.1 ± 16.9 to 58.8 ± 10.3 (p <0.001); SVA decreased from 5.1 ± 1.9 to 3.4 ± 2.1 cm (p < 0.001), PT – from 23.9° ± 7.2° to 19.1° ± 3.8° (p < 0.001). According to GAP score, the number of patients with severe and moderate disproportion was reduced (p < 0.001). Perioperative complications were observed in 12 (66.7 %) patients.Conclusion. Multi-stage surgical correction of the residual and aggravated sagittal imbalance with obligatory anterior corrective interbody fusion after instrumental correction of degenerative spinal deformity through the posterior approach significantly improves clinical and radiological parameters and allows restoring a harmonious sagittal profile in 61.1 % of cases.
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