Результаты применения обогащенной тромбоцитами аутоплазмы в спинальной нейрохирургии

Досліджено ефективність інтраопераційного місцевого застосування збагаченої тромбоцитами аутоплазми (ЗТА) при встановленні систем транспедикулярної стабілізації в поперековому відділі хребта – за динамікою регресу больового синдрому (використовували візуальну аналогову шкалу) та станом післяопераційної рани. Інтенсивність болю у групі пацієнтів, яким вводилась ЗТА (n = 20), в першу ж післяопераційну добу була істотно нижчою (1,6 ± 0,7 балів), порівняно з контролем (n = 30) (3,8 ± 0,9 балів), і перед випискою склала, відповідно, 0,3 ± 0,3 та 2,0 ± 0,4 балів. У всіх пацієнтів після введення ЗТА візуально відмічено значно меншу вираженість набряку та гіперемії країв рани. Ускладнень, побічних реакцій, системного впливу біопрепарату не спостерігали. Таким чином, місцеве введення ЗТА під час проведення відкритих хірургічних втручань на хребті є безпечною та ефективною процедурою, що дозволяє покращити перебіг раннього післяопераційного періоду.Исследована эффективность интраоперационного местного использования обогащенной тромбоцитами аутоплазмы (ОТА) при установке систем транспедикулярной стабилизации в поясничном отделе позвоночника – по динамике регресса болевого синдрома (применяли визуальную аналоговую шкалу) и состоянию послеоперационной раны. Интенсивность боли в группе пациентов, которым вводилась ОТА (n = 20), в первые же послеоперационные сутки была значительно ниже (1,6 ± 0,7 бала) по сравнению с контролем (n = 30) (3,8 ± 0,9 баллов), и перед выпиской составила, соответственно 0,3 ± 0,3 и 2,0 ± 0,4 баллов. У всех пациентов после введения ОТА визуально отмечена значительно меньшая выраженность отека и гиперемии краев раны. Осложнений, побочных реакций, системного воздействия биопрепарата не наблюдали. Таким образом, местное введение ОТА во время проведения открытых хирургических вмешательств на позвоночнике является безопасной и эффективной процедурой, которая позволяет улучшить течение раннего послеоперационного периода.Introduction. Рlatelet-rich plasma (PRP), a blood plasma separated by centrifugation with highly abundant platelets, has multiple applications in many healthcare fields for the improvement of soft and bone tissues regeneration. The studies of PRP implementation results in spine neurosurgery are of high demand in case of pathologies related to the degeneration or injury of living bone and cartilaginous elements of vertebral column, which require the installation of vertebral interbody fusion system. Purpose. Improvement of surgical treatment outcomes by means of improving postoperative wound healing and reducing pain severity after the installation of transpedicular fixation systems in the lumbar spine using a biotechnological method which has a multimodal effect on regeneration processes and is simple and cost-effective Materials and Methods. The results of transpedicular stabilization in lumbar spine vertebral column were assessed within the early postoperational period in two groups of patients comparable in age and health status with spondylolisthesis and spinal motion segment instability. Patients from the main group (n = 20, average age 47.8 ± 6.6 years) received PRP during the operation as compared to the control one (n = 30, average age 46.9 ± 5.6 years) without PRP injections. Results. It was found that during the first day post-operation the pain severity in the main group was significantly reduced (1.6 ± 0.7 points according to the visual analogous scale) as compared to the control (3.8 ± 0.9 points). Moreover, these characteristics before the discharge of the patients were 0.3 ± 0.3 and 2.0 ± 0.4 points respectively. It is noteworthy that the swelling and wound edges hyperemia were remarkably reduced after the PRP use. Finally, no complications, side-effect or systemic consequences of PRP were observed. Conclusions. Therefore, the local injections of PRP during the installment of transpedicular stabilization system in lumbar spine is easyto-handle and safe approach favoring the quick recovery in early postoperational period

Long-Term Results of Surgical Treatment for Herniated Discs Using the Technique of Autologous Chondrocyte Transplantation

Objective: to evaluate the effectiveness of autologous chondrocyte (AC) transplantation in patients after lumbar microdiscectomy in the long-term period. Materials and methods. Transplantation of cryopreserved AC has been carried out in 6 patients 3 months after lumbar microdiscectomy. Evaluation of clinical status was performed using VAS and NASS scales, before and 3 months after microdiscectomy, 1 and 2 years after AC transplantation. In the same period, there were also evaluated magnetic resonance characteristics of hydration of intervertebral disc. Results. According to magnetic resonance imaging, recovery of nucleus pulposus hydrophilicity was found in 4 of 6 patients (66.7 %), who underwent AC transplantation. Pain severity decreased significantly in the early period after microdiscectomy, and 3 months after (by the time of AC transplantation) it has reduced by almost 6 times. One and 2 years after this procedure, pain continued to decline steadily. Functional status and quality of life after microdiscectomy significantly improved during first 3 months, and after transplantation they have not changed. Conclusions. Autologous chondrocyte transplantation after lumbar microdiscectomy is a safe method of surgical treatment for degenerative diseases of the spine, it helps to recover the biomechanical properties of the operated intervertebral disc

Some aspects of differential diagnosis of pain syndromes in discogenic neurocompression pathology

Background. A lot of factors may cause development of failed back surgery syndrome after disc hernia (DH) excision. One of them is non-adequate preoperative choice with over-diagnosis or over-estimation of clinical value of discogenic neurocompression pathology (DNP). Neurosurgical intervention is poor effective or in-effective if combined with prevailing non-vertebral disorder or the DH is a mask of another pathology, concomitant silent MRI finding. The purpose of the study was to improve preoperative choice of DH patients due to improvement of differential diagnosis of discogenic neurocompression and other pathologies associated with cervicobrachial or low back or pelvic pain or pain syndrome in extremities. Materials and methods. According to data of the Background. A lot of factors may cause development of failed back surgery syndrome after disc hernia (DH) excision. One of them is non-adequate preoperative choice with over-diagnosis or over-estimation of clinical value of discogenic neurocompression pathology (DNP). Neurosurgical intervention is poor effective or in-effective if combined with prevailing non-vertebral disorder or the DH is a mask of another pathology, concomitant silent MRI finding. The purpose of the study was to improve preoperative choice of DH patients due to improvement of differential diagnosis of discogenic neurocompression and other pathologies associated with cervicobrachial or low back or pelvic pain or pain syndrome in extremities. Materials and methods. According to data of the Clinic of Minimally Invasive and Laser Spinal Neurosurgery of SI “Romodanov Neurosurgery Institute of NAMS of Ukraine” (2013–2015) just 35.3 % of DH patients consulted for persistent pain syndrome had DNP and required surgical intervention. The rest patients (674.7 %) did not undergo DH excision as other disorders caused pain. In this group of patients (4437) with clinically not significant DH the reasons for pain syndrome were assessed. Results. More than half patients were found to have musculo-tonic and myoscleromy syndromes (vertebrogenic reflector (secondary) and primary cervicobrachial or low back or pelvic enthesopathy and in extremities) causing pain and in 17 % patients pathology of extra-vertebral joints and nervous system inflammatory disorders (NSID). The authors represents the criteria for differential diagnosis of pain syndromes in DH and NSID. The etiologic factors of NSID were estimated by complex laboratory data. A clinical case of NSID in DH patient and algorithm for preoperative choice are considered. Conclusions. Diagnosis of DH as a reason for neurologic syndrome is verifying if clinical and neuroimaging data fall together.  The identified disruption of neurologic manifestation and MRI data  requires thorough examination to distinguish DH patients requiring surgical intervention and patients with silent DH concomitant to other disorders or prevailing non-vertebrogenic disease in a case of combined pathology

The influence of cationic liposome-mediated APOE2 gene transfer on brain structural changes after experimental traumatic brain injury

The possibilities to prevent the evolution of structural changes caused by secondary damage after traumatic brain injury by means of gene therapy aimed at the induction of apoE2 synthesis in brain tissue were studied. Traumatic brain injury in rats was inflicted under an overall anesthesia by free falling load weighing 450 g, falling from a 1.5 m elevation. The mixture of DOTAP liposome and 25 μg of plasmid vector pCMV•SPORT6 with cDNA of APOE2 gene was infused intraventricularly. At day 10 after traumatic brain injury the histological examination of brain tissue was performed. Cationic liposome-mediated APOE2 gene transfer protected the brain parenchyma and vascular system and prevented the evolution of secondary injuries in damaged brain

Autologous cell using for the restoration of functional defects in patients with ischemic cerebrovascular accident

Stroke is a global medical and socio-economic problem and a great demand for alternative therapies, the leading one being stem cell (SC) therapy. Pathogenetic processes in ischemic stroke (II) trigger the mechanisms of necrotic and apoptotic death of neurons with the formation of the central infarct zone («core of ischemia») and the ischemic «penumbra» zone; the severity and reversibility of the injury directly depends on the duration of ischemia. In parallel with pathogenetic processes, endogenous neurogenesis occurs – the proliferation of neurogenic stem and progenitor cells (NSC/NPC) and their migration into the ischemic focus; however, most NSCs and newly formed neurons undergo apoptosis and recovery of lost functions does not occur. Significant efforts are being made to find ways to control neurogenesis, in particular through the transplantation of exogenous SCs. The main factors preventing the use of SCs in humans are moral, ethical, religious and legal aspects related to the source and method of obtaining cells, as well as possible immunocompromised complications due to incompatibility of donor cells with the recipient of the main histocompatibility complex antigens. The safest is the use of autologous SCs (the patient’s own cells), as it does not require the use of immunosuppressive protocols. Due to the relative safety and ease of production, the most common are multipotent mesenchymal stem cells (MSCs), namely MSCs of the bone marrow (BM). Numerous preclinical studies in experimental animals with modeled II, as well as clinical trials conducted over the past 15 years, have shown the safety and feasibility of transplantation of autologous MSCs in patients with severe neurological deficits after II. Two different approaches to the use of MSCs are discussed: neuroprotection in the acute phase and neurorestoration in the chronic phase II. Proposals are currently being developed for phase II/III clinical trials in acute and chronic stroke using BM MSCs, the results of which will form the basis for certified standardized II treatment protocols

Результаты применения обогащенной тромбоцитами аутоплазмы в спинальной нейрохирургии

Досліджено ефективність інтраопераційного місцевого застосування збагаченої тромбоцитами аутоплазми (ЗТА) при встановленні систем транспедикулярної стабілізації в поперековому відділі хребта – за динамікою регресу больового синдрому (використовували візуальну аналогову шкалу) та станом післяопераційної рани. Інтенсивність болю у групі пацієнтів, яким вводилась ЗТА (n = 20), в першу ж післяопераційну добу була істотно нижчою (1,6 ± 0,7 балів), порівняно з контролем (n = 30) (3,8 ± 0,9 балів), і перед випискою склала, відповідно, 0,3 ± 0,3 та 2,0 ± 0,4 балів. У всіх пацієнтів після введення ЗТА візуально відмічено значно меншу вираженість набряку та гіперемії країв рани. Ускладнень, побічних реакцій, системного впливу біопрепарату не спостерігали. Таким чином, місцеве введення ЗТА під час проведення відкритих хірургічних втручань на хребті є безпечною та ефективною процедурою, що дозволяє покращити перебіг раннього післяопераційного періоду.Исследована эффективность интраоперационного местного использования обогащенной тромбоцитами аутоплазмы (ОТА) при установке систем транспедикулярной стабилизации в поясничном отделе позвоночника – по динамике регресса болевого синдрома (применяли визуальную аналоговую шкалу) и состоянию послеоперационной раны. Интенсивность боли в группе пациентов, которым вводилась ОТА (n = 20), в первые же послеоперационные сутки была значительно ниже (1,6 ± 0,7 бала) по сравнению с контролем (n = 30) (3,8 ± 0,9 баллов), и перед выпиской составила, соответственно 0,3 ± 0,3 и 2,0 ± 0,4 баллов. У всех пациентов после введения ОТА визуально отмечена значительно меньшая выраженность отека и гиперемии краев раны. Осложнений, побочных реакций, системного воздействия биопрепарата не наблюдали. Таким образом, местное введение ОТА во время проведения открытых хирургических вмешательств на позвоночнике является безопасной и эффективной процедурой, которая позволяет улучшить течение раннего послеоперационного периода.Introduction. Рlatelet-rich plasma (PRP), a blood plasma separated by centrifugation with highly abundant platelets, has multiple applications in many healthcare fields for the improvement of soft and bone tissues regeneration. The studies of PRP implementation results in spine neurosurgery are of high demand in case of pathologies related to the degeneration or injury of living bone and cartilaginous elements of vertebral column, which require the installation of vertebral interbody fusion system. Purpose. Improvement of surgical treatment outcomes by means of improving postoperative wound healing and reducing pain severity after the installation of transpedicular fixation systems in the lumbar spine using a biotechnological method which has a multimodal effect on regeneration processes and is simple and cost-effective Materials and Methods. The results of transpedicular stabilization in lumbar spine vertebral column were assessed within the early postoperational period in two groups of patients comparable in age and health status with spondylolisthesis and spinal motion segment instability. Patients from the main group (n = 20, average age 47.8 ± 6.6 years) received PRP during the operation as compared to the control one (n = 30, average age 46.9 ± 5.6 years) without PRP injections. Results. It was found that during the first day post-operation the pain severity in the main group was significantly reduced (1.6 ± 0.7 points according to the visual analogous scale) as compared to the control (3.8 ± 0.9 points). Moreover, these characteristics before the discharge of the patients were 0.3 ± 0.3 and 2.0 ± 0.4 points respectively. It is noteworthy that the swelling and wound edges hyperemia were remarkably reduced after the PRP use. Finally, no complications, side-effect or systemic consequences of PRP were observed. Conclusions. Therefore, the local injections of PRP during the installment of transpedicular stabilization system in lumbar spine is easyto-handle and safe approach favoring the quick recovery in early postoperational period