Surgical treatment of the lumbar disc herniation complicated by lumbar spinal stenosis

Degenerative disc diseases of the lumbar spine are a relevant medical and social problem. Annually, about 8 % of the population lose their ability to work because of spinal pain, and of the total number of disability cases, 40 % are associated with pain in the lumbar region. Common causes of lumbar spine pain are disc herniation and spinal canal stenosis. There are rare cases of their combination (15–45 %). The lumbosacral spine has a tendency to develop intervertebral disc herniation due to the peculiarities of biomechanics and is, therefore, the main cause of spinal surgery among adults. The clinical picture depends on several factors: the location of the herniated disc, the size and direction of the hernia, the diameter of the spinal canal at this level, the presence of concomitant stenosis and its variant. The purpose of surgical treatment of degenerative disc diseases in the lumbar spine is to carry out complete decompression of the roots of the cauda equina with minimal anatomical destruction of the structures of the spine. An adequate understanding of anatomical ratios and optimal volume of bone resection make it possible to minimize access, reduce traction and surgical traumatization of nerve structures, which ensures effective postoperative rehabilitation of patients.The paper covers the issues of etiology, pathophysiology and surgical treatment of disc herniation complicated by concomitant spinal canal stenosis. The reviews the literature and recent researches of the most optimal methods of surgical treatment of this pathology. The lack of uniform approaches to the surgical treatment of discs herniation complicated by spinal canal stenosis indicates the urgency of the problem and requires further scientific research

Effect of platelet-rich fibrin matrix in complex with artificial material Nubiplant on expression of chondrogenic marker genes and morphogenesis of the nucleus pulposus cells of intervertebral discs in rats

The purpose was to study the barrier and biological properties of platelet-rich fibrin matrix (PRFM), an artificial biopolymer Nubiplant, and a mixture of PRFM / Nubiplant by assessing the viability and morphological characteristics of nucleus pulposus (NP) cells in rats, as well as the expression level of chondrogenic marker genes during cell cultivation in the presence of these matrices.Materials and methods. PRFM was obtained from platelet-rich plasma using a SiO2 coagulation activator. A suspension of nucleus pulposus cells was obtained from the caudal spine of rats. Cultivation was carried out in the presence of one of three matrices — PRFM, Nubiplant, or their mixture for 3, 7, and 14 days under standard culture conditions in an EC-160 incubator (Nüve, Turkey). Observation of the living culture was carried out in the area bordering with the matrix within one field of view using an inverted microscope (Nicon TS100, Japan). The expression of chondrogenic marker genes in the cell culture of the NP was determined by the method of PCR with reverse transcription.Results. The study of the viability and morphological characteristics of NP cells during their cultivation for 3, 7, and 14 days in the presence of PRFM, PRFM / Nubiplant, or Nubiplant showed a decrease in the content of living cells in control samples; in cultures with PRFM and PRFM / Nubiplant, the number of living cells significantly exceeded the control values, aggregation of cells was observed in the area bordering with the matrices from the side of the application. None of the experimental samples showed the outflow of cells to the opposite side of the matrix after 14 days of cultivation; thus, PRFM, Nubiplant, and their mixture can perform barrier functions to keep the cell population in a certain location. Expression of the COL II, ACAN, GPC3, ANXA3, PTN, MGP, and VIM genes by the NP cells during cultivation for 3 and 7 days in the presence of PRFM and PRFM / Nubiplant increased as compared to the control samples.Conclusions. The use of PRFM, Nubiplant, or a mixture of PRFM / Nubiplant during the cultivation of NP cells demonstrated the absence of cell outflow to the opposite side of the studied matrices during the study period (14 days). The use of PRFM, Nubiplant, or a mixture of PRFM / Nubiplant promoted the formation of cell colonies with chondrocyte-like morphology in the zone bordering with the matrices and maintained cell viability throughout the study period. PRFM and PRFM / Nubiplant contributed to the maintenance of the expression of chondrogenic genes in the NP cells in the zone bordering the matrices. The results obtained indicate the positive effect of the matrix based on platelet-rich fibrin on the NP cells and its barrier functions, which is promising for the use of PRMF for preventing the formation of cicatricial adhesion

Differentiated tactics of surgical treatment of intervertebral disc herniation complicated by spinal canal stenosis

Objective: to conduct a retrospective analysis and evaluate the results of various methods of surgical treatment of patients with intervertebral disc herniation (IDH), which is complicated by spinal canal stenosis (SCS) of the lumbar spine.Materials and methods: 80 patients (36 (45%) men and 44 (55%) women) with a diagnosis of IDH complicated by SCS took part in the study. The average age of patients is under 50 years. All patients were operated on in the neurosurgery department of Zaporizhzhya Regional Clinical Hospital between 2016 and 2020. Patients were divided into two groups depending on the area of ​​the spinal canal and the method of surgical treatment. Group A (n=20) – relative SCS, area of the spinal canal – 75‒100 mm2, the presence of IDH >6 mm (according to magnetic resonance imaging). These patients underwent a standard microdiscectomy. Group B (n=60) ‒ absolute SCS, spinal canal area 0.05). In both groups, a significant decrease in the Oswestry index was registered immediately after surgery and its further decrease until the end of the follow-up period. When comparing the groups at the end of the first day after the operation, after 3 and 6 months, no statistically significant differences were found (p>0.05), but preoperative Oswestry index was significantly higher in group B, (р=0.04 according to the Mann‒Whitney test).Conclusions. In group A, the treatment effectiveness of patients reached 80‒85%, in the observation period on the 3 and 6 months. In group B, the treatment effectiveness of patients was also high and amounted to 75‒80%, in the observation period on the 3 and 6 months. Thus, taking into account the high variability of clinical and morphological changes in patients with IDH complicated by SCS, it is optimal to use differentiated surgical treatment tactics

The comparative analysis of MRI data in the early period after lumbar microdiscectomies with epidural injection of polyacrylamide hydrogel

Objective: To perform a comparative analysis of MRI data obtained in the early postoperative period after repeated lumbar microdiscectomies in patients with and without epidural injection of “Nubiplant” polyacrylamide hydrogel (HG). Material and methods: The MRI data of the lumbar spine in the early postoperative period after repeated removal of herniated disc (on the 3-15th day) in 84 (100%) patients were analyzed: 30 (35,7%) patients were injected intraoperatively epidurally with “Nubiplant” HG to prevent epidural fibrosis (main group (MG) and in 54 (64,3%) patients the HG was not injected (control group (CG). Results: Comparative analysis of MRI data on the 3-15th day after surgery showed that the frequency of epidural edema and hemorrhage signs within the postoperative area in the MG was significantly lower as compared to the CG (p = 0,0444 and p = 0,0288 respectively). To assess the accuracy of the epidural administration of an artificial biopolymer Nubiplant during lumbar microdiscectomy, in the early postoperative period the following MRI criteria could be helpful: i) absence of the dural sac deformation and dislocations of the spinal root; ii) well-defined margin of the adjacent spinal root; iii) homogeneous MRI signals of the Nubiplant zone; iv) absence of Nubiplant areas outside the postoperative area; v) sufficient sectoral coverage of the adjacent root with epidurally administered Nubiplant (optimally >1800). Nubiplant” HG in the patients of the MG was evaluated, and MRI criteria for assessing the correctness of its introduction were proposed. Conclusions: In the early period after repeated lumbar microdiscectomies (on the 3-15th day), intraoperative epidural injection of “Nubiplant” HG was accompanied by a significant decrease of epidural edema and hemorrhage signs within the postoperative area. The proposed criteria of correctness of HG “Nubiplant” introduction allow unifying the approaches in radiological assessment of this patients

Вплив збагаченого тромбоцитами фібринового матриксу в комплексі зі штучним матеріалом Nubiplant на експресію хондрогенних маркерних генів та морфогенез клітин пульпозного ядра міжхребцевих дисків щурів

The purpose was to study the barrier and biological properties of platelet-rich fibrin matrix (PRFM), an artificial biopolymer Nubiplant, and a mixture of PRFM / Nubiplant by assessing the viability and morphological characteristics of nucleus pulposus (NP) cells in rats, as well as the expression level of chondrogenic marker genes during cell cultivation in the presence of these matrices.Materials and methods. PRFM was obtained from platelet-rich plasma using a SiO2 coagulation activator. A suspension of nucleus pulposus cells was obtained from the caudal spine of rats. Cultivation was carried out in the presence of one of three matrices — PRFM, Nubiplant, or their mixture for 3, 7, and 14 days under standard culture conditions in an EC-160 incubator (Nüve, Turkey). Observation of the living culture was carried out in the area bordering with the matrix within one field of view using an inverted microscope (Nicon TS100, Japan). The expression of chondrogenic marker genes in the cell culture of the NP was determined by the method of PCR with reverse transcription.Results. The study of the viability and morphological characteristics of NP cells during their cultivation for 3, 7, and 14 days in the presence of PRFM, PRFM / Nubiplant, or Nubiplant showed a decrease in the content of living cells in control samples; in cultures with PRFM and PRFM / Nubiplant, the number of living cells significantly exceeded the control values, aggregation of cells was observed in the area bordering with the matrices from the side of the application. None of the experimental samples showed the outflow of cells to the opposite side of the matrix after 14 days of cultivation; thus, PRFM, Nubiplant, and their mixture can perform barrier functions to keep the cell population in a certain location. Expression of the COL II, ACAN, GPC3, ANXA3, PTN, MGP, and VIM genes by the NP cells during cultivation for 3 and 7 days in the presence of PRFM and PRFM / Nubiplant increased as compared to the control samples.Conclusions. The use of PRFM, Nubiplant, or a mixture of PRFM / Nubiplant during the cultivation of NP cells demonstrated the absence of cell outflow to the opposite side of the studied matrices during the study period (14 days). The use of PRFM, Nubiplant, or a mixture of PRFM / Nubiplant promoted the formation of cell colonies with chondrocyte-like morphology in the zone bordering with the matrices and maintained cell viability throughout the study period. PRFM and PRFM / Nubiplant contributed to the maintenance of the expression of chondrogenic genes in the NP cells in the zone bordering the matrices. The results obtained indicate the positive effect of the matrix based on platelet-rich fibrin on the NP cells and its barrier functions, which is promising for the use of PRMF for preventing the formation of cicatricial adhesion.Цель: исследовать барьерные и биологические свойства обогащенного тромбоцитами фибринового матрикса (ОТФМ), искусственного биополимера Nubiplant и смеси ОТФМ и Nubiplant путем оценки жизнеспособности и морфологических характеристик клеток пульпозного ядра (ПЯ) межпозвоночных дисков крыс, а также уровня экспрессии хондрогенных маркерных генов при культивировании этих клеток при наличии указанных матриксов.Материалы и методы. ОТФМ получали из обогащенной тромбоцитами плазмы с использованием активатора свертывания SiO2, суспензию клеток ПЯ ‒ из хвостового отдела позвоночника крыс. Культивирование осуществляли при наличии одного из трех матриксов ‒ ОТФМ, Nubiplant или их смеси в течение 3, 7 и 14 суток при стандартных культуральных условиях в инкубаторе ЕС-160 (Nüve, Турция). Наблюдение за живой культурой проводили в пограничной с матриксом зоне в пределах одного поля зрения с использованием инвертированного микроскопа (Nicon TS100, Япония). Экспрессию хондрогенных маркерных генов в культуре клеток ПЯ определяли методом полимеразной цепной реакции с обратной транскрипцией.Результаты. Исследование жизнеспособности и морфологических характеристик клеток ПЯ при их культивировании продемонстрировало снижение содержания живых клеток в контрольных образцах. В культурах с ОТФМ и смесью ОТФМ и Nubiplant количество живых клеток статистически значимо превышало контрольные показатели. Наблюдали агрегацию клеток в пограничной с матриксами зоне со стороны нанесения. Выселения клеток на противоположную сторону матрикса в течение 14 суток ни в одном из экспериментальных образцов не отмечено. Таким образом, ОТФМ, Nubiplant и их смесь могут выполнять барьерные функции по удержанию клеточной популяции в определенном участке. Экспрессия генов COL II, ACAN, GPC3, ANXA3, PTN, MGP и VIM клетками ПЯ при культивировании в течение 3 и 7 суток при наличии ОТФМ и смеси ОТФМ и Nubiplant возрастала по сравнению с контрольными образцами.Выводы. Применение ОТФМ, Nubiplant или смеси ОТФМ и Nubiplant при культивировании клеток ПЯ продемонстрировало отсутствие выселения клеток на противоположную сторону упомянутых матриксов в течение всего периода исследования (14 дней). Использование ОТФМ, Nubiplant или смеси ОТФМ и Nubiplant способствовало формированию колоний клеток хондроцитоподобной морфологии в пограничной с матриксами зоне и поддерживало жизнеспособность клеток в течение всего исследуемого периода. Применение ОТФМ и ОТФМ и Nubiplant позволяло поддерживать экспрессию хондрогенных генов клетками ПЯ в пограничной с матриксами зоне. Полученные результаты свидетельствуют о положительном действии матрикса на основе обогащенного тромбоцитами фибрина на клетки ПЯ и его барьерные функции, что является перспективным для применения ОТФМ с целью предотвращения формирования рубцово-спаечных процессов.Мета: дослідити бар’єрні та біологічні властивості збагаченого тромбоцитами фібринового матриксу (ЗТФМ), штучного біополімеру Nubiplant та їх суміші шляхом оцінки життєздатності та морфологічних характеристик клітин пульпозного ядра (ПЯ) міжхребцевих дисків щурів, а також рівня експресії хондрогенних маркерних генів при культивуванні цих клітин за наявності зазначених матриксів.Матеріали і методи. ЗТФМ отримували зі збагаченої тромбоцитами плазми з використанням активатора згортання SiO2, суспензію клітин ПЯ ‒ із хвостового відділу хребта щурів. Культивування здійснювали за наявності одного з трьох матриксів – ЗТФМ, Nubiplan або їх суміші протягом 3, 7 та 14 діб за стандартних культуральних умов в інкубаторі ЕС-160 (Nüve, Турція). Спостереження за живою культурою проводили в пограничній з матриксами зоні в межах одного поля зору з використанням інвертованого мікроскопа (Nicon TS100, Японія). Експресію хондрогенних маркерних генів у культурі клітин ПЯ визначали методом полімеразної ланцюгової реакції зі зворотною транскрипцією.Результати. Дослідження життєздатності та морфологічних характеристик клітин ПЯ при їх культивуванні продемонструвало зниження вмісту живих клітин у контрольних зразках. У культурах із ЗТФМ та сумішшю ЗТФМ і Nubiplant кількість живих клітин статистично значущо перевищувала контрольні показники. Спостерігали агрегацію клітин у зоні безпосереднього межування з матриксами з боку нанесення. Виселення клітин на протилежний бік матриксу протягом 14 діб у жодному з експериментальних зразків не відзначено. Таким чином, ЗТФМ, Nubiplant та їх суміш можуть виконувати бар’єрні функції щодо утримання клітинної популяції в певній ділянці. Експресія генів COL II, ACAN, GPC3, ANXA3, PTN, MGP та VIM клітинами ПЯ при культивуванні протягом 3 та 7 діб за наявності ЗТФМ і суміші ЗТФМ та Nubiplant зростала порівняно з контрольними зразками.Висновки. Застосування ЗТФМ, Nubiplant або суміші ЗТФМ і Nubiplant при культивуванні клітин ПЯ продемонструвало відсутність виселення клітин на протилежний бік зазначених матриксів протягом усього періоду дослідження (14 діб). Використання ЗТФМ, Nubiplant або суміші ЗТФМ і Nubiplant сприяло формуванню колоній клітин хондроцитоподібної морфології у зоні межування з матриксами та підтримувало життєздатність клітин протягом усього досліджуваного періоду. Застосування ЗТФМ і суміші ЗТФМ та Nubiplant давало змогу підтримувати експресію хондрогенних генів клітинами ПЯ в пограничній з матриксами зоні. Отримані результати свідчать про позитивну дію матриксів на основі збагаченого тромбоцитами фібрину на клітини ПЯ та його бар’єрні функції, що є перспективним для застосування ЗТФМ з метою запобігання формуванню рубцево-спайкових процесів