Objective. To evaluate the outcomes of the differentiated surgical treatment in patients with aggressive vertebral hemangiomas. Material and Methods. The study included 127 patients with aggressive vertebral hemangiomas operated on in 2013-2016. The tumor localization was cervical in 9.5% of cases, thoracic in 59.8 % and lumbar in 30.7 %. Patients were divided into two groups: Group I (n = 110) with type IIIA aggressive hemangiomas, and Group II (n = 17) with type IIIB aggressive hemangiomas. Preoperative assessment included clinical and neurological examination, VAS, ODI, JOA, Weinstein-Boriani-Biagini classification, and radiography; MSCT and MRI studies of the spine were performed before treatment and in 12 months after surgery. Results. Patients in Group I underwent puncture vertebroplasty. Back pain was 6 VAS, after 12 months-2 VAS. The average preoperative ODI score was 32 and decreased to 9 in 12 months after surgery. In Group II, patients underwent decompression and stabilization with intraoperative open vertebroplasty of the affected vertebra. Preoperative embolization of tumor vessels was performed in two of 17 patients to reduce intraoperative blood loss. Preoperative back pain was 6 VAS, in 12 months after surgery-2 VAS. The ODI score showed the improvement in all patients as compared to preoperative values. Conclusion. Puncture vertebroplasty ensures the achievement of good functional result in 95.4 % of cases of type IIIA aggressive hemangioma. Decompression and stabilization surgery with intraoperative open vertebroplasty provides good functional result in 93.4 % of cases of type IIIB aggressive hemangioma. The use of vertebroplasty in type IIIB aggressive hemangiomas allows for vertebral segment stabilization with a low risk of the tumor recurrence.
Objective. To evaluate the effectiveness of a modified Wiltse approach to the lumbar spine for extraforaminal disk herniation. Material and Methods. A total of 1020 patients with herniated lumbar intervertebral disc were operated on, out of them 30 (2.9 %) patients were diagnosed as having extraforaminal disc herniations most often observed at the L4-L5 (53.3 %) and L5-S1 (40.0 %) levels. Clinical manifestations included back pain in 20 patients (66.6 %) and radicular syndrome -in all patients, which was accompanied by movement disorders in 15 (50.0 %) cases and by sensitivity disorders in 9 (30 %). Evaluation of surgical results was performed in the early postoperative period and at 3 and 6 months after surgery. Clinical outcomes were assessed using modified MacNab criteria. Results. Based on MacNab criteria, an excellent outcome was observed in 45 %, good -in 42 %, and satisfactoryin 13 % of cases at 6 months after surgery. The volume of intraoperative blood loss was on average 52.8 ± 30 mL, the average length of hospital stay was 2.6 days. Conclusion. The modified Wiltse approach is an effective surgery to remove extraforaminal herniation in the lumbar spine, which allows achieving excellent and good results of treatment in 87 % of cases. Please cite this paper as: Klimov VS, Evsyukov AV, Kosimshoev MA. The modified Wiltse approach for treatment of extraforaminal disc herniation in the lumbar spine. Hir.Статья поступила в редакцию 02. 02.2016 Владимир Сергеевич Климов, канд. мед. наук, врач-нейрохирург, заведующий спинальным отделением; Алексей Владимирович Евсюков, канд. мед. наук, врач-нейрохирург; Муроджон Азамович Косимшоев, врач-нейрохирург, Федеральный центр нейрохирургии, Новосибирск. Vladimir Sergeyevich Klimov, MD, PhD, neurosurgeon, head of the spinal department; Aleksey Vladimirovich Evsyukov, MD, PhD, neurosurgeon in the spinal department; Murodzhon Azamovich Kosimshoev, neurosurgeon in the spinal department, Federal Center of Neurosurgery, Novosibirsk, Russia.
Introduction. Metastatic spinal lesion remains one of the most difficult problems of modern medicine. The purpose of treatment of patients with metastatic spinal lesion is to reduce pain, improve the quality of life, restore stability in the affected segment, prevent or reduce neurological deficits. In order to build the right treatment tactics, it is necessary to evaluate the prognosis of the life of a patient with spinal metastases before treatment.The study objective is to evaluate the prognostic significance of the Tokuhashi scale in patients with metastatic spinal lesion.Materials and methods. The study included 124 patients with metastatic spinal lesion operated in the spinal department in the period from March 2013 to July 2019 (64 (52 %) men and 60 (48%) women). The average age was 59 years and ranged from 18 to 78 years. The catamnesis ranged from 1 month to 6 years. 6 (5 %) spinal tumors were radically removed, palliative removal was performed in 77 (62 %) cases. In the remaining cases, 41 (33 %) underwent vertebroplasty. The mandatory diagnostic protocol of the preoperative examination included oncological status, clinical and neurological examination. The functional status of the patient was assessed on the Karnofski scale, life expectancy – on the Tokuhashi scale. In terms of preoperative examination, patients underwent computed tomography examination with intravenous contrast of three zones: the thoracic, abdominal cavities and pelvic region to determine the degree of dissemination of the process and, in some cases, to identify the primary focus. Currently, positron emission tomography is the optimal method of investigation at the preoperative stage. However, this method is not yet available in all clinics, so performing computed tomography scans of three zones is currently the optimal “gold standard” for examining this category of patients..Results. The life expectancy estimate was calculated for each patient according to the Tokuhashi scale (2005). Survival analysis was performed using Kaplan-Meier curves within the Tokuhashi prognostic groups. The median survival within the Tokuhashi groups was more than 3 years for the group of 12–15 points (life expectancy over a year), 14 months for the group of 9–11 points (life expectancy 6 to 12 months) and 7 months for the group of 1–8 points (life expectancy less than 6 months). The Cox model was used to identify factors related to survival.Conclusion. Determining the tactics of surgical treatment of a patient with a metastatic lesion of the spine is a complex and multicomponent question to which there is no unambiguous answer. A multidisciplinary consultation is currently the most adequate and reliable way to determine the treatment strategy for this category of patients. The use of the Tokuhashi prognostic scale is an additional effective tool for determining the life expectancy of patients with spinal metastases, and thus, in some cases, serve as the tool with which it is possible to determine the tactics of surgical treatment of patients.
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