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1.
Artigo em Russo | MEDLINE | ID: mdl-38549409

RESUMO

OBJECTIVE: To describe own experience of treating patients with extramedullary tumors at the level of craniovertebral junction using minimally invasive surgical approaches. MATERIAL AND METHODS: The study included 29 patients who underwent minimally invasive microsurgical resection of extramedullary tumors at the level of craniovertebral junction. We analyzed the main clinical and surgical parameters. RESULTS: Gross total resection was achieved in most patients with high degree of safety. Two patients required redo surgery due to CSF leakage and soft tissue cyst. Mean length of hospital-stay was 7 days. VAS score of pain syndrome at discharge was 2 points and 0 points after 3 months. No significant differences in neurophysiological monitoring indicators were observed (p=0.76). CONCLUSION: Minimally invasive posterior approaches to extramedullary tumors at the level of craniovertebral junction can significantly reduce surgical trauma with equal extent of resection.


Assuntos
Neoplasias da Medula Espinal , Humanos , Neoplasias da Medula Espinal/cirurgia , Neoplasias da Medula Espinal/patologia , Procedimentos Cirúrgicos Minimamente Invasivos , Procedimentos Neurocirúrgicos , Resultado do Tratamento , Estudos Retrospectivos
2.
Zh Vopr Neirokhir Im N N Burdenko ; 88(1): 109-114, 2024.
Artigo em Russo | MEDLINE | ID: mdl-38334738

RESUMO

The main problem in microsurgical resection of spinal cord tumors is excessive surgical aggression. The last one often leads to unsatisfactory clinical and neurological outcomes. Laser fluorescence spectroscopy is a modern neurosurgical approach to distinguish tumor boundaries even if standard visible fluorescence techniques are ineffective. OBJECTIVE: To evaluate the effectiveness of laser fluorescence spectroscopy alone or in combination with visual 5-ALA fluorescence for improvement of safety and quality of resection, as well as intraoperative diagnosis. MATERIAL AND METHODS: Searching for literature data was carried out in accordance with the PRISMA recommendations. The authors reviewed articles independently of each other. These data were systematized. RESULTS: Laser fluorescence spectroscopy is valuable to identify fragments of intramedullary ependyomas in 86% of cases, while visual fluorescence only in 81% of cases. Advisability of this technique for low-grade astrocytomas is still unclear and requires further study. Its effectiveness is 87.5% for extramedullary meningiomas. Neuromas do not accumulate 5-ALA. In addition, this method can be used to determine the boundaries of intradural metastatic lesions. CONCLUSION: 5-ALA fluorescence is a safe and useful intraoperative method for identifying tumor tissue and resection margins in patients with intramedullary or infiltrative extramedullary spinal cord tumors. Visual fluorescence combined with laser spectroscopy is a perspective method for intraoperative visualization of tumor remnants. This approach can improve safety and postoperative outcomes while maintaining resection quality.


Assuntos
Neoplasias da Medula Espinal , Neoplasias da Coluna Vertebral , Humanos , Neoplasias da Coluna Vertebral/cirurgia , Espectrometria de Fluorescência , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/cirurgia , Procedimentos Neurocirúrgicos/métodos , Lasers
3.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-37830465

RESUMO

One of the important problems in microsurgical resection of intramedullary spinal cord tumors is excessive surgical aggression and subsequent neurological impairment. Laser fluorescence spectroscopy with electrophysiological monitoring provides high-quality resection of intramedullary tumors with monitoring of spinal cord structures in real time. This approach increases safety and quality of resection. OBJECTIVE: To analyze efficacy of fluorescence navigation technique and laser fluorescence spectroscopy in surgical treatment of various spinal cord tumors. MATERIAL AND METHODS: There were more than 1000 patients with intramedullary spinal cord tumors between 2001 and 2022. Intraoperative fluorescence navigation with laser spectroscopy was used in 47 cases. All patients underwent examination before and after surgery. We analyzed somatic, neurological and functional status (McCormick scale). MRI of the spinal cord and intraoperative fluorescence spectroscopy (OPMI Pentero 900 microscope with a fluorescent module, Carl Zeiss, Germany) were performed. To induce visible fluorescence, we used 5-ALA-Alasens (NIOPIK, Russia). Laser spectroscopy was carried out on a LESA-01-BIOSPEC analyzer (Biospec JSC, Russia). Morphological analysis of intramedullary spinal cord tumors was carried out in the laboratory of neuromorphology of the Burdenko Neurosurgery Center. RESULTS: In our sample, fluorescence navigation and laser fluorescence spectroscopy were used only in surgical treatment of intramedullary tumors. Laser fluorescence spectroscopy was valuable to identify fragments of intramedullary ependymoma and astrocytoma in 86% of cases, visual fluorescence - only in 81% of cases. Advisability of this technique for low-grade astrocytomas is unclear and requires further study. CONCLUSION: Visual fluorescence combined with laser spectroscopy is a promising method for intraoperative imaging of tumor remnants. This approach can improve safety, quality and results of surgical treatment.


Assuntos
Astrocitoma , Ependimoma , Neurocirurgia , Neoplasias da Medula Espinal , Humanos , Espectrometria de Fluorescência , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/cirurgia , Neoplasias da Medula Espinal/patologia , Procedimentos Neurocirúrgicos/métodos , Ependimoma/cirurgia , Lasers , Resultado do Tratamento , Estudos Retrospectivos
4.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-37325821

RESUMO

Odontoidectomy is indicated for anterior compression of the brainstem by invaginated odontoid process. This procedure can currently be performed via transoral microsurgical and transnasal endoscopic access. OBJECTIVE: To analyze the results of endoscopic transnasal odontoidectomy. MATERIAL AND METHODS: We assessed treatment outcomes in 10 patients with anterior compression of the brainstem by invaginated odontoid process. All patients underwent endoscopic transnasal odontoidectomy. RESULTS: Brainstem decompression was achieved in all cases. CONCLUSION: Currently, endoscopic transnasal approach is gradually replacing the transoral one in some patients requiring anterior odontoidectomy. Analysis of literature data reflects the development of this technique taking into account various features of surgical treatment including optimization of dimensions of surgical field, attempts to perform C1-sparing surgeries and analysis of sufficient size of trepanation. Nasopalatine and nasoclival lines are used to select optimal access. Nevertheless, the choice of access depends on equipment of the hospital and surgical experience in most cases.


Assuntos
Processo Odontoide , Humanos , Processo Odontoide/diagnóstico por imagem , Processo Odontoide/cirurgia , Descompressão Cirúrgica/métodos , Endoscopia/métodos , Resultado do Tratamento , Trepanação
5.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-37325822

RESUMO

There are few studies comparing clinical efficacy of decompression/fusion surgery (transforaminal lumbar interbody fusion (TLIF) + transpedicular interbody fusion) and minimally invasive microsurgical decompression (MMD) in patients with single-segment lumbar spinal stenosis. OBJECTIVE: To compare the results of TLIF + transpedicular interbody fusion and MMD in patients with single-segment lumbar spinal stenosis. MATERIAL AND METHODS: A retrospective observational cohort study included medical records of 196 patients (100 (51%) men, 96 (49%) women). Age of patients ranged from 18 to 84 years. Mean postoperative follow-up period was 20.1±6.7 months. Patients were divided into 2 groups: group I (control) included 100 patients who underwent TLIF + transpedicular interbody fusion, group II (study) included 96 patients who underwent MMD. We analyzed pain syndrome and working capacity using visual analogue scale (VAS) and Oswestry Disability Index (ODI), respectively. RESULTS: Analysis of pain syndrome in both groups after 3, 6, 9, 12 and 24 months clearly demonstrated stable relief of pain syndrome (VAS score) in the lower extremities. In group II, VAS score of lower back and leg pain was significantly higher in long-term follow-up period (after 9 months or more) compared to the 1st group (p<0.05). In long-term follow-up period (after 12 months), there was significant decrease in degree of disability (ODI score) in both groups (p<0.001) without between-group differences. We assessed achievement of treatment goal in 12 and 24 months after surgery in both groups. The result was significantly better in the 2nd group. At the same time, some respondents failed to achieve the final clinical goal of treatment in both groups (group I - 8 (12.1%), group II - 2 (3%) patients). CONCLUSION: Analysis of postoperative outcomes in patients with single-segment degenerative lumbar spinal stenosis revealed similar clinical effectiveness of TLIF + transpedicular interbody fusion and MMD regarding decompression quality. However, MMD was associated with less traumatization of paravertebral tissues, blood loss, fewer unwanted phenomena and earlier recovery.


Assuntos
Fusão Vertebral , Estenose Espinal , Masculino , Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Estenose Espinal/cirurgia , Fusão Vertebral/métodos , Vértebras Lombares/cirurgia , Estudos Retrospectivos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Dor , Descompressão
6.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-37011330

RESUMO

Typical symptoms of spontaneous intracranial hypotension syndrome are severe headache, weakness, dizziness and inability to stay upright for a long time. Most often, this syndrome occurs due to CSF fistula in spinal space. Pathophysiology and diagnosis of this disease are poorly known for neurologists and neurosurgeons that can complicate timely surgical care. In case of correct diagnosis, we can identify the exact location of CSF fistula in 90% of cases. Treatment eliminates symptoms of intracranial hypotension and provides functional recovery. The purpose of this article is to describe the diagnostic algorithm and successful microsurgical treatment of a patient with spinal dural CSF fistula Th3-Th4 through posterolateral transdural approach.


Assuntos
Fístula , Hipotensão Intracraniana , Humanos , Hipotensão Intracraniana/complicações , Hipotensão Intracraniana/diagnóstico por imagem , Vazamento de Líquido Cefalorraquidiano/complicações , Vazamento de Líquido Cefalorraquidiano/diagnóstico por imagem , Coluna Vertebral , Imageamento por Ressonância Magnética
7.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-36763557

RESUMO

Intramedullary abscesses of the spinal cord are the rarest form of infectious lesions of the central nervous system. We report surgical treatment of a patient with intramedullary cervical abscess caused by L. monocytogenes. Features of this case are absence of primary purulent focus and atypical infectious agent. The patient underwent surgical treatment for intramedullary cervical abscess and subsequent antimicrobial therapy. Subtotal regression of neurological symptoms was noted in early postoperative period. The authors emphasize strict collegial decision-making regarding diagnosis of this disease and choice of optimal treatment strategy.


Assuntos
Abscesso , Doenças da Medula Espinal , Humanos , Abscesso/diagnóstico por imagem , Abscesso/cirurgia , Imageamento por Ressonância Magnética , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/cirurgia , Pescoço/patologia
8.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-36252195

RESUMO

Surgical treatment of degenerative lumbar spinal stenosis is an actual problem of modern spinal surgery and orthopedics. OBJECTIVE: To analyze the results of minimally invasive microsurgical decompression (MI-MD) in patients with monosegmental lumbar spinal stenosis. MATERIAL AND METHODS: A retrospective observational cohort study was performed. We analyzed medical records of patients who underwent MI-MD for monosegmental degenerative lumbar spinal stenosis. Clinical and objective results of MI-MD, as well as the types and prevalence of adverse clinical events were studied. RESULTS: The study included 96 medical records (50 (52%) males and 46 (48%) females aged 18-84 years). Analysis of pain in lower back and lower extremities in 3, 6, 9, 12 and 24 months after MI-MD showed a significant decrease of this indicator (p<0.001). There was significant improvement of capacity according to ODI score up to 5-12% in 72.9% of patients in early postoperative period (p=0.055). In delayed postoperative period, we also observed significant improvement of working capacity according to ODI score and gradual decrease in disability index (p<0.001). Adverse clinical events occurred in 6 (6.2%) patients. CONCLUSION: MI-MD is a highly effective surgical method for monosegmental lumbar spinal stenosis with minimal incidence of adverse clinical events.


Assuntos
Estenose Espinal , Descompressão Cirúrgica/métodos , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos , Estudos Retrospectivos , Estenose Espinal/cirurgia , Resultado do Tratamento
9.
Artigo em Russo | MEDLINE | ID: mdl-35942843

RESUMO

Extramedullary spinal cord tumors at the level of craniovertebral junction are a rare group of neoplasms with their own characteristics. Taking into account the peculiarities of clinical course and complex anatomy of craniovertebral complex, these tumors present a complex diagnostic and surgical problem. A systematic review of literature data on epidemiology, clinical picture, diagnostic methods and dorsal minimally invasive methods of surgical treatment of patients with extramedullary spinal cord tumors of craniovertebral junction was performed.


Assuntos
Neoplasias da Medula Espinal , Humanos , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/patologia , Neoplasias da Medula Espinal/cirurgia
10.
Artigo em Russo | MEDLINE | ID: mdl-35758077

RESUMO

Syndrome of spontaneous intracranial hypotension is increasingly described in the literature as a multifactorial disease with impairment of the quality of life and risk of mortality. CSF-venous fistula as a cause of intracranial hypotension syndrome is extremely rare and requires complex diagnosis and timely surgical treatment. OBJECTIVE: We present a 55-year-old patient with acute spontaneous intracranial hypotension and spinal CSF-venous fistula. Literature data are also analyzed. RESULTS: Algorithm for diagnosis and efficacy of microsurgical resection of CSF-venous fistula is demonstrated. CONCLUSION: Intracranial hypotension following spinal fistula requires careful examination. Accurate understanding of pathophysiological and anatomical features of this disease is necessary to select an effective treatment method.


Assuntos
Fístula , Hipotensão Intracraniana , Vazamento de Líquido Cefalorraquidiano/terapia , Humanos , Hipotensão Intracraniana/diagnóstico por imagem , Hipotensão Intracraniana/etiologia , Hipotensão Intracraniana/cirurgia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Mielografia/efeitos adversos , Mielografia/métodos , Qualidade de Vida , Síndrome
11.
Artigo em Russo | MEDLINE | ID: mdl-35170272

RESUMO

Analysis of historical and modern approaches to teaching neurosurgery by professional communities and public authorities in the United States, the European Union and the Russian Federation makes it possible to develop a modern training program regarding content and duration. High-tech and dynamically developing specialty has acquired several large sub-specializations over the past decades. Each direction requires a long-term training and a special program. Training in neurosurgery in the modern world takes 5-7 years and involves acquisition of clinical and scientific knowledge. Some issues are brought up for discussion by professional community. Solution of these problems will provide an opportunity for international integration of the Russian training program for neurosurgeons. High level of neurosurgery in our country and a single educational space with the European community will allow exchanging students, adopting foreign experience and sharing our own experience.


Assuntos
Neurocirurgiões , Neurocirurgia , Humanos , Federação Russa , Estados Unidos
12.
Artigo em Russo | MEDLINE | ID: mdl-35170273

RESUMO

BACKGROUND: Individual polymer implants are widespread for bone reconstruction after decompressive craniectomy. Despite the availability of customized titanium products, various specialists and hospitals prefer polymer implants. OBJECTIVE: To compare the methods of modeling and manufacturing the polymethylmethacrylate implants and identify the features affecting the quality of reconstruction. MATERIAL AND METHODS: We analyzed 14 patients with extensive skull defects after installation of polymethyl methacrylate implants. Software used for modeling of individual implants by different specialists was compared. RESULTS: Satisfactory reconstruction result was obtained in all cases. There were no infectious complications. The authors outlined certain important aspects for modeling of individual polymer products: local use of anatomical thickness of the implant, leaving safe spaces, prevention of temporal retraction, template-based resection before reconstruction. CONCLUSION: To date, skull defect closure with polymeric materials remains relevant, and even has certain advantages over customized titanium products.


Assuntos
Craniectomia Descompressiva , Procedimentos de Cirurgia Plástica , Craniotomia/efeitos adversos , Craniectomia Descompressiva/efeitos adversos , Humanos , Polímeros , Próteses e Implantes , Crânio/diagnóstico por imagem , Crânio/cirurgia , Titânio
13.
Artigo em Russo | MEDLINE | ID: mdl-34714002

RESUMO

High neuroprotective activity of renin-angiotensin-aldosterone system (RAAS) inhibitors in patients with vascular diseases of the brain and spinal cord has been confirmed. OBJECTIVE: To evaluate the effect of renin-angiotensin-aldosterone system inhibitors on functional activity of the spinal cord and nerve roots in patients with degenerative lumbar spine diseases. MATERIAL AND METHODS: A retrospective observational cohort study was performed. We evaluated clinical and radiological parameters (gender, age of patients, type of antihypertensive drug, concomitant diseases, ODI (6) and SF-36 (7) scores of patient quality of life), functional recovery, increase of signal intensity and its area in T2WIs, localization and maximum spinal canal stenosis, as well as maximum spinal cord and nerve root compression. RESULTS: The study included 117 medical records of respondents (88 men and 29 women aged 56.9±13.2 years) who underwent lumbar spine surgery for degenerative diseases. Arterial hypertension was verified in 68 (58.1%) patients, diabetes mellitus in 22 (18.8%) respondents. Age (p=0.002), diabetes mellitus (p=0.007), arterial hypertension (p=0.015) and antihypertensive therapy (p=0.023) were significantly associated with worse clinical and neurological status of patients. Binary logistic regression model demonstrated that only arterial hypertension was significantly associated with low preoperative quality of life (p=0.002). CONCLUSION: Intake of AT II-1 receptor blockers and angiotensin converting enzyme inhibitors for arterial hypertension is a significant predictor of decrease in signal intensity of the spinal cord and its roots according to T2WIs.


Assuntos
Hipertensão , Sistema Renina-Angiotensina , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Feminino , Humanos , Masculino , Qualidade de Vida , Estudos Retrospectivos , Medula Espinal
14.
Artigo em Russo | MEDLINE | ID: mdl-34463446

RESUMO

Professional athletes have a high basic level of physical fitness and significant motivation for returning to previous rhythm of functional activity within the shortest period after trauma without deterioration of baseline level of sportsmanship. Despite the well-presented results of lumbar spine fusion in general population, these data among professional athletes are not well understood. OBJECTIVE: To analyze the results of minimally invasive lumbar fusion in professional athletes. MATERIAL AND METHODS: A retrospective study included 27 athletes (19 men and 8 women) aged 29 (26; 34) years after minimally invasive lumbar spine decompression and fusion via anterior, lateral and posterior approaches. Total lumbar lordosis, degenerative changes in adjacent segment, area of multifidus muscle, perioperative complications and timing of sports rehabilitation were analyzed within 3-5 (mean 4) years after surgery. RESULTS: We found an increase of total lumbar lordosis from 35.2° to 44.1° (p=0.02), no significant muscle atrophy (<30%) and degeneration of adjacent segment (p>0.05). There were 5 perioperative complications (18.5%). Mean period of sports rehabilitation was 14 (9; 17) weeks. One (3.7%) patient did not return to his previous sports career. CONCLUSION: Minimally invasive short-segment lumbar interbody fusion in professional athletes is characterized by low risk of fixation element failure, no significant degeneration of adjacent level and postoperative muscle atrophy. This procedure ensures early rehabilitation and returning to sports.


Assuntos
Vértebras Lombares , Fusão Vertebral , Atletas , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos , Estudos Retrospectivos , Resultado do Tratamento
15.
Artigo em Russo | MEDLINE | ID: mdl-34463455

RESUMO

Degenerative lumbar spine stenosis is one of the main causes of chronic pain and radiculopathy in advanced age people. Along with increase in average life expectancy, degenerative lumbar spine stenosis becomes the most common indication for spinal surgery. There is still no consensus regarding the most optimal surgical approach due to the variety of modern surgical methods. In recent years, minimally invasive spinal surgery has become a more advisable alternative to open surgery due to its advanced technical features combined with less soft tissue damage, lower risk of complications and shorter postoperative recovery.


Assuntos
Estenose Espinal , Constrição Patológica , Descompressão Cirúrgica , Humanos , Laminectomia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Estenose Espinal/diagnóstico por imagem , Estenose Espinal/cirurgia , Resultado do Tratamento
16.
Artigo em Russo | MEDLINE | ID: mdl-34156204

RESUMO

Surgical treatment of spine and spinal cord diseases is one of important objectives in modern neurosurgery. Patient safety is a priority in spine and spinal cord surgery. Intraoperative imaging ensures efficacy and safe surgery with and without stabilization, preoperative marking, control of decompression and correct implant placement. Surgical C-arms and intraoperative cone-beam CT scanners are the most widespread in everyday practice. The latest achievement was intraoperative spiral computed tomography. C-arms and CT scanners with intraoperative navigation increase the efficiency and safety of surgical interventions.


Assuntos
Doenças da Medula Espinal , Doenças da Coluna Vertebral , Cirurgia Assistida por Computador , Tomografia Computadorizada de Feixe Cônico , Humanos , Procedimentos Neurocirúrgicos , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/cirurgia , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/cirurgia , Coluna Vertebral , Tomografia Computadorizada por Raios X
17.
Zh Vopr Neirokhir Im N N Burdenko ; 85(3): 104-113, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34156212

RESUMO

Cavernous malformations (CMs) of central nervous system are vascular malformations usually localized in the brain and rarely in the spinal cord. To date, these malformations are well studied. However, some problems of the management of this pathology are still unresolved. This is due to rare localization of intramedullary CMs in the spinal cord and difficult treatment of spinal pathology per se. To date, about 1000 cases of spinal CM are described in the literature. This review is devoted to natural course of disease and postoperative outcomes. These data allow getting a complete picture of modern concepts of the treatment of spinal CMs and formulating the questions requiring further discussion.


Assuntos
Hemangioma Cavernoso do Sistema Nervoso Central , Neoplasias da Medula Espinal , Encéfalo , Hemangioma Cavernoso do Sistema Nervoso Central/diagnóstico por imagem , Hemangioma Cavernoso do Sistema Nervoso Central/cirurgia , Humanos , Imageamento por Ressonância Magnética , Período Pós-Operatório , Medula Espinal , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/cirurgia
18.
Artigo em Russo | MEDLINE | ID: mdl-33864669

RESUMO

Hemangioblastoma of the filum terminale and cauda equina is a rare tumor of nervous system. There are only few case reports in the literature. In this manuscript, the authors analyze the diagnosis and treatment of patients with this disease. MRI data and intraoperative images of stage-by-stage resection allow one to get an idea about radiological characteristics of hemangioblastoma of the filum terminale and surgical intervention. The authors discuss the world experience of surgical treatment and consider intraoperative complications.


Assuntos
Cauda Equina , Hemangioblastoma , Cauda Equina/diagnóstico por imagem , Cauda Equina/cirurgia , Humanos , Imageamento por Ressonância Magnética
19.
Artigo em Russo | MEDLINE | ID: mdl-33560617

RESUMO

Smoking is an obvious risk factor of adverse events in early and long-term postoperative period after spine surgery including lumbar total disk arthroplasty. Objective. To study the effect of smoking on clinical and radiological outcomes after lumbar total disk arthroplasty. MATERIAL AND METHODS: A single-center retrospective observational cohort study was performed. We have analyzed medical records of patients who underwent single-level lumbar total disk arthroplasty for degenerative disease. RESULTS: The study included 57 medical records of respondents. The examined medical records were divided into two groups - smokers (n=26) and non-smokers (n=31). There were no significant between-group differences in clinical outcomes. Incidence of adverse events was similar too. Kaplan-Meier event-free survival was similar in both groups. There were no significant between-group differences in X-ray data. Development of heterotopic ossification after lumbar total disk arthroplasty was more active in smokers. CONCLUSION: Smoking has no significant effect on clinical and radiological outcomes in patients after single-level after lumbar total disk arthroplasty. On the other hand, smoking significantly increases formation of heterotopic ossification after lumbar total disk arthroplasty.


Assuntos
Degeneração do Disco Intervertebral , Ossificação Heterotópica , Substituição Total de Disco , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/etiologia , Degeneração do Disco Intervertebral/cirurgia , Ossificação Heterotópica/diagnóstico por imagem , Ossificação Heterotópica/epidemiologia , Ossificação Heterotópica/etiologia , Estudos Retrospectivos , Fatores de Risco , Fumar/efeitos adversos , Resultado do Tratamento
20.
Artigo em Russo | MEDLINE | ID: mdl-33560619

RESUMO

Minimally invasive procedures reduce the trauma of spine surgery. However, they are associated with high complexity of manipulations, long learning curve, need for expensive equipment for intraoperative navigation and significant irradiation. Various options for surgical approaches are being developed to reduce irradiation of medical staff and patients, surgery time and the number of drugs administered for general anesthesia. Simultaneous surgical interventions (SiSI) is one of these options. OBJECTIVE: To compare the effectiveness of simultaneous and staged minimally invasive dorsal decompression-stabilization procedures in patients with lumbar spine degenerative diseases. MATERIAL AND METHODS: A prospective study included 67 patients (41 men and 26 women) aged 48 (34; 56) years who underwent a single-level minimally invasive spinal root decompression and transforaminal interbody fusion via Wiltse posterior-lateral approach. Two study groups were distinguished: group I (simultaneous surgical interventions, SiSI) (n=29), in which guide spokes and transpedicular screws were installed simultaneously by two surgeons within one x-ray session from two sides; group II (staged surgical interventions, StSI) (n=38), in which staged transpedicular stabilization was performed (decompression side followed by contralateral side). Mean follow-up was 14 months in group I and 20 months in group II. We considered intraoperative fluoroscopy and irradiation dose, duration of surgery and anesthesia with calculation of doses of opioid drugs, blood loss, time of activation, hospital-stay and perioperative morbidity. Clinical outcomes were studied in long-term postoperative period. RESULTS: Simultaneous approach ensured less time of intraoperative fluoroscopy (p=0.029) and irradiation dose (p=0.035), duration of surgery (p=0.01) and anesthesia (p=0.02), amount of opioid drugs during anesthesia (p=0.017). Blood loss, duration of activation and hospitals-stay were similar in both groups (p=0.35, p=0.12 and p=0.57, respectively). There was comparable improvement in VAS score of pain in the lumbar spine and lower extremities in both groups (p=0.63 and p=0.31, respectively). According to SF-36 questionnaire, there was no between-group difference in physical and psychological components (p=0.44 and p=0.72, respectively). There was significantly greater number of adverse effects of anesthesia in the StSI group (26.2% vs. 6.8%, p=0.003). At the same time, the number of surgical postoperative complications was similar in both groups (3.4% vs. 5.3%, p=0.62). CONCLUSION: Simultaneous minimally invasive dorsal decompression-stabilization procedures have some significant advantages over staged approach regarding intraoperative parameters and adverse effects of anesthesia in patients with lumbar spine degenerative diseases. Nevertheless, there were similar clinical data and small incidence of surgical perioperative complications.


Assuntos
Fusão Vertebral , Descompressão , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
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