In the article initial experience of spinal cord stimulation for chronic pain syndromes is described. The trial was done for 62 patients, in 52 cases trial was successful and subcutaneous pulse generator were implanated. Maximal follow-up is 26 months. The level of pain evaluates at VAS. Permanent pain-relieve results were achieved in 46 patients (74,2%). These results correspond to literature data.
Background. Neurofibromatosis is a fairly rare disease (1/3000). In 1992, V. Riccardi described seven types of neurofibromatosis. Segmental neurofibromatosis (sh), also known as type V neurofibromatosis, is an extremely rare variant characterized by the development of typical cutaneous manifestations or one body segment neurofibromas. Clinical case. Currently, the literature describes about 100 cases of sh and only one of them with compression of the spinal cord. We present our first case of this nosological form with spinal cord compression in a Russian patient. A 70-year-old patient, due to an increasing paresis in the left extremities, underwent mri of the cervical spine, which revealed solid tumors located extramedullary intra-extradurally at the level of c2-c3 vertebrae with pronounced compression of the spinal cord. At the time of hospitalization, clinical presentation was characterized by deep spastic tetraparesis (1–2 points), impairment of all types of sensitivity from the c4 level by the conductive type, and dysfunction of the pelvic organs by the type of delay. Karnofsky index was 50 %, 2 points on the Fim scale. Standard c2-c3 vertebrae laminectomy was performed. Spinal cord compression was eliminated due to the removal of intradural tumors. Subsequently, extradural tumors were removed step by step. On histological examination, tumors were represented by intertwining bundles of elongated schwann cells with wavy nuclei with pointed ends and ileogenic fibers. Mucin present in the stroma separated cells and fibers. Conclusion. Sn is a rare type of neurofibromatosis. However, from the point of view of genetics, it is most likely incorrect to attribute it to a separate type of neurofibromatosis, since the cause of its development is mosaicism of somatic cells due to mutation of the NF 1 gene. Sn is rarely manifested by the development of spinal nerves multiple neurofibromas, however, it can be accompanied by a gross neurological deficit caused by compression of the spinal cord such neurofibromas. Surgical treatment is based on basic and special surgical principles that determine the anatomical and morphological characteristics of the area of intervention, the compliance of which allows for good treatment results.
This study considers modern surgical navigation systems based on augmented reality technologies. Augmented reality glasses are used to construct holograms of the patient's organs from MRI and CT data, subsequently transmitted to the glasses. Thus, in addition to seeing the actual patient, the surgeon gains visualization inside the patient's body (bones, soft tissues, blood vessels, etc.). The solutions developed at Peter the Great St. Petersburg Polytechnic University allow reducing the invasiveness of the procedure and preserving healthy tissues. This also improves the navigation process, making it easier to estimate the location and size of the tumor to be removed.We describe the application of developed systems to different types of surgical operations (removal of a malignant brain tumor, removal of a cyst of the cervical spine). We consider the specifics of novel navigation systems designed for anesthesia, for endoscopic operations. Furthermore, we discuss the construction of novel visualization systems for ultrasound machines. Our findings indicate that the technologies proposed show potential for telemedicine.
В исследовании приведены предварительные результаты использования стереорентгенографии в качестве способа интраоперационного контроля и навигации в хирургии позвоночника. В настоящее время для навигации и контроля в спинальной хирургии рутинно используется двухмерная рентгенография. Анализ плоских рентгеновских изображений может быть сопряжен со значительными трудностями в случаях сложной анатомии, в рентген-экранированных зонах и у начинающих хирургов. Способ стереорентгенографии предложен для оценки объемных характеристик структур, имеющих сложную геометрию, и особенно актуален в условиях суммации изображений от нескольких объектов. В предложенном способе используется эффект рентгеновского параллакса, позволяющий после аппаратной компьютерной обработки получить трехмерные изображения. Ранее способ успешно адаптирован для пункционной холангиографии и показал высокую точность и надежность навигации. Целью настоящей работы являлась оценка возможности клинического использования стереорентгеновской навигации для имплантации систем, стабилизирующих позвоночник. Авторами продемонстрирована возможность качественной интраоперационной визуализации основных анатомических ориентиров, используемых при транспедикулярной имплантации без увеличения лучевой нагрузки и длительности операции. Приведены методологические основы и технические приемы, улучшающие качество стереорентгеновских изображений. Предложенный способ может быть использован при выполнении стабилизирующих операций на всех отделах позвоночника, включая рентген-экранированные зоны нижнешейных и верхнегрудных позвонков. Ключевые слова: рентген-контроль, интраоперационная навигация, стереорентгенография, рентгеновский стереоэффект, хирургия позвоночника, спондилолистез, транспедикулярная фиксация. Tigliev, Saint Petersburg, 4 City Hospital No. 17, Saint Petersburg,.ru The study presents preliminary results of the use of stereoradiography as a method of intraoperative control and navigation in spine surgery. Currently, two-dimensional radiography is routinely used for navigation and control in spinal surgery. Analysis of flat X-ray images can be associated with significant difficulties in cases of complex anatomy, in X-ray screened areas and in beginning surgeons. The method of stereoradiography is proposed for estimating the volume characteristics of structures having complex geometry and is especially relevant in the context of the summation of images from several objects. The proposed method uses the X-ray parallax effect, which allows three-dimensional images to be obtained after computer-assisted processing. Previously, the method was successfully adapted for puncture cholangiography and showed high accuracy and reliability of navigation. The purpose of this work was to assess the possibility of clinical use of stereoradentgen navigation for the spinal implantation. The authors demonstrated the possibility of qualitative intraoperative visualization of the main anatomical landmarks used for transpedicular implantation without increasing the radiation dose and ...
In the article is proposed the method for preoperative spinal structures state prediction based on biomechanical studies of the spine stress -strain state. Is developed the technology and are shown the results of research for spine ligaments sprains performed at INSTRON installation. Also are shown the spine departments and implants geometric and computer models.Spine operations are divided to two main categories: operations of decompression during which pressure upon nerve roots is removed, and merge operations during which two or more vertebras are spliced among themselves, forming motionless connection. Many stabilizing operations belong to decompressive-stabilizing type, during which operations of both types are combined.Methods of visualization and diagnostics of the spine condition don't contain information required for the choice of reasonable correction method. For example, the effective operation treatment method of vertebrae's hernia often leads to postoperative complications and to diseases of in other spine departments. The issue of expediency and reduction degree of vertebras concerning a sacrum at a spondilolistez in surgical practice has no unambiguous decision.For ensuring patient treatment it is necessary to have opportunity to carry out preoperative forecasting of spine structures condition as a result of pathology elimination. Such forecasting can be constructed on the basis of biomechanical study of the spine stress -strain state. The adequate model of the patient spine should reflect: 1) individual geometrical parameters of spine structures 2) strain conditions when performing certain movements; 3) boundary conditions for the allocated spine department; 4) mechanical properties of spine structure.
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