ON THE EXTENT OF PREOPERATIVE RADIOLOGICAL AND CT EXAMINATION OF PATIENTS WITH DEGENERATIVE DISEASES OF THE LUMBAR SPINE
https://doi.org/10.14531/ss2018.2.66-75
Abstract
Objective. To specify the extent of preoperative examination of patients with lumbar degenerative diseases and to study the effect of examination results on the tactics of surgical treatment.
Material and Methods. The study included retrospective analysis of 1340 patients with lumbar degenerative diseases treated in the Neurosurgical Department No. 2 of Novosibirsk RITO n.a. Ya.L. Tsivyan during 2017.
Results. The average height of the intervertebral disc as evaluated with MRI was 7.4 ± 1.8 mm, and that evaluated with MSCT – 4.9 ± 1.5 mm, with a statistically significant difference between them (p < 0.05). Immediate preoperative examination of patients with lumbar disc herniation showed reduction or lysis of the hernia fragment in some of them. Reduction of the leg pain and hernia size (by more than 50 %) and lysis of the herniated disc fragment evidenced by MRI were observed in 21 (3.2 %) patients. Comparison of the preplanned and actually performed extent of decompression and stabilization interventions showed that tactics and/ or extent of surgical treatment changed in 37.6 % of cases.
Conclusion. The complex of instrumental radiological and neuroimaging studies, as well as methods of provocative procedure in the lumbar spine performed immediately before the planned surgical treatment allow choosing the proper treatment tactics, specifying or correcting the volume of surgical treatment, and to prognosing its outcome in lumbar degenerative diseases.
About the Authors
A. V. Krutko
Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan
Russian Federation
Russian Federation
Aleksandr Vladimirovich Krutko - MD, DMSc, Head of Neurosurgery Department No. 2.
Frunze str., 17, Novosibirsk, 630091
A. D. Sanginov
Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan
Russian Federation
Russian Federation
Abdugafur Jabborovich Sanginov - postgraduate student, Department of neuroorthopaedics.
Frunze str., 17, Novosibirsk, 630091
References
1. Ageenko AM, Lebedeva MN, Volkov SG, Golikov RI. The rates of cognitive function recovery after anesthesia with sevoflurane or desflurane in neuroorthopedic surgery. Problems of modern science and education. 2016;(5):130. In Russian.
2. Byvaltsev VA, Kalinin AA, Belykh EG, Stepanov IA. Simulation technologies in spinal surgery. Annals of the Russian academy of medical sciences. 2016;71(4):297-303. In Russian. DOI: 10.15690/vramn681.
3. Krutko AV. Comparative analysis of posterior interbody fusion and transforaminal interbody fusion in combination with transpedicular fixation. Journal of Traumatology and Orthopedics. Priorov. 2012;(1):12–21. In Russian.
4. Krutko AV, Baikov ES, Konovalov NA, Nazarenko AG. Segmental spinal instability: unsolved problems. Hir. Pozvonoc. 2017;14(3):74–83. In Russian. DOI: 10.14531/ss2017.3.74-83.
5. Lutsik AA. Diagnosis and Neurosurgical Treatment of Spinal Osteochondrosis: An Advisory Protocol. Novokuznetsk, 2006. In Russian.
6. Atlas SJ, Keller RB, Robson D, Deyo RA, Singer DE. Surgical and nonsurgical management of lumbar spinal stenosis: four-year outcomes from the Maine Lumbar Spine Study. Spine. 2000;25:556–562. DOI: 10.1097/00007632-200003010-00005.
7. Belykh E, Krutko AV, Baykov ES, Giers MB, Preul MC, Byvaltsev VA. Preoperative estimation of disc herniation recurrence after microdiscectomy: predictive value of a multivariate model based on radiographic parameters. Spine J. 2017;17:390– 400. DOI: 10.1016/j.spinee.2016.10.011.
8. Bodiu A. Diagnosis and operatory treatment of the patients with failed back surgery caused by herniated disk relapse. J Med Life. 2014;7:533–537.
9. Carragee EJ, Han MY, Suen PW, Kim D. Clinical outcomes after lumbar discectomy for sciatica: the effects of fragment type and anular competence. J Bone Joint Surg Am. 2003;85:102–108. DOI: 10.2106/00004623-200301000-00016.
10. Goh TS, Shin JK, Youn MS, Lee HS, Kim TH, Lee JS. Surgical versus nonsurgical treatment of lumbar degenerative kyphosis. Eur Spine J. 2017;26:2153–2159. DOI: 10.1007/s00586-017-5008-8.
11. Hussain A, Erdek M. Interventional pain management for failed back surgery syndrome. Pain Pract. 2014;14:64–78. DOI: 10.1111/papr.12035.
12. Koller H, Pfanz C, Meier O, Hitzl W, Mayer M, Bullmann V, Schulte TL. Factors influencing radiographic and clinical outcomes in adult scoliosis surgery: a study of 448 European patients. Eur Spine J. 2016;25:532–548. DOI: 10.1007/s00586-015-3898-x.
13. Le Huec JC, Faundez A, Dominguez D, Hoffmeyer P, Aunoble S. Evidence showing the relationship between sagittal balance and clinical outcomes in surgical treatment of degenerative spinal diseases: a literature review. Int Orthop. 2015;39:87– 95. DOI: 10.1007/s00264-014-2516-6.
14. Lequin MB, Barth M, Thome C, Bouma GJ. Primary limited lumbar discectomy with an annulus closure device: one-year clinical and radiographic results from a prospective, multi-center study. Korean J Spine. 2012;9:340–347. DOI: 10.14245/kjs.2012.9.4.340.
15. Lurie JD, Tosteson TD, Tosteson AN, Zhao W, Morgan TS, Abdu WA, Herkowitz H, Weinstein JN. Surgical versus nonoperative treatment for lumbar disc herniation: eight-year results for the spine patient outcomes research trial. Spine. 2014;39:3–16. DOI: 10.1097/BRS.0000000000000088.
16. Malmivaara A, Slatis P, Heliovaara M, Sainio P, Kinnunen H, Kankare J, Dalin-Hirvonen N, Seitsalo S, Herno A, Kortekangas P, Niinimaki T, Ronty H, Tallroth K, Turunen V, Knekt P, Harkanen T, Hurri H. Surgical or nonoperative treatment for lumbar spinal stenosis? A randomized controlled trial. Spine. 2007;32:1–8. DOI: 10.1097/01.brs.0000251014.81875.6d.
17. Margetic P, Pavic R, Stancic MF. Provocative discography screening improves surgical outcome. Wien Klin Wochenschr. 2013;125:600–610. DOI: 10.1007/s00508-013-0404-5.
18. Schwaiger BJ, Behr M, Gersing AS, Meyer B, Zimmer C, Kirschke JS, Ryang YM, Ringel F. Computed tomography findings associated with clinical outcome after dynamic posterior stabilization of the lumbar spine. World Neurosurg. 2016;93:306– 314. DOI: 10.1016/j.wneu.2016.06.048.
19. Shapiro CM. The failed back surgery syndrome: pitfalls surrounding evaluation and treatment. Phys Med Rehabil Clin N Am. 2014;25:319–340. DOI: 10.1016/j. pmr.2014.01.014.
20. Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Blood E, Hanscom B, Herkowitz H, Cammisa F, Albert T, Boden SD, Hilibrand A, Goldberg H, Berven S, An H. Surgical versus nonsurgical therapy for lumbar spinal stenosis. N Engl J Med. 2008;358:794–810. DOI: 10.1056/NEJMoa0707136.
21. Xi MA, Tong HC, Fahim DK, Perez-Cruet M. Using provocative discography and computed tomography to select patients with refractory discogenic low back pain for lumbar fusion surgery. Cureus. 2016;8:e514. DOI: 10.7759/cureus.514.
22. Yang X, Zhang Q, Hao X, Guo X, Wang L. Spontaneous regression of herniated lumbar discs: Report of one illustrative case and review of the literature. Clin Neurol Neurosurg. 2016;143:86–89. DOI: 10.1016/j.clineuro.2016.02.020.
Review
For citations:
Krutko A.V., Sanginov A.D. ON THE EXTENT OF PREOPERATIVE RADIOLOGICAL AND CT EXAMINATION OF PATIENTS WITH DEGENERATIVE DISEASES OF THE LUMBAR SPINE. Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika). 2018;15(2):66-75. https://doi.org/10.14531/ss2018.2.66-75
Email this article 