Background: Pain in the lower back is an urgent health issue in industrialized countries. The dominant cause of pain in the lumbosacral spine is the degeneration of the inter vertebral discs (I VD). The total prosthetics I VD is a modern method of surgical treatment of I VD degenerative diseases, an alternative method of rigid stabilization.Aim: To analyze the results of surgical inter vention (I VD prosthesis M6-L implantation) in patients with I VD degeneration of lumbar spine at the 6, 12, 24, and 36 months after the surger y.Materials and methods: The study included 156 patients (92 men, 64 women) aged 23 to 45 years who under went a single-level discectomy with implantation of an artificial IVD prosthesis M6-L at the bases of three neurosurgical centers. For dynamic assessment, clinical parameters (pain intensity from the visual analogue pain scale (VAS), quality of life according to the Oswestry index, subjective satisfaction with the result of surgical treatment on the Macnab scale) and instrumental data (amplitude of movements in the operated spinal-motor segment, degree of heterotopic ossification according to McAfeeSuchomel classification) were applied at 6, 12, 24, and 36 months after surger y.Results: The mean value of the quality of life for the Oswestr y index before surger y was 40.2±6.9%, after ― 12.3±6.1% (t-test, p0.001). The mean value of the level of pain according to VAS before surger y was 6.9±1.6 cm; after surger y ― 1.3±1.2 cm (t-test, p0.001). The average range of motion in the operated segment at baseline was 36.8±2.6°, within 36 months after the operation increased up to 41.2±2.9°. During the entire period of obser vation the initial (13.4%) or moderate (10.2%) signs of heterotopic ossification were revealed. Conclusions: The use of prosthetic I VD M6-L can significantly reduce the level of pain, improve the life quality, and maintain the physiological range of motion in the operated spinal motion segment with a low level of adverse outcomes.
Objective. To assess the degree of influence of heterotopic ossification on the motion amplitude of the operated segment and on clinical outcomes in patients after total intervertebral disc replacement. Material and Methods. Results of total replacement of the intervertebral disc with the M6-L prosthesis were analyzed in 74 patients aged 23-45 years. Follow-up period was 36 months. The motion amplitude of operated segments and the degree of heterotopic ossification were estimated. Clinical outcomes were analyzed based on pain syndrome severity according to the VAS and on the level of the back pain-related quality of life according to the Oswestry index. Results. Signs of heterotopic ossification were found in 27 (36.4%) patients: Grade I-in 11 (14.8 %), Grade II-in 14 (18.9 %), and Grade III-in 2 (2.7 %). The mean values of the motion amplitude of operated segments, VAS score and Oswestry index in the group of patients without signs of heterotopic ossification were 11.2° ± 2.7°, 2.8 ± 1.2 cm and 17.3 ± 6.5 %, respectively, and those in the group of patients with signs of heterotopic ossification-11.5° ± 1.2°, 3.4 ± 1.8 cm and 19.8 ± 7.3 %, respectively. Conclusion. Heterotopic ossification following total lumbar disc replacement occurs in 36.4 % of cases. High grade of heterotopic ossification reliably affects the amplitude of segment motion, though there was no significant influence on clinical results in patients.
Objective. To evaluate the relationship between the radiological and neuroimaging parameters of the spinal motion segment and the clinical outcome of surgical treatment of patients with degenerative diseases of the lumbosacral junction to clarify the indications for dynamic and rigid stabilization.Material and Methods. The study included 267 patients with degenerative diseases of the lumbosacral spine. Depending on the stabilization method, patients were divided into two groups: Group I (n = 83) with dynamic intervertebral disc (IVD) prosthesis; and Group II (n = 184) with interbody fusion and transpedicular fixation. Long-term clinical parameters and biomechanical characteristics before and after surgery were analyzed.Results. A significant nonparametric correlation of the long-term result of surgical treatment assessed by VAS and Oswestry Disability Index with radiological parameters and results of neuroimaging was revealed. It was determined that the use of artificial IVD allows achieving a minimum level of pain syndrome and good functional recovery with effective preservation of the volume of physiological movements in the operated segment and restoration of the total angle of lumbar lordosis.Conclusion. Objective neuroimaging data (grade II-IV of degeneration according to the measured diffusion coefficient) and radiological parameters (linear displacement of vertebrae not more than 4 mm, sagittal volume of movements in the spinal motion segment less than 6°, decrease in the height of intervertebral disc space no more than 2/3 of the superjacent one) make possible using total arthroplasty. It is advisable to perform interbody fusion and rigid stabilization in grade IV-V of degeneration, linear displacement of vertebrae more than 4 mm, sagittal volume of movements of at least 6°, and decrease in the interbody space height over 2/3 of the superjacent one.
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