COMPARATIVE ANALYSIS OF THE TREATMENT OF THE EOSINOPHILIC GRANULOMA WITH VERTEBRAL INVOLVEMENT USING ORTHOPEDIC CORSET AND SURGICAL OPERATION

The results of treatment of 72 patients with pathological fracture of vertebra bodies against eosinophilic granuloma a spine are analysed. Orthopedic corset technologies are used in treatment of 42 patients, surgical treatment was applied. Orthopedic corset may be used in patients with eosinophilic granuloma of backbone. This method of treatment was used in a case of the absence of spine secondary deformations and neurologic semiology. Orthopedic corset treatment is associated with long immobilization on the average within 1,5-2 years and never leads to a complete recovery of the damaged spine. Surgical treatment consists in use only at loss of height of a body to 30-40%, when destruction of spine more severe it is necessary to use operative treatment in two stages. Absolute indications to surgical treatment are the neurologic deficit and secondary deformations of a spine. Surgical treatment allows to reduce terms of treatment till 3-4 months and quickly to return the patient to an active life

ЕFFECTIVENESS OF FOUR-ROD FIXATION FOR PEDICLE SUBTRACTION SPINAL OSTEOTOMY

Introduction. Pedicle subtraction osteotomy (PSO) provides for significant segmental correction of the sagittal balance of the spine. At the same time, the technique is associated with a high risk of complications, with rod fracture at the osteotomy site being the most common. The purpose of this study — to assess the effectiveness of four-rod fixation compared to literature data on standard two-rod fixation in patients undergoing PSO. Materials and Methods. The study is a retrospective analysis of 47 consecutive patients with rigid spinal deformities, who underwent pedicle subtraction osteotomy at the lumbar level. The average age of the patients (33 females and 14 males) was 59.7 years. In all cases spinal fixation carried out using a four-rod construct with additional short rods at the osteotomy site. The minimal postoperative follow-up was 2 years. A detailed analysis of the radiographic data was carried out with calculation of the global sagittal balance and spinopelvic parameters. A detailed assessment of complications in the early and late postoperative periods was also performed. After an exhaustive review of literature, a comparative analysis was made of the four-rod fixation technique with current literature data on the frequency of complications (in particular, rod fractures in the osteotomy zone) after two-rod fixation. Results. In all cases the osteotomy was performed at one level, most often at L3 (49%). The average length of fixation was 9.8 segments. The average angle of segmental correction was 27.1°. In most cases, it was possible to achieve adequate correction of spinopelvic parameters. Among complications, bone resorption around screws was most prevalent (23.4% of cases). Proximal junctional kyphosis occurred in 12.8% of cases, neurologic deficit — in 14.9% of cases, infectious complications — in 10.6% cases. Asymptomatic pseudarthrosis, confirmed by CT data, was observed in 12.8% of patients. Rod fracture at the PSO site and adjacent segments was not observed in any of the cases. Rod fractures of other localization were observed in 10.6% of patients. Conclusion. According to the literature, the frequency of rod fractures at the osteotomy site is the most frequent complication of PSO. The results of this study showed that four-rod fixation in PSO significantly reduces the incidence of pseudarthrosis and rod fracture rate in the long-term follow-up and provides greater control over the process of osteotomy closure

Cage Subsidence after Surgery on the Anterior Part of the Subaxial Cervical Spine: a Monocentric Prospective Clinical Study with a 3-Year Follow-Up

The choice of an implant for vertebra body defect replacement in corpectomy for traumatic lesions remains a point of discussion among spinal surgeons. Nanostructured carbon cages are promising for use in spinal surgery.The purpose of this study was to determine the rate and degree of cage subsidence in the patients with traumatic lesions of the cervical spine undergone a single-level anterior corpectomy in the subaxial part of the cervical spine with reconstruction using a carbon or titanium cage. Materials and Methods. A prospective study included 47 patients undergone a single-level corpectomy of the cervical spine due to traumatic injury. Two groups were formed by adaptive randomization: group I with the patients with carbon cages (n = 23), and group II with the patients with titanium cages (n = 24). The evaluation of cages subsidence and stability was carried by X-rays and CT before and after surgery. The quality of life before and after the surgery was evaluated using NDI and VAS questionnaires.Results. According to the questionnaires, the absolute majority of the patients in both groups showed a statistically significant improvement of quality of life in the postoperative period (p<0.01). The first signs of implant subsidence were noted 3 months after surgery in group II. There were none of such cases in group I. The final result of the subsidence at the end of the follow-up comprised: for group I 0.6±0.4 mm, for group II 3.1±1.4 mm (p = 0.023). In group II, the bone block between bone tissue and the cage was recorded in 30% of patients (p = 0.037), in group I, the bone block was not formed. At the same time, according to the functional X-ray data, there were no signs of carbon cages instability in group I. None of the patients in groups I and II required revision surgery due to complications associated with cages placement.Conclusion. The outcomes of carbon nanostructure cages placement as bodyreplacing implants in the cervical spine were not inferior to the outcomes of titanium mesh cages using. In group I, the carbon cages subsidence was significantly lower than in group II with titanium cages. The bone block was not formed in the case of carbon cages. It is worth noting that the carbon structure of the cages allowed the radiological diagnostics of the operated segment without artifacts formation