SPINE INJURIES
Objective. To analyze results of clinical application of the developed technique for stabilization of the cervical vertebrae and restoration of the segmental cervical sagittal contour with vertical cylindrical mesh implants.
Material and Methods. Results of surgical treatment in two patients with cervical spine disorders were analyzed. Patients underwent anterior interbody fusion with vertical cylindrical mesh implants having the adapted caudal terminal portion in accordance with the developed technique.
Results. Both patients demonstrated differential positive dynamics of clinical symptoms. Long-term treatment results were assessed as excellent in one case and as good in the other according to Odom’s criteria. No complications associated with the developed technique of anterior interbody fusion were registered during and at different terms after surgery.
Conclusion. This technique provides full contact between the implant terminal portion and the vertebral body with the account for segmental cervical sagittal contour, which reduces the load per unit area of the vertebral bone and the risk of the implant postoperative dislocation.
SPINE DEFORMITIES
Objective. Comparative analysis of treatment outcomes in patients with idiopathic scoliosis in the thoracic spine using anterior and posterior segmental instrumentation.
Material and Methods. The study included 56 patients aged 12 to 18 years with Lenke type 1 scoliotic deformity in the thoracic spine. Correction with anterior instrumentation was performed in 36 cases and with posterior – in 20.
Results. The mean value of deformity correction in patients with anterior instrumentation was 81.1 %. Physiological sagittal contour was formed in all patients after surgery. The mean value of deformity correction in patients with posterior instrumentation was 52.5 %. After surgery the magnitude of the primary curve was 32.2° (range, 30–42°), of the compensatory curve – 12.4° and at long-term follow-up it comprised 13.3°.
Conclusion. Efficacy of anterior correction is comparable with results of posterior segmental instrumentation. Correction of the thoracic scoliosis using anterior instrumentation is the equivalent method of choice for surgical treatment of idiopathic scoliosis.
Objective. To present specific surgical technique for juvenile kyphosis correction and analyze results of surgical treatment for spinal deformity in children with Scheuermann’s disease using transpedicular spinal instrumentation systems.
Material and Methods. The study included ten patients aged 14 to 17 years with kyphotic spinal deformity associated with Scheuermann’s disease. The mean deformity magnitude was 73.1° (range, 60° to 90°). Kyphosis apex was located at the T7 (n = 5), T8 (n = 1), T9 (n = 3), or T10 (n = 1) level. Surgical intervention was performed through combined approach using disc-apophysis-ectomy and fusion at the apex of kyphosis, and placement of multiple anchor spinal instrumentation.
Results. Five patients received the hybrid instrumentation, and other five – transpedicular one. Surgical treatment resulted in reduction of kyphosis to 32.1° with average deformity correction of 41°. Average number of fixed vertebrae in patients with hybrid instrumentation was 14, and in those with total transpedicular fixation – 13. The loss of correction in the long-term follow-up was observed in patients with hybrid multiple anchor instrumentation.
Conclusion. The use of pedicle screws as anchors in surgical treatment of juvenile kyphosis in children with Scheuermann’s disease allows for effective deformity correction, restoration of physiological profiles of the spine, elimination of postoperative curve progression, shortening of instrumentation length, prevention of junctional kyphosis development, and maintaining of the achieved results.
Objective. To evaluate the results of surgical treatment in children with congenital deformity of the thoracic spine associated with isolated vertebral anomalies.
Material and Methods. A total of 50 patients aged 1 year 4 months to 7 years 8 months with isolated congenital lateral hemivertebra or posterolateral hemivertebra in the thoracic spine were operated on. Surgical intervention through combined anterolateral and posterior approach included extirpation of the abnormal vertebra with adjacent discs, correction of the deformity with posterior instrumentation, and 360-degree spinal fusion with bone autograft.
Results. After surgery the angle of scoliotic deformity in patients with lateral hemivertebrae ranged from 6° to 14°, the degree of correction ranged from 82.3 % to 94.7 %. In patients with posterolateral hemivertebrae the angle of scoliotic deformity ranged from 0° to 9° (the degree of correction – from 86.7 % to 100.0 %), and the angle of kyphotic component – from 0° to 9° (the degree of correction – from 79.6 % to 100.0 %). The formation of solid bone block was noted in all patients at 1.5–2 years after surgery. There were no early or late postoperative complications and neurological disorders.
Conclusion. A combined approach to treat children with isolated vertebral anomalies in the thoracic spine including extirpation of the malformed vertebra and additional mobilization of the posterior spinal column provides a selective treatment approach and radical correction of the spinal deformity, the smallest number of fixed spinal motion segments, and prevention of internal organ complications.
DEGENERATIVE DISEASES OF THE SPINE
Objective. To study feasibility of the computer-assisted stabilometry in detection of postural balance changes in patients with degenerative dystrophic diseases of the lumbar spine after decompression and stabilization surgery.
Material and Methods. Postural balance was studied in 62 patients with compression and complex regional pain syndromes associated with the lumbar spine degenerative disease. Patients were examined using the Romberg’s test with eyes open and eyes closed before and after surgical treatment. Changes in the following stabilometric parameters were assessed: center-of-pressure (COP) displacement in the coronal and sagittal planes, path and velocity of COP displacement and its sway area.
Results. Operated patients gained greater freedom of the COP spatial displacement under visual control. Center-of-pressure displacements increased in the coronal and sagittal planes, the COP path lengthened, its velocity and sway area increased.
Conclusion. Stabilometric examination allows controlling compensatory mechanism activation at stages of postural balance recovery to assess the adequacy of patient’s movement pattern formation in the early postoperative period.
Objective. To analyze natural biochemical changes in proteoglycans and glycosaminoglycans of patients with recurrent and nonrecurrent herniations of lumbar intervertebral discs.
Material and Methods. Biochemical parameters of primary intervertebral disc hernias were prospectively investigated in 50 patients who underwent repeated surgery for recurrent hernia at the same level, and in 50 patients without recurrence. The quantity and quality of glycosaminoglycans in tissues of the hernia and surrounding annulus fibrosus were determined by analytical biochemistry methods. The properties of proteoglycans in the hernia tissue were studied by composite gel electrophoresis.
Results. Type 1 recurrent hernia tissues are characterized by high content of water and glycosaminoglycans, but relatively few glycosaminoglycans tightly bound within the extracellular matrix (ECM) are retained in the tissue after its treatment with 4 M guanidinium chloride. Type 2 hernia tissues showed reduced content of water and glycosaminoglycans, and increased content of neutral hexoses. More than a half of them were tightly bound to ECM structures. On MRI evidence, Type 1 hernias correspond to Grade III disc degeneration, and Type 2 – to Grade IV. Biochemical profile of glycosaminoglycans in intervertebral disc tissues of the recurrence group reliably differed from that of the nonrecurrence group by the higher content of chondroitin sulfates and proteoglycans loosely bound to ECM structures.
Conclusion. The tissue structure of nucleus pulposus and annulus fibrosus in recurrent and nonrecurrent intervertebral disc differs in qualitative and quantitative characteristics of glycosaminoglycans.
DIAGNOSTICS
Objective. To compare electroneuromyography (ENMG) characteristics of sensomotor innervation status of lower limb muscles in patients with different level injuries in the thoracic and lumbar spine.
Material and Methods. Findings of global (maximal voluntary muscle tension) and stimulated (M-response, Н-reflexes) ENMG were analyzed in 48 patients aged 11 to 55 years. All patients were divided into three groups depending on the injury level.
Results. The most marked ENMG signs of functional insufficiency in pre- and postoperative periods were registered in patients with spinal cord injuries at the D9 through D12 levels, which topologically correspond to localization of segmental neuronal populations responsible for formation of spinal motor centres controlling voluntary and reflex activity of lower limb muscles.
Conclusion. Consideration of the study results can be useful in predicting functional outcomes of surgical treatment and rehabilitation of patients with consequences of spinal cord injury.
EXPERIMENTAL STUDIES
Objective. To compare the efficacy of spinal motion segment stabilization with rigid instrumental fixation and dynamic NiTi clamps.
Material and Methods. Fixation of contiguous vertebral bodies in the lumbar spine was performed in 20 mongrel dogs, males and females, 4 months of age. A plate for internal osteosynthesis as a fixator was used in the first experimental series and NiTi clamps with thermochemical shape memory effect – in the second. All animals were examined using radiography and roentgenometry of the lumbar spine. The instrumented lumbar vertebrae were investigated histologically.
Results. Fixing screws of a plate migrated in the coronal plane during the animal’s growth. Fixation of contiguous vertebrae with NiTi clamps results in formation of well-vascularized connective-tissue capsule with well-developed fibrous bundle framework connected to bone bed with perforating fibers, thus providing micromotion of the spinal segment, prevention of implant migration, and trophic support of the fixed area.
Conclusion. The study showed that fixation of contiguous vertebral bodies with NiTi clamps was more effective.
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