[Assessment of the safety and accuracy of implantation of screws into the C2 vertebra using individual 3D-navigation matrices]. / Otsenka bezopasnosti i tochnosti implantatsii vintov v S2 pozvonok s primeneniem individual'nykh 3D-navigatsionnykh matrits.

INTRODUCTION: Individual 3D-navigation matrices are valuable to increase the safety of screw implantation into the axis. OBJECTIVE: To analyze safety and accuracy of screw deployment into the axis using individual 3D-navigation matrices compared to free hand technique. MATERIAL AND METHODS: A retrospective analysis included 23 patients (group 1) who underwent implantation of 44 screws into the axis using the «free hand¼ technique. The screws were installed along the transpedicular or pars trajectory. A prospective analysis enrolled 17 patients (group 2) who underwent installation of 34 screws using individual navigation matrices. 3D-printing technology was applied for manufacturing these matrices. Implantation results were evaluated considering postoperative CT data and SGT (Screw Guide Template) system. RESULTS: In the 1st group («free hand¼), grade 0 and 1 (no malposition or less than 50% of screw diameter) were recorded for 29 (65.91%) screws, grade 2 - for 13 (29.55%) screws, grade 3 - for 2 (4.45%) screws. Intraoperative injury of the vertebral artery without postoperative neurological deficit occurred in 4 (8.89%) patients. In the 2nd group, 97% of screws were implanted in accordance with grades 1 and 2. Deviation grade 2 was registered in 11 cases (32.35%). Mean deviation was 1.8 ± 1.0 mm. In the 2nd group, 28 (82.35%) out of 34 screws were completely within the bone structures (grade 0), 4 (11.76%) screws perforated pedicles for less than 50% of their diameter (grade 1). There were 2 cases of malposition grade 2 and 3 without vertebral artery injury. CONCLUSION: Individual 3D navigation matrix is an effective method for screw installation into the axis. This approach exceeds fluoroscopy-assisted "free hand" technique in terms of safety of implantation.

[The impact of spinopelvic parameters on the rate of adjacent segment instability after short-segment spinal fusion]. / Vliianie pozvonochno-tazovykh parametrov na chastotu razvitiia nestabil'nosti smezhnogo segmenta pri monosegmentarnoi fiksatsii v poiasnichnom otdele.

AIM: The objective of this study is to determine the impact of postoperative spinopelvic parameters on the development of adjacent segment instability after single-level lumbar fusion. MATERIAL AND METHODS: A total of 116 patients with degenerative spine conditions after lumbar fusion were enrolled in this study and subdivided into two groups. Group I consisted of 24 patients with signs of adjacent segment instability; Group II included 92 patients without signs of instability. The minimal follow-up period was 24 months. RESULTS: The mean postoperative lumbar lordotic (LL) angle in both groups was within the normal range (-60.9±12); no statistically significant intergroup differences were revealed (56.6±12.1 and 58.4±11.2 for Groups I and II, respectively; p=0.314). In Group I patients, the mean pelvic incidence (PI) angle differed significantly from the mean PI values in Group II patients (70.4±7.6 and 53.2±8.4, respectively; p=0.006) and from the normal PI values (51.9±10). Therefore, the mean difference between PI and LL (PI-LL) angles in the Group I patients was significantly higher than in Group II (16.2±5.4 and 4.8±8.6, respectively; p=0.004). Significant PI-LL mismatch (PI-LL ≥10°) was observed in 22 (91.7%) patients in Group I and in 11 (11.95%) patients in Group II. According to regression analysis data, the PI-LL mismatch was identified as a risk factor for adjacent segment instability; the odds ratio =4.2; 95% confidence interval 1.46-12.25; and p=0.007. CONCLUSION: Patients with the high PI value and low LL value have a significantly higher risk of adjacent segment instability after short-segment spinal fusion.

[Diagnosis and interventional treatment of pain syndromes after surgery for degenerative lumbar spine diseases]. / Diagnostika i interventsionnoe lechenie bolevykh sindromov posle operativnykh vmeshatel'stv po povodu degenerativno-distroficheskikh zabolevanii poiasnichnogo otdela pozvonochnika.

Postoperative pain accompanies up to 20% of interventions for degenerative spine diseases (DSDs). The epidemiologic data are contradictory; clinical and radiological diagnostics is often low efficient; capabilities of interventional diagnosis and treatment techniques are poorly understood. PURPOSE: The study purpose was to investigate the structure of pain syndromes after surgery for DSDs of the lumbar spine, based on complex diagnostics, as well as to evaluate the capabilities of interventional treatment. MATERIAL AND METHODS: We examined 310 patients with postoperative pain syndromes. Patients with obvious indications for repeated surgery were excluded from the analysis; the remaining patients underwent selective diagnostic blockades followed by interventional (puncture) treatment. A positive outcome was defined as a reduction in pain by 50% on the numerical rating scale (NRS-11), by 20% in the Oswestry index (ODI), and by 8 points in the sciatica bothersomeness index (SBI), with the effect lasting for 12 months. Predictive factors for the risk of pain syndromes were analyzed. RESULTS: Out of 310 patients, 162 (52.6%) patients had no obvious indications for surgery. Radicular pain was detected in 56 (18.6%) of 310 patients; the positive treatment outcome was achieved in 38 (67.86%) of 56 patients. Facet pain was present in 29 (9.35%) patients; the positive treatment outcome was achieved in 23 (79.31%) patients. Discogenic pain was found in 12 (3.87%) patients; the positive treatment outcome was achieved in 5 (41.63%) patients. sacroiliac joint (SIJ) pain was present in 42 (13.55%) patients; the positive treatment outcome was achieved in 36 (85.71%) patients. Myofascial and competing pain was detected in 12 (3.87%) patients; the causes were not identified in 11 (3.55%) cases. The main risk factors were sagittal balance parameters. CONCLUSION: Complex diagnostics revealed postoperative pain not associated with surgical causes in 52.6% of cases; the origin of pain was identified in 49.95% of cases. Interventional treatment was effective in 64.81% of cases; failed back surgery syndrome was diagnosed in 16.13% of patients.

[The effect of spinal deformity correction on the quality of life of elderly patients]. / Vliyanie korrektsii deformatsii pozvonochnika na kachestvo zhizni pozhilykh patsientov.

AIM: At present, there is no consensus on the approach to treatment of patients older than 60 years of age who have spinal deformity and clinical symptoms. The article describes the effect of two different types of surgery on the quality of life of elderly patients with deformities. MATERIAL AND METHODS: A prospective study included 58 patients operated on at the Verden Russian Research Institute of Traumatology and Orthopedics in the period between 2007 and 2010. The inclusion criteria were as follows: patients older than 60 years of age, having spinal deformity (sagittal modifiers of grade 2(+) and higher according to the SRS-Schwab classification), radicular syndromes, and back pain. The patients were examined in accordance with a general algorithm, including general clinical and neurological examinations and an X-ray examination with evaluation of deformity, spinopelvic relationships, and sagittal imbalance. We compared two groups of patients. The first group included 28 patients who underwent decompressive foraminotomy. The second group consisted of 30 patients who underwent decompressive foraminotomy and deformity correction. The patients were evaluated using the following scales: VAS, ODI, and SRS-24 before surgery and after 3, 6 months, 1, 2, and 5 years. RESULTS: Preoperatively, there was no difference between the groups. We found no differences between the groups 1 year after surgery. After 5 years, the group with isolated decompression had poorer results. CONCLUSION: Spinal deformity correction is a more aggressive surgical procedure compared to isolated decompression. However, the efficacy of the former operation is higher.

[Prevention of blood loss during resection of hypervascular spinal tumors with the use of preoperative embolization and local hemostatic agents].

Currently there is no consensus how to reduce the risk of hemorrhage in spinal decompression surgery of hypervascu- lar spinal tumors. A retrospective study of 128 patients oper- ated in our institute was held in the period between 2003 and 2014. There were 80 male and 48 female patients with extradural hypervascular spinal tumor. The study included 71 patients with metastases of renal cell carcinoma, 28 - with multiple myeloma, 18 - with plasmacytoma and 11 - with aggressive hemangioma. The first group included 59 patients who underwent preoperative tumor embolization. The second group consisted of 69 patients who were treated surgically using intraoperative local hemostatic agents. We performed 2 types of treatment options: palliative decompression and total spondylectomy. We did not get evidence that embolization was more effective than using local hemostatic agents for patients with hypervascular spinal tumors who underwent palliative decompression. In the same time efficiency of embolization for patients with total spondylectomy was significantly higher.

[PROGNOSIS OF DEEP INFECTIOUS COMPLICATIONS IN HIP ARTHROPLASTY].

The retrospective research analyzed the data of 893 patients undergoing total hip arthroplasty. There were used the data about patients undergoing hip arthroplasty without complications (the first group--808 cases) and patients with developed deep surgical site infection following total joint arthroplasty after 12 months (the second group--85 patients). It was applied as the training matrix in creation of mathematical prognosis and algorithm of prophylaxis of deep infection in patients undergoing the primary total hip arthroplasty. There were revealed 21 prognostic significant criteria of deep infection development in surgical site. The program was tested in prospective investigation (293 clinical cases) with follow-up term of 12 months after operation. The rate of development of postoperative deep infection in surgical wound reduced as compared with the rate in group of retrospective research from 1.7% to 0.7%. The efficacy of proposed program was 80%.