Objective. To assess inter-expert agreement among spine surgeons having different levels of clinical experience when working with the AOSpine classification (TLCS, 2013). Materials and Methods. The study involved nine surgeons divided into three equal groups depending on work experience. All respondents were asked to classify the MSCT data of 50 patients with acute injuries to the thoracic and lumbar spine pursuant to TLCS (2013) classification. To evaluate inter-expert agreement, a Kappa coefficient interpreted according to Landis-Koch criteria was used. Results. The overall coefficient of inter-expert agreement for all observations among all groups of respondents was 0.43, which reflects a moderate level of agreement. Moderate inter-expert agreement was revealed for injury types A (0.45) and C (0.56), and satisfactory-for type B (0.34). The highest levels of agreement were obtained for subtypes A1 (0.67) and A4 (0.80) in the group of advanced specialists and for type C (0.70) in the group of specialists with a basic level of experience. Conclusion. The study demonstrated predominantly moderate level of inter-expert agreement when working with the AOSpine classification (TLCS, 2013). The accuracy of its use increases with a gain in practical experience of a surgeon.
Background. Minimally invasive technology of fusion broadly introduced in clinical practice represent one of modern trends in spinal surgery on the other hand those technical solutions lack to provide posterior fusion. As a consequence, patients treated with minimally invasive techniques are vulnerable in terms of pseudarthrosis and implant instability therefore measures focused on those complications’ prevention are still actual.The study objective is to evaluate efficacy and safety of suggested percutaneous facet joints arthrodesis technique as an auxiliary option to interbody fusion.Materials and methods. This is a prospective non-randomized study of 80 patients with degenerative diseases of the lumbar spine who were treated applying minimally invasive transforaminal lumbar interbody fusion, lateral lumbar interbody fusion and anterior lumbar interbody fusion. In 20 cases out of those enrolled interbody fusion was supplemented with percutaneous posterior facet joints arthrodesis. Computed tomography was administered at the period of 6 and 12 months after surgery to assess anterior and posterior fusion. The minimal follow-up period accounted for 12 months.Results. The suggested percutaneous facet joints arthrodesis fifty-fold increased the probability of posterior fusion formation compared to the rate of spontaneous spinal fusion (p <0.0001, logistic regression was applied). In three cases posterior fusion formed prior to interbody fusion providing stability of segment operated on. No adverse events and no complications associated with percutaneous arthrodesis were detected.Conclusion. The suggested percutaneous facet joints arthrodesis is safe and effective minimally invasive technique that facilitates additional posterior spinal fusion formation in a short-term period herewith decreasing symptomatic pseudarthrosis development in patients operated on using minimally invasive spinal fixation and fusion.
Objective. To analyze cases of pulmonary cement embolism and to determine possible causes of the complication. Material and Methods.A heterogeneous group of 49 patients was retrospectively analyzed. Vertebroplasty was prescribed to the patients for restoration of vertebral support ability after osteoporotic compression fractures and hemangiomas, and as an auxiliary manipulation for transpedicular fixation of the osteoporotic spine. Thoracic computed tomography was performed and pulmonary cement embolism was revealed in the early or late postoperative periods.Results. Pulmonary cement embolism was revealed in 7 (14 %) patients, two of them presented with massive pulmonary cement embolism. In one case it was caused by excessive injection of cement, and in the other -by anomalous anastomosis. In one case, the vertebroplasty was cancelled taking into account the results of venospodilography. Conclusion
Objective. To assess risk factors for the imbalance of the shoulder girdle and to identify reproducible X-ray criteria for persistent shoulder imbalance after correction of idiopathic scoliosis. Material and Methods. A total of 94 patients with idiopathic scoliosis were included in the retrospective study. All patients underwent primary posterior correction of the deformity using pedicle screw instrumentation. Radiography of the spine throughout its length was performed before surgery, in the early postoperative and in the long-term (at least 12 months after surgery) periods. The shoulder imbalance was considered clinically significant with radiographic shoulder height difference more than 2 cm. Results. A significant decrease in the magnitude of all curves after surgery and in the long-term period was noted. The magnitude of the proximal curve decreased from 25.38° ± 15.89° to 14.51° ± 8.17° (p < 0.0001) and to 14.29° ± 8.25° (p = 0.24); the main thoracic curve from 59.33° ± 20.76° to 20.096° ± 9.89° (p < 0.0001) and to 20.87° ± 9.48° (p = 0.19); and thoracolumbar curve from 47,20° ± 15,99° to 15.69° ± 8.66° (p < 0.0001) and to 16.98° ± 7.6° (p = 0.01), respectively. The shoulder imbalance was recorded in 27 patients (28.72 %) after surgery and in 13 (13.83 %)-in the long-term period. In these patients, various Lenke types of deformity were presented. A correla-Цель исследования. Оценка факторов риска развития дисбаланса плечевого пояса и выявление воспроизводимого рентгенологического критерия стойкого плечевого дисбаланса после коррекции идиопатического сколиоза. Материал и методы. В ретроспективное исследование включены 94 пациента с идиопатическим сколиозом. Всем пациентам проводили первичную дорсальную коррекцию деформации с использованием транспедикулярных винтовых конструкций. Рентгенографию позвоночника на всем его протяжении выполняли перед операцией, в раннем послеоперационном и в отдаленном (не менее 12 мес. после операции) периодах. Плечевой дисбаланс считали клинически значимым при рентгенологической разнице высоты надплечий более 2 см. tion of the distal adding-on phenomenon with self-correction of the shoulder balance is revealed (r = 0.56; p < 0.005). Persistent shoulder imbalance correlated with presence of a structural proximal thoracic curve (p = 0.041642), residual proximal curve magnitude after surgery (r = 0.22; p = 0.03), and presence of a symptom of double rib hump on radiographs after surgery (r = 0.75; p ≤ 0.005). Conclusion. The most characteristic pattern of persistent shoulder imbalance is the presence of asymmetry in the proximal and main regions of the chest. This sign can be detected by intraoperative lateral radiography of the spine, which will allow the surgeon to take measures to eliminate this phenomenon and reduce the probability of persistent shoulder imbalance development.
Федеральное государственное бюджетное образовательное учреждение высшего образования "Приволжский исследовательский медицинский университет" Министерства здравоохранения Российской Федерации, г. Нижний Новгород, Россия Influence of local lordosing transforaminal lumbar interbody fusion on adjacent segments and spino-pelvic relationships. Radiographic study
To analyze the causes of interspinous dynamic stabilization failures in patients with lumbar spine degenerative disorders. Material and Methods. Retrospective analysis of 155 cases of interspinous dynamic stabilization using DIAM device was performed. Twenty three cases with poor results were selected for detailed analysis. Results. It was revealed that reoperation rate for this method was 15 %, but only 8 % of failures were related to the technology itself. Main complications associated with interspinous stabilization devices included fracture and erosion of the spinous processes, destruction and migration of implants, and infection. In nine cases poor results were associated with surgeon's mistake in planning or performing of the procedure. Conclusion. Decision making for performing interspinous stabilization should be based on evaluation of indications and factors, which adversely affect its prognosis. These factors include elderly age of a patient, decreased bone quality, narrow and short interspinous gap, significant deformation and hypertrophy of the articular processes, significant slope of the spinous process, and essential amount of the planned bone decompression.
Приволжский федеральный медицинский исследовательский центр, г. Нижний Новгород РЕЗЮМЕЦель исследования -оценить факторы риска дестабилизации транспедикулярного инструментария после выполнения декомпрессивно-стабилизирующих вмешательств у пациентов с дегенеративной пато-логией поясничного отдела позвоночника.Материал и методы. Исследование является нерандомизированным продольным проспективным, исследованы результаты наиболее распространенных декомпрессивно-стабилизирующих оперативных вмешательств у 130 пациентов с дегенеративными заболеваниями поясничного отдела позвоночника. Минимальный срок наблюдения -18 мес. Пациентам перед операцией проводилась компьютерная томография (КТ) поясничного отдела позвоночника и определялась радиоденсивность костной ткани. Пациентам выполнялась микрохирургическая декомпрессия корешков спинного мозга с применением транспедикулярной фиксации в сочетании с межтеловым спондилодезом или без него. В послеопера-ционном периоде регистрировались все случаи с рентгенографическими признаками дестабилизации винтов. Используя логистический регрессионный анализ, определялась зависимость частоты расшаты-вания транспедикулярных винтов от радиоденсивности губчатой костной ткани позвонка по данным КТ, степени резекции костно-связочного аппарата в ходе декомпрессии, протяженности фиксации и биомеханических нарушений, обусловленных неполной редукцией позвонка. Также определялось влияние межтелового спондилодеза и неоднородности исследуемой группы пациентов по диагнозу.Результаты. Снижение радиоденсивности костной ткани, увеличение протяженности фиксации и эк-стенсивности декомпрессии сопряжены с повышенным риском развития нестабильности транспедику-лярного инструментария. Такие признаки, как ляминэктомия, отсутствие межтелового спондилодеза в пределах фиксированной области, включение в фиксированную область сегмента L5-S1 и фактор био-механического нарушения в результате неполной редукции позвонка не оказывали влияния на частоту расшатывания винтов. Незначимым оказалось влияние фактора неоднородности исследуемой группы. Общая пригодность регрессионной модели ¹ 2 = 67,57851; p < 0,0001. Модель правильно классифици-рует 81,5% наблюдений, чувствительность ее составила 77,4%, специфичность -85,3%.Çаключение. Радиоденсивность костной ткани по результатам КТ является значимым прогностическим фактором развития нестабильности имплантов. Существенными факторами риска расшатывания винтов также являются увеличение протяженности ригидной фиксации и экстенсивная резекция дугоотростча-тых суставов и связочного аппарата позвоночно-двигательных сегментов. Перечисленные факторы риска необходимо учитывать при планировании декомпрессивно-стабилизирующих вмешательств, особенно у пациентов пожилого возраста.КЛЮЧЕВЫЕ СЛОВА: транспедикулярная фиксация, нестабильность имплантов, компьютерная томо-графия, дегенеративные заболевания поясничного отдела позвоночника.
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