[Comparative analysis of the results of anterior decompression-stabilization techniques in the treatment of degenerative stenosis of the cervical spine in elderly patients: a retrospective study.]

The purpose of the study was to compare the clinical and radiological efficacy of 2-level anterior cervical discectomy and fusion (ACDF) and 1-level anterior cervical corpectomy and fusion (ACCF) in the treatment of two-segment degenerative stenosis of the cervical spine in elderly patients. The retrospective study included 74 elderly patients (over 60 years old), two cohorts were identified: the 1st (n=38) - patients who underwent staged 2-level ACDF; the 2nd (n=36) - patients operated on using the technique of 1-level ACCF. For comparative analysis, we used general information about patients (gender, age, body mass index, physical status according to ASA), characteristics of surgical interventions (time of surgery, volume of blood loss), features of the postoperative period, clinical data, radiological outcomes, and the presence of complications. Analysis of the results was carried out in a minimum period of 36 months. As a result, it was found that 2-level ACDF in the treatment of two-segment degenerative stenosis of the cervical spine in older patients is associated with less blood loss and the level of local pain syndrome. At the same time, better clinical outcomes and fewer revision interventions after 1-level ACCF were recorded in the long-term postoperative period.

[Long-term results and predictors of postoperative outcomes in patients with cauda equina syndrome following degenerative lumbar spine disease]. / Otdalennye rezul'taty i faktory, vliyayushchie na iskhod khirurgicheskogo lecheniya sindroma konskogo khvosta, obuslovlennogo degenerativnym zabolevaniem poyasnichnogo otdela pozvonochnika.

Cauda equina syndrome (CES) associated with acute disc extrusion or spinal stenosis often requires emergency surgery. Analysis of the Pubmed, Medline and eLibrary databases revealed a few studies devoted to long-term postoperative outcomes in patients with CES caused by degenerative spine disease. OBJECTIVE: To evaluate long-term postoperative results and predictors of clinical and neurological outcomes in patients with CES caused by degenerative lumbar spine disease. MATERIAL AND METHODS. D: Ecompressive and decompressive-stabilizing procedures were performed in 211 patients with CES caused by degenerative lumbar spine disease between 2000 and 2020. Long-term clinical parameters were available in 174 patients with mean follow-up period of 7 years. Sixty-eight patients had unsatisfactory postoperative outcomes. We assessed postoperative clinical and neurological outcomes in patients with CES and predictors of these outcomes. RESULTS: We identified the following predictors of clinical and neurological outcomes using binary logistic regression model: period between clinical manifestation and surgery >48 hours, preoperative neurological impairment, spinal canal diameter, surgical procedure, dimension of herniated disc, ASA score and long-term postoperative analgesia with narcotic analgesics. CONCLUSION: Preoperative planning and possible correction of the above-mentioned risk factors will potentially improve postoperative outcomes in patients with CES caused by degenerative lumbar spine disease.

[Comparative analysis of the results of decompressive interventions in elderly patients with cauda equine syndrome caused by lumbar spinal stenosis.]

The aim of the study was to evaluate the results of surgical treatment and the effectiveness of clinical recovery in elderly patients with cauda equina syndrome (CES) caused by degenerative spinal canal stenosis after isolated open and minimally invasive decompression. A retrospective analysis of the results of surgical treatment of 50 patients over 60 years of age who underwent isolated open (n=21) and minimally invasive (n=29) decompressive interventions for CES caused by lumbar spinal stenosis was performed. For comparative analysis, we used the technical features of the intervention, the specificity of postoperative management of patients, clinical parameters, and the number of perioperative complications. As a result, the advantages of minimally invasive isolated decompression compared to open decompression due to a smaller volume of blood loss and duration of hospitalization, low need for postoperative pain relief, a minimum number of perioperative surgical complications, as well as the dynamics of neurological symptoms, better efficiency of clinical recovery of functional state indicators according to ODI and quality life according to SF-36 in the late postoperative period.

[Results of the study of functional recovery of professional athletes after minimally invasive lumbar fusion]. / Rezul'taty provedeniya minimal'no-invazivnogo poyasnichnogo spondilodeza u professional'nykh sportsmenov.

OBJECTIVE: To conduct a comprehensive clinical-neurological assessment and to study the results of functional recovery of professional athletes after minimally invasive lumbar interbody fusion. MATERIALS AND METHODS: The retrospective study included 27 patients-professional athletes who were operated on using minimally invasive decompression and stabilization techniques in the period 2010 to 2019. Clinical-neurological effectiveness was assessed when returning to previous sports activity was 14 (9; 17) weeks and 4 (3; 5) years after surgery. RESULTS: The follow-up showed a significant improvement in clinical and neurological parameters: persistent elimination of radicular and muscular-skeletal symptoms, a decrease in the level of pain according to a visual analogue scale in the lumbar spine from 68 (61; 85) mm to 3 (2; 11) mm (p=0.002) and in the lower extremities from 84 (78; 91) mm to 1 (0; 3) mm (p=0.001), change in the physical component of health from 26.18 (23.58; 28.37) to 49.82 (49.03; 53.04) (p=0.002) and the psychological component of health from 27.87 (26.22; 29.29) to 52.18 (49.12; 55.66) (p=0.001), significant improvement in the perception of physical activity according to the Borg RPE Scale from 17 (16; 18) points to 9 (8; 9) (p<0.001). In one case (3.7%), the patient did not return to his previous sports career. CONCLUSION: The use of minimally invasive rigid stabilization in the overwhelming majority of professional athletes made it possible in the shortest possible time to achieve regression of neurological symptoms, reduce pain, improve the quality of life, restore the functional state and return to previous sports activities.

Accelerated Recovery Program for Patients with Polysegmental Degenerative Lumbar Spine Disease.

The aim of the study was to evaluate the effectiveness of the accelerated recovery program for patients with polysegmental degenerative diseases of the lumbar spine. Materials and Methods: This prospective study included 53 patients who underwent two-level transforaminal interbody fusion in the LII-SI segments. Two groups were identified: in group 1 (n=24), operations were performed using the accelerated recovery program; in group 2 (n=29), open rigid stabilization was used under traditional intravenous anesthesia. The end-point parameters were the number of bed-days spent in the hospital after the operation, the number of perioperative surgical complications and adverse effects of anesthesia, and the number of re-hospitalizations within 90 days. We also recorded the time of patient activation, the level of pain around the operated zone (using a visual analogue scale), and the quality of life in the long-term postoperative period (median 18 months); the latter was assessed using the SF-36 questionnaire (physical and psychological components of health). Results: Patients under the accelerated recovery program were found to have a shorter duration of surgery and anesthesia, less blood loss, lower amounts of injected opioids, faster verticalization, and a reduced period of inpatient treatment (p<0.05 for all parameters). As compared to group 2, patients in group 1 had a lower level of pain in the surgery zone (p<0.05), better long-term indicators of the physical and psychological components of health (p<0.05), a lower number of anesthesia-associated adverse events (p<0.05), and a lower rate of postoperative complications (p<0.05). During the 90-day postoperative observation, four patients of group 2 (13.8%) were urgently referred to a medical institution for additional medical care. Conclusion: The accelerated recovery program for two-level interbody fusion showed its safety and high clinical efficiency in the treatment of patients with polysegmental degenerative diseases of the lumbar spine. The program can be used in any center for spine surgery where effective interaction between polyvalent medical and nursing teams is maintained.

[A comparative analysis of clinical efficiency of laser and radiofrequency denervation in patients with primary trigeminal neuralgia]. / Sravnitel'nyi analiz klinicheskoi effektivnosti primeneniya lazernoi i radiochastotnoi denervatsii u patsientov s pervichnoi nevralgiei troinichnogo nerva.

OBJECTIVE: To compare the clinical efficacy of laser and radiofrequency denervation in patients with primary trigeminal neuralgia. MATERIAL AND METHODS: The study included 50 patients with primary trigeminal neuralgia who were operated on by laser (group I, n=25) or radiofrequency denervation (group II, n=25) in the period from 2018 to 2019. To assess the clinical efficacy, we analyzed the dynamics of the pain syndrome level according to the scale of facial pain and the quality of life according to the Short Form Medical Outcomes Study (SF-36), as well as patient satisfaction with the operation according to the Macnab scale, the presence of postoperative surgical complications and adverse effects of anesthesia. RESULTS: In the postoperative period, according to the scale of facial pain, a decrease in its intensity was noted in both study groups (p<0.001). Comparative analysis showed a comparable level of pain in the early postoperative period: at discharge (p=0.43) and 6 months after surgery (p=0.07). At the same time, after 12 months, lower scores on the scale of facial pain were noted in patients of group I (p=0.02). According to SF-36, a significant improvement in the physical and psychological components of health was determined in group I (p<0.001) and group II (p<0.05). Comparison of SF-36 scores in the long-term postoperative period revealed the best indicators in group I (p=0.02 and p=0.01, respectively). Comparative analysis verified a greater subjective satisfaction with the operation in group I, compared with group II (p<0.001). A comparable number of adverse effects of anesthesia was determined in both groups. Comparative analysis revealed a significantly greater number of postoperative surgical complications in group II (p=0.0017). CONCLUSION: Laser denervation and radiofrequency denervation are highly effective methods of minimally invasive treatment of primary trigeminal neuralgia.

[Analysis of the results of laser destruction of the articular branch of the obturator nerve in elderly and senile patients with degenerative coxarthrosis.]

The aim of the study was to analyze the results of the use of laser destruction of the articular branch of the obturator nerve in elderly and senile patients with degenerative coxarthrosis. The results of treatment of 34 patients over 65 years of age with symptomatic degenerative diseases of the hip joint (HJD) and somatic contraindications for total hip arthroplasty have been prospectively studied. In the study group, in the period from 2017 to 2019, laser destruction of the articular branch of the obturator nerve (970 nm, frequency 9 Hz and power 3 W in a total dose of 100 J) was carried out. The average follow-up was 12 months. To assess the effectiveness of surgical treatment, the dynamics of the pain syndrome in the hip joint was analyzed according to the visual analogue scale, the quality of life according to the SF-36 questionnaire, the functional state of the hip joint according to the W.H.Harris scale and the presence perioperative surgical complications. As a result, it was found that the use of laser destruction of the articular branch of the obturator nerve in degenerative coxarthrosis in elderly and senile patients (if total hip arthroplasty was not possible) made it possible to significantly reduce the level of preoperative pain syndrome, restore the quality of life and improve the functional state of patients with low risks of surgical complications.

[Evaluation of the results of using the accelerated recovery program after performing two-level lumbar spinal fusion in patients of an older age group.]

The aim of the study was to evaluate the results of using the accelerated recovery program after performing two-level lumbar spinal fusion in patients of an older age group. The results of surgical treatment of 29 patients older than 65 years with multisegmental degenerative diseases of the lumbar region, who performed minimally invasive two-level rigid stabilization using the concept of «accelerated recovery program¼ (PAR), were retrospectively studied. We studied the technical features of surgical interventions, the specificity of the postoperative period, the number of adverse outcomes of anesthetic benefits and perioperative surgical complications, the frequency of repeated hospitalizations for 90 days. Clinical parameters were used to evaluate the effectiveness of PAR: the level of pain in the area of operation according to the visual analogue scale (VAS) during hospitalization, the quality of life of patients on the SF-36 questionnaire, and patient satisfaction with the result of treatment using the Macnab scale. As a result, it was established that the introduced PAR after performing two-level lumbar spinal fusion in patients of an older age group provides the minimum number of adverse consequences of anesthesiological aid and perioperative surgical complications, a significant restoration of the quality of life and high patient satisfaction with the treatment.

[Analysis of the results of surgical treatment of primary trigeminal neuralgia using laser destruction of the sensitive root in elderly and senile patients.]

The aim of the study was to analyze the results of surgical treatment of primary trigeminal neuralgia using laser destruction of the sensitive root in elderly and senile patients. The results of treatment of 25 patients older than 65 years with conservative treatment-resistant trigeminal pain who underwent laser destruction of the sensitive trigeminal root (970 nm, 9 Hz and 3 W power in a total dose of 100 J) in the period from 2018-2019 were prospectively studied. The average follow-up was 12 months. As a result, a significant decrease in the intensity of pain on the scale of facial pain was found from 87 (83,5; 91,5) mm to 15,5 (12,5; 18,5) mm (p=0,002) in the long-term period. On average, 12 months after the operation, a significant improvement in the indicators of the physical and psychological components of health was revealed on the SF-36 questionnaire (p=0,02 and p=0,01, respectively). In the follow-up on the Macnab scale, predominantly excellent (n=23; 92%) and good (n=2; 8%) treatment results were noted. Registered 1 (4%) perioperative complication and 2 (8%) adverse effects of anesthesiology benefits. Thus, the use of laser denervation of the sensitive root in primary trigeminal neuralgia in elderly and senile patients can significantly reduce the level of preoperative pain and improve the quality of life, with low risks of adverse effects.

[Analysis of the clinical efficacy of platelet-rich plasma therapy in the treatment of patients with isolated facet-syndrome of the lumbar spine]. / Analiz klinicheskoi éffektivnosti primeneniia PRP-terapii pri lechenii patsientov s izolirovannym fasetochnym sindromom poiasnichnogo otdela pozvonochnika.

AIM: To analyze clinical results of the surgical treatment of patients with isolated facet-syndrome of the lumbar spine using platelet-rich plasma (PRP) therapy for arcuate spine joints. MATERIAL AND METHODS: The study included 49 patients, aged 39.5 (34; 45), who, after provocative tests, were diagnosed with isolated facet syndrome and operated on from 2015 to 2018 using PRP therapy. A visual analogue pain scale (VAS), Oswestry questionnaire (ODI), Macnab subjective satisfaction scale, and the presence of complications were used to evaluate clinical efficacy. Dynamic evaluation was made on average 18 months after surgery. RESULTS AND CONCLUSION: PRP therapy is a highly effective method for treatment of patients with isolated facet syndrome caused by degenerative diseases of the facet joints. Clinical efficacy is confirmed by the persistent significant reduction of pain symptoms and restoration of functional status in the early and late postoperative periods with low risks of adverse outcomes.