Purpose. Compare the clinical and radiological results of treatment of patients with spinal deformities operated on using the PSO method and corrective fusion in the lumbar spine. Materials and methods. Retrospective monocenter cohort study. The data of 42 patients were analyzed. PSO (group I) was performed in 12 patients; 30 patients had a combination of surgical methods (group II) with mandatory ventral corrective spinal fusion at levels L4-L5, L5-S1. Clinical and radiological parameters were evaluated during hospitalization and at least 1 year later. Results. Postoperative hospitalization in group I 32.5 7.4 days, 27.1 7.4 in group II (p = 0.558758). The duration of the operation in group I was 402.5 55.6 minutes, in group II 526.0 116.2 minutes (p = 0.001124); blood loss 1862.5 454.3 ml versus 1096.0 543.3 ml (p = 0.000171). In both groups, significantly improved clinical and radiological parameters after surgery and after 1 year (p 0.05). In group II, as compared with group I after surgery and more than 1 year: lower back pain according to VAS (p = 0.015424 and p = 0.015424); below ODI after 1 year was (p = 0.000001). In group I, compared with group II after surgery and after 1 year, SVA is less (p = 0.029879 and p = 0.000014), lumbar lordosis is higher (p = 0.045002 and p = 0.024120), LDI is restored more optimally (p = 0.000001 and p = 0.000002), the GAP is lower (p = 0.005845 and p = 0.002639). The ideal Russoly type is restored more often in patients of group II (p = 0,00032). Complications in group I were noted in 12 (100%) patients, in group II in 13 (43.3%) patients (p = 0.001). Conclusions. In multistep surgical treatment compared with PSO, the anterior corrective interbody fusion L4-L5, L5-S1 reliably better and more harmoniously restores the sagittal balance parameters, has significantly lower volume of intraoperative blood loss, fewer perioperative complications and significantly improves the quality of life of patients.
Aim: to identify possible predictors of screw loosening (SL) in patients after decompression and fusion at the lumbar level for degenerative spinal diseases. Methods. The data of patients with degenerative lumbar diseases who underwent primary decompression and fusion and who were re-hospitalized were analyzed. Clinical data (demography, characteristics of primary surgical procedures and characteristics of the perioperative period), results of radiological methods (presence and characteristics of resorption around screws, bone density (BMD) by densitometry and CT, intervertebral fusion grade and implant subsidence) were evaluated. Results. The study included 19 patients with SL and 37 patients without resorption, median age 59.1 [51.4; 63.1] years, men 20 (35.7%). When comparing patients with and without SL, there was no significant difference in gender, age, method of surgery, length of the fixation (p 0.05). According to CT scans, the bone density of the vertebrae between the groups did not differ significantly (p 0.05). In the group with SL, fusion failure was more common than in the group without SL (22.6% versus 20.7%), but the differences are not significant (p 0.05). In the intergroup comparison, it was determined that, in general, there were more complications in the group with SL than in the group without SL (p = 0.00015) due to the greater number of infectious complications (p = 0.00044). Also, patients with SL had a significantly longer duration of primary hospital stay (p = 0.000021). Conclusion. Patients with SL after primary surgery have a significantly longer hospital stay duration, mainly (45.8%) due to infectious complications. Patients with SL have comparable bone density in both the vertebral bodies and pedicles compared to patients without SL.
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