ObjectivesTo determine the feasibility and evaluate effectiveness of full-endoscopic surgery in gunshot wound of the spine.MethodsThree clinical cases of lumbar and thoracic spine bullet wounds made by firearms and traumatic weapons are described. Percutaneous endoscopic surgery was performed to extract bullet from the spinal canal. The results are compared to the data from literature.ResultsPercutaneous endoscopic approach to spinal canal with a possibility to extract a bullet, decompression of nerve roots, defect closure of the dura mater is demonstrated.ConclusionGood clinical outcomes allows to recommend percutaneous endoscopic surgery to manage similar lumbar and thoracic spine bullet wounds at the tertiary care level.
A clinical example of surgical treatment of a patient with long-term consequences of a gunshot blind non-penetrating wound of the lumbar spine received 15 years ago is presented. The indication for performing surgical intervention was the development of recurrent retroperitoneal phlegmon in the last year and a half against the background of the presence of a foreign body (bullet) in the interbody gap L1–L2. In the “cold” period of the inflammatory process, the least invasive operation was performed. The article describes the course of percutaneous transforaminal endoscopic removal of a foreign body, and demonstrates the possibilities of such access. The above clinical observation indicates that the method of percutaneous transforaminal endoscopic surgery may not be limited in its indications only to degenerative-dystrophic diseases of the spine.
Gliomas make up about 8 cases per 100,000 population and the number of patients with this disease is only increasing. There can be not only various types of neurological deficits among the symptoms, but also personal and emotional changes, that seriously affects the quality of life. The modern model of health care includes not only recovery of the patient’s physical functions, but also his or her psychosocial well-being. In particular, the assessment and study of the characteristics of health-related quality of life, as well as cognitive functions in patients with gliomas, is increasingly recognized as an important criterion when considering the effectiveness of treatment. To date, the features of health related quality of life and cognitive functions of patients with epilepsy and acute cerebral circulation disorders have been studied sufficiently, and, as a result, techniques have been developed that accurately assess the QOL and CF in patients with these diseases. These are QOLIE-31 and QOLIE-AD-48 questionnaires for patients with epilepsy. This is the National Institutes of Health Stroke Scale (NIHSS), Orgogozo stroke scale (OSS), World Federation of Neurological Surgeons (WFNS) scale for the clinical assessment of subarachnoid hemorrhage (SAH) for patients with acute cerebrovascular accident. At the same time, there are no generally accepted methods for assessing quality of life and neurocognitive functions that are sensitive to changes in the condition of patients with gliomas in the early postoperative period by the time of discharge from the hospital. As a result, there is no systematic information on the dynamics of the quality of life of such patients, their neurocognitive functioning. The purpose of this article was to study the literature on QOL and CF in patients affected by neurological and neurosurgical disorders for the further selection of optimal methods for assessing dynamics of the condition of patients with glial brain tumors before and after surgery. At the moment, such requirements are only partially met by the EORTC QLQ-C30 questionnaire and its application EORTC QLQ-BN20.
The morphometric parameters and surgical areas of risk of retroperitoneal approach were studied for endoprosthetics of intervertebral discs in the lumbar spine to reduce trauma and reduce the risk of complications. The study included 110 patients operated on in the period from 2017 to 2020 (72 men, 38 women) in the neurosurgical department of the 1586 Military Clinical Hospital. The average age of the patients was 44.9 15.4 years. According to the localization of access to the lumbar spine, the patients were distributed as follows: LIIILIV 8 (7.3%), LIVLV 46 (41.7%), LVSI 56 (51%). It was found that, for the intervertebral disc LV SI, the length of the skin incision was 92.5 (80; 100) mm, the length of the surgical wound was 80 (80; 110) mm, the thickness of the subcutaneous fat layer was 30 (15; 40) mm, the depth of the wound was to the spine 85 (70; 120) mm, the depth of the wound to the spinal canal 125 (107.5; 152.5) mm, the angle of operation in the horizontal plane at the level of the spine 52 (47; 59.5) degrees. On the basis of the anthropometric data of patients, the optimal length of the skin incision was determined for performing the retroperitoneal approach (120 mm for level LIIILIV, 100 mm for level LIVLV). Three variants of the inferior vena cava bifurcation have been identified for different levels of intervertebral discs in the lumbar spine: high bifurcation, left common iliac vein mainly overlaps the left half of the LIVLV intervertebral disc and does not overlap the LVSI intervertebral disc; middle bifurcation, left common iliac vein overlaps the central part of the intervertebral discs LIVLV and LVSI; low bifurcation, inferior vena cava overlaps the right side of the intervertebral disc LIVLV, inferior vena cava and left common iliac vein completely overlap the intervertebral disc LVSI. The data obtained can be used when planning retroperitoneal access to the lumbar spine in order to reduce the trauma of the operation.
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.