Currently, there are no clinical decision support information technologies (CDSIT) that would consider civil-legal grounds when forming a decision for clinicians. Therefore, the design, development, and implementation of CDSIT, which considers civil-legal grounds when forming decisions, are actual problems. Methodology for the development and application of knowledge-driven, rule-based, clinical decisions support information technologies with consideration of civil-legal grounds has been developed, which provides a theoretical basis for developing clinical decisions support information technology with consideration of civil-legal grounds and partial CDSITs regarding the possibility of providing medical services of a certain type. In addition to the conclusion about the possibility or impossibility of providing certain medical services, the developed methodology ensures the presence of all essential terms (from the viewpoint of civil law regulation) in the contract for the certain medical service's provision and/or the data on potential patients for the provision of such a service, as well as minimization of the influence of the human factor when making clinical decisions. It is advisable to evaluate the CDSITs with consideration of civil-legal grounds, developed according to the proposed methodology, from the viewpoint of the correctness of the decisions generated by them, as well as from the viewpoint of their usefulness for clinics. In this paper, experiments with the methodology-based CDSIT regarding the possibility of performing a surrogate motherhood procedure with consideration of civil-legal grounds were conducted. Such experiments showed the correctness of the generated decisions at the level of 97 %. Experiments also demonstrated the usefulness of such IT for clinics from the viewpoint of eliminating adverse legal consequences, as they might arise due to violation or disregard of legal, and moral and ethical norms.
Objective. To analyze and summarize the data of modern literature on the issues of surgical treatment and natural course of the spine and spinal cord pathology in patients with various types of caudal regression syndrome (CRS).Material and Methods. A systematic review of the literature on the issue of treatment of the spine and spinal cord pathology in patients with CRS was performed. Selection criteria were: articles for the period 2002–2022, original studies of populations/patients with various forms of CRS with a description of treatment methods and long-term results of treatment or observation. A total of 28 articles on the treatment of various forms of CRS with the described results of treatment of 212 patients were analyzed: 29 patients with CRS in combination with open neural tube defects and 183 patients with closed forms of CRS. Evaluation criteria included number of patients, gender, type of spinal cord pathology, type of sacral agenesis, presence of the spine and lower extremities deformities, concomitant pathology, operations performed and their complications, and results.Results. The studied patients underwent the following surgeries on the spine and spinal cord: untethering of the spinal cord, correction and stabilization surgeries on the spine, plasty of the spinal cord herniation, plasty of the terminal meningocele, and removal of the presacarial volumetric mass. The greatest number of complications occurred after operations on the spine and sacrum. The majority of patients (67 %) with sacral agenesis by the end of the follow-up period (average 14 years) walked independently or with the help of devices, and a minority of them (33 %) could not walk. More than half of patients with CRS (67 %) had a neurogenic bladder, urinary incontinence, or suffered from a chronic urinary tract infection. Fecal incontinence and constipation were less common (46 %).Conclusions. Patients with CRS have a good potential for improvement/recovery of walking and pelvic organ dysfunction. This is extremely important to timely carry out multimodality treatment of patients with CRS who have neurosurgical, orthopedic, urogenital and colorectal problems in CRS, and to start early motor rehabilitation and physiotherapy.
Objective. To analyze possibilities and limitations of various stabilization technologies in the surgical treatment of cervical spine pathology. Material and Methods. Study design: retrospective monocentric observational analysis. Level of evidence: 3b (UK Oxford, version 2009). Diagnostic and treatment data are presented for 433 patients operated on using stabilization systems: patients in Group 1 (n = 228) underwent anterior fixation, those in Group 2 (n = 175)-posterior fixation with polyaxial screw systems, and in Group 3 (n = 30)-combined (anterior and posterior) fixation.
Study Design:
This study involves literature review, technical note, and case series.
Objectives:
The objectives were to analyze indications and contraindications, advantages, and disadvantages for C1 lateral mass screw (LMS) insertion above or partially above the arch, to descript technical features, and to give examples of the practical application of this technique and investigated its safety.
Methods:
A literature review was carried out in English and Russian in PubMed, Google Scholar, and eLibrary databases. We selected four patients, treated in our clinic, which was carried out partially supralaminar C1 LMS.
Results:
Only three descriptions of supralaminar C1 LMS were found in the literature. Four adult patients underwent posterior C1–C2 screw fixation with C1 LMS along the superior edge of the C1 arch at our clinic. Partially supralaminar C1 screws were inserted on one of the sides due to the difficulties of using classical techniques. The main reasons for supralaminar screw fixation were narrow C1 lamina, hypertrophied venous plexus, and intraoperative failures of classic techniques application (broken screw trajectory, profuse venous bleeding from the plexus). The average follow-up time for the patients was 2.7 years, no complications were noted, and all had a satisfactory spinal fusion.
Conclusions:
The proposed types of C1 LMS above or partially above the C1 arch can be useful alternative method of C1 screwing in selected patients. Indications for the use of the supralaminar C1 LMS method can be narrow C1 posterior arch and pedicle, pronounced C1-C2 venous plexus, some V3 segment anomalies at C1 level, small arthritic inferior part of lateral mass, and intraoperative failures of classic techniques application.
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