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.
Objective. To compare the effectiveness of surgical methods for treating patients with recurrent lumbar disc herniation.Material and Methods. The sample consisted of 160 patients operated on in 2014–2019 for recurrent lumbar disc herniation by percutaneous endoscopic discectomy (Group 1), microsurgical discectomy (Group 2), single-level transforaminal interbody fusion (Group 3) and single-level total intervertebral disc replacement (Group 4). The effectiveness of surgical treatment was evaluated using the NRS-11, ODI, and MacNab questionnaires.Results. Assessment of the pain syndrome severity and the vital activity level of patients revealed significant (p < 0.05) differences in favor of total intervertebral disc replacement. Excellent and good outcomes after arthroplasty according to MacNab criteria were noted in all patients in this group. Similar outcomes were reported in 77.5 % (31/40) of patients in the TLIF group, in 75.1 % (24/32) of patients in the percutaneous endoscopic discectomy group and in 72.6 % (45/62) of patients in the microdiscectomy group. The operation time and length of hospital stay were shorter in the endoscopic and microsurgical discectomy groups (p < 0.001). However, the lower incidence of complications and reoperations was observed in groups of posterior interbody fusion and arthroplasty (p > 0.05).Conclusion. Arthroplasty with the M6-L implant expands the possibilities of surgery for recurrent lumbar disc herniation. Total intervertebral disc replacement and posterior interbody fusion for recurrent lumbar disc herniation are more effective in comparison with decompressive operations, which is reflected in the improvement of clinical treatment outcomes, reduction of perioperative complications and frequency of repeated interventions.
BackgroundTechnical achievements and surgical techniques improvement contribute to the expansion of the endoscopic spine surgery possibilities. However, today there are few reports about the use of percutaneous endoscopy in spinal tumor surgery. A case of percutaneous transforaminal endoscopic removal of the lumbar spinal nerve tumor with intraoperative neuromonitoring is presented.Case DescriptionA 59-year-old female was complaining of a left shin and foot pain, weakness, and paresthesia. Preoperative magnetic resonance imaging (MRI) revealed a tumor (neurinoma) at the left L5-S1 intervertebral foramen. Transforaminal endoscopic removal of an extramedullary tumor from an 8-mm skin incision with intraoperative neuromonitoring was performed. Postoperative MRI revealed the signs of total resection of the tumor.ConclusionThe presented case confirms that percutaneous endoscopic removal of lumbar spine intraforaminal neurinomas can be safe and effective.
BACKGROUND: At present, metal implants are widely used in neuro-orthopedics, of which titanium alloys are of particular interest. A team of authors developed an original combined implant for posterior spinal fusion as an import substitution, which can be used from one-way access during minimally invasive operations on the lumbar spine. The implant was manufactured at the Endocarbon Enterprise in Penza. For better osseointegration, it is made of VT6 alloy and titanium nickelide. The middle part of the implant is laser-treated to create an uneven surface in the hope of better integration in the tissues of the body. This study was conducted to assess the cytotoxicity and biocompatibility of this implant for its further application in clinical practice. AIM: To determine the cytotoxicity of an interspinous implant made of titanium alloys for its further introduction into spinal surgery. MATERIALS AND METHODS: To determine the cytotoxicity of titanium samples of interspinous implants, a methyltetrazolium test was conducted to assess the viability of stromal cells in the presence of a nutrient medium after incubation with the test material. The biocompatibility of the material was analyzed using scanning electron microscopy of samples 1 and 7 days after cell culture. RESULTS: The viability of cells cultured in the presence of a nutrient medium after incubation with samples of titanium VT6 was 105% and that of titanium nickelide was 98%, which were comparable to the viability of cells in a standard nutrient medium. With electron microscopy, after 1 day of cultivation, cells form a monolayer on a titanium surface, all cells were well spread out and formed intercellular contacts, and after 7 days of cultivation, the number of cells increased and they formed a dense monolayer. CONCLUSIONS: The interspinous implant, which includes alloys of titanium VT6 and titanium nickelide, is biocompatible with cultured cells and can be introduced into spinal surgery.
The OBJECTIVE was to improve the results of surgical treatment of patients with discogenic radiculopathy by preoperative neuropsychological examination of patients with an increased risk of unsatisfactory outcome of the operation.METHODS AND MATERIALS. Neuropsychological status of 77 patients with discogenic radiculopathy in the preoperative period was studied. For this purpose, we assessed the intensity of pain, levels of personal and situational anxiety and the presence and severity of depression. The obtained data were compared with postoperative results of quality of life assessment for the main parameters, which include the level of pain and adaptation to daily activities.RESULTS. Data from neuropsychological tests were revealed, the presence of which in patients with discogenic pain syndrome suggests the risk of an unsatisfactory assessment of the operation performed by the patient. According to the long-term results of neurosurgical treatment, patients were divided into three groups: 1 – with a good result; 2 – patients with a number of preserved complaints, who rated the result of the operation as satisfactory; 3 – unsatisfactory outcome. In patients with unsatisfactory results of surgical treatment of discogenic radiculopathies with pain syndrome, patterns of psychological indices were found that were significantly associated with the outcome of treatment.CONCLUSION. Conducting a neuropsychological examination prior to surgery with the identification of predictors of chronic discogenic pain and patient dissatisfaction with the results of treatment can influence the surgical tactics and optimize the process of further treatment.
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