Неспецифические гнойно-воспалительные поражения позвоночника: спондилодисцит, эпидурит

Nonspecific infectious lesions of the spine are relatively rare, difficult to diagnose and severe diseases of the spine. The urgency of treating nonspecific infectious spinal diseases is explained by an increase in the frequency of these diseases, new antibiotic-resistant strains of microorganisms, and the severity of the course and unsatisfactory treatment outcomes. In this review, we describe spondylodiscitis and epiduritis in detail. On the basis of literature data, we thoroughly studied and described etiology, clinical pattern and diagnosis of these diseases. We thoroughly covered modern laboratory and radiologic methods for the diagnosis of spondylodiscitis and epiduritis, such as spondylography, computed tomography, magnetic resonance imaging, scintigraphy, positron emission tomography of the spine and biopsy and described modern methods of conservative and surgical treatment. The particular attention is paid to the technique of surgical treatment of spondylodiscitis and epiduritis.Неспецифические гнойно-воспалительные поражения позвоночника (НГВПП) относятся к довольно редким, трудно диагностируемым и тяжелым заболеваниям. Актуальность проблем диагностики и лечения НГВПП объясняется увеличением частоты встречаемости данной патологии, возникновением новых антибиотикорезистентных штаммов микроорганизмов, тяжестью течения заболевания и неудовлетворительными исходами лечения. В данном обзоре подробно рассмотрены следующие вертебральные инфекции: спондилодисцит и эпидурит. Авторами на основе данных литературы обстоятельно изучены и описаны этиология, клиническая картина и диагностика данных заболеваний. Досконально в работе освещены современные методы диагностики спондилодисцита и эпидурита: лабораторные, лучевые методы: спондилография, компьютерная томография, магнитно-резонансная томография, сцинтиграфия, позитронно-эмиссионная томография позвоночника и данные биопсии. Развернуто описаны современные методы консервативного и хирургического лечения. Особое внимание уделено технике оперативного лечения спондилодисцита и эпидурита

Topical issues of treatment of degenerate scoliosis at adults at the present stage (review)

Degenerative scoliosis is a prevalent issue among the aging population. Controversy remains over the role of surgical intervention in patients with this disease. Authors carry out the review of literature data, consider various approaches of surgical treatment depending on a stage of a disease and extent of deformation, including a decompression, instrumented posterior spinal fusion, an anterior spinal fusion, and osteotomy. These treatment options are based on clinical analysis, radiographic analysis of the mechanical stability of the deformity, given pain generators, and necessary sagittal balance. The high potential complication rates appear to be outweighed by the eventual successful clinical outcomes in patients suitable for operative intervention. This approach has had favorable outcomes and could help resolve the controversy

MULTIPLE MYELOMA OF THE SPINE: SURVIVAL, COMPLICATIONS, AND NEUROLOGICAL STATUS AFTER SURGICAL TREATMENT

Purpose – to evaluate the survival, neurological status, and complications after surgical management of patients with multiple myeloma of the spine. Materials and methods. A retrospective study of 44 patients with multiple myeloma of the spine operated in Vreden Institute of Traumatology and Orthopedics was held in the period between 2000 and 2015. Patients underwent decompressive surgery with additional spinal instrumentation. following parameters were evaluated: demographic data, pain intensity, neurological deficit, survival, and complications after surgery. Results. Overall results showed efficiency of surgical management of spinal instability and neurological compromise due to multiple myeloma of the spine. The mean postoperative survival time was 63 months. A significant improvement in VAS scale and neurological function was observed in the study population after surgery. Postoperative VAS was 7.1 scores compared with 3.6 scores preoperatively (p = 0.021). Twenty nine of 31 patients improved their neurological status. Poor life expectancy was associated with neurological deficit both before and after surgery (p<0.0001). There were 28 postoperative complications. Most frequent complications were deep wound infection and adjacent degenerative disease. There was no survival difference in cohorts with and without complications (p = 0.942).> <0.0001). There were 28 postoperative complications. Most frequent complications were deep wound infection and adjacent degenerative disease. There was no survival difference in cohorts with and without complications (p = 0.942). Conclusion. Decompression surgery with additional instrumentation significantly decrease pain intensity and improve neurological function in selected patients affected by spinal myeloma with spinal instability. Severe neurological deficit influence on survival both before and after surgery. Survival did not depend on complications

Individual Lordotic Cages Implantation and Radiographic Evaluation of Segmental and Lumbar Lordosis Correction for Patients with Adult Degenerative Scoliosis

Relevance. The development of minimally invasive surgery has led to the development of new methods for surgical treatment of the spine. Conventional surgical technique, such as vertebrotomy is accompanied by a several number of disadvantages (high blood loss, prolonged hospital stay, long intraoperative time, postoperative neurological deficit). An alternative to improve sagittal balance in the spine is to use custom-made hyperlordotic cages, which can also be used for indirect decompression of neural structures. The objective is to compare the degree of segmental and total lumbar lordosis using hyperlordotic cages through ALIF and TLIF with posterior instrumentation.Materials and Methods. A single-center retrospective cohort study using 96 patients treated from 2018 to 2019 about degenerative spinal deformities. Comparison of two groups: group 1 (A) consisted of 30 patients who were held anterior spinal fusion with individual lordotic cages from minimally invasive anterior approach (MISS ALIF) without posterior fixation. Group 2 (B) consisted of 33 patients whom were performed spinal fusion from the posterior approach (TLIF) with Smith-Peterson Osteotomy (SPO) and transpedicular fixation. Measuring segmental and lumbar lordosis, teleradiographs were used in a standing position. For an accurate assessment, the non-commercial available Surgimap software, © Nemaris, was used.Results. Segmental lordosis were superior to preoperative ones. In the intergroup comparison, the ALIF group showed an excellent increase in the enlarged lordosis segment (L3-L4 in 8 degrees; p = 0.0005, L4-L5 in 7 degrees; p = 0.0002, L5-S1 in 7 degrees; p = 0.0001). When conducting an intergroup comparison of total lumbar lordosis in the preoperative period, there was a statistically significant difference between them (p = 0.0043). At the same time, a greater degree of correction of lordosis is shown in ALIF compared to TLIF group (29,1 in comparison with 22,5; p = 0.00005).Conclusion. The results of this study confirm that the using of custom-made lordotic cages can significantly increase segmental and total lumbar lordosis for patients with degenerative scoliosis in adults

Risk Factors for Infectious Complications after Surgical Treatment of Spinal Metastases in Patients with Breast and Kidney Cancer

Relevance. In patients with the most common malignant new growth such as breast, kidney and lung cancer the rate of spinal metastases amounts to 70%. Increasing number of surgical procedures results in growing frequency of postoperative complications including surgical site infection (SSI) which do not only deteriorate the quality of patient’s life but change the timelines for renewal of therapy for the primary disease. Study design — case control study. Purpose of the study — to identify key risk factors as well as impact of tumor therapy on development of infectious complications in patients with breast and kidney cancer after surgical management of metastatic spine lesion. Materials and Methods. The authors collected and compiled the data on 2023 oncological patients who underwent specialized neuroorthopaedic treatment in the period from 2000 until 2017 due to tumor spine lesions. Inclusion criteria: malignant breast and kidney tumors with spine metastases, continued systemic tumor therapy, decompression and stabilization spine surgery irrespective of used implants. Patients that corresponded to inclusion criteria were divided into two groups. The first (main) group included patients (n = 22) with infectious complications after surgery. The second (control) group (n = 23) was formed by propensity score matching. Results. The analysis of obtained data resulted in identification of severe significant factors (р<0.05): diabetes mellitus, postoperative liquorrhea, certain classes by ASA (3, 4) and ECOG (2, 3, 4) scales, volume of blood loss, time of surgery and type of tumor therapy. However, the three latter have the highest statistical significance (р<0.01): surgical factors (blood loss volume and time of procedure) and type of tumor therapy. Conclusion. Postoperative SSI remains a common severe complication after surgeries due to metastatic spine lesions. The causes of postoperative infection after tumor resection are compromised immune status of the patient; long time of procedure with heavy blood loss and adjuvant tumor therapy

Nonspecific Pyoinflammatory Lesions of the Spine: Spondylodiscitis, Epiduritis

Nonspecific infectious lesions of the spine are relatively rare, difficult to diagnose and severe diseases of the spine. The urgency of treating nonspecific infectious spinal diseases is explained by an increase in the frequency of these diseases, new antibiotic-resistant strains of microorganisms, and the severity of the course and unsatisfactory treatment outcomes. In this review, we describe spondylodiscitis and epiduritis in detail. On the basis of literature data, we thoroughly studied and described etiology, clinical pattern and diagnosis of these diseases. We thoroughly covered modern laboratory and radiologic methods for the diagnosis of spondylodiscitis and epiduritis, such as spondylography, computed tomography, magnetic resonance imaging, scintigraphy, positron emission tomography of the spine and biopsy and described modern methods of conservative and surgical treatment. The particular attention is paid to the technique of surgical treatment of spondylodiscitis and epiduritis

TREATMENT OUTCOMES IN ELDERLY AND SENILE PATIENTS WITH DEGENERATIVE DEFORMATIONS AND INSTABILITY OF THE SPINAL COLUMN

Degenerative  scoliosis  is  a  prevalent  issue  among  the  aging  population.  Controversy  remains   over  the  role of surgical intervention in patients with such disease. The authors  present  the results of 14-year experience in treatment of this pathology.  Various approaches  to the surgical treatment depending  on the stage of the disease and the degree of deformation, including  decompression, instrumental posterior spinal fusion, anterior spinal fusion, and osteotomy were examined. Above treatment options are based on the analysis of clinical aspects, mechanical  stability of deformation, the degree of imbalance in the body and causes of pain or neurological  deficit.The  risk of postoperative complications is extremely  high and seems to be outweighed by the  possible successful outcomes of surgical treatment. The results presented in the treatment of degenerative scoliosis mainly provide positive outcomes and can assist in the selection of treatment for this group of patients.The purpose of the  study  is to  evaluate  the  treatment outcomes  of elderly  and  senile patients with  degenerative deformations and instability of the spinal column using various surgical techniques.Material and methods. During  the present  retrospective study the authors  analyzed 437 patients (337 (77%) women and  100  (23%)  men)  aged  60 years  and  older  who  underwent surgical  treatment at  Russian  Research  institute of traumatology and orthopaedics named  after  R.R.Vreden between  2000 and 2016. The  study  group  included  patients with  diseases and consequences  of injuries  in the  spine, leading  to its deformation and following spinal stenosis  with development of neurological  deficit in some cases.The  patients were subdivided into  four  groups  depending  on surgical  procedure.  Patients in group  I underwent decompression  of neural  structures at affected levels on both  sides without implants  for fixation. This group was used as the  comparison  group.  Patients in group  II  underwent fixation  the  affected  spinal  motion  segments  locally  with transpedicular system without correction of deformity  and with decompression  of neural structures at the level of spine stenosis.  Patients of group  III  underwent surgery  for fixation  of affected  PDS  up to lower thoracic  spine using short transpedicular system along with decompression  of the neural  structures and correction of spine deformity.  Patients in group IV underwent surgery  for fixation  of affected PDS  up to upper thoracic  spine using transpedicular system, bone cement, decompression  of neural structures and correction of spine deformity.The average postoperative follow up was 5 years (from 3 months  to 15 years), 266 patients were followed for more than three years.Results.  The  best  results   were  obtained  in  group  IV:  good  results   – 57,2%  (60  patients),  satisfactory  40% (42 patients), poor 2,8% (3 patients).The  worst  results  were  obtained in group  I: after  5 years  follow up satisfactory results  were  observed  in 13,4% (15 patients), poor in 86,6% (97 patients) and no good results were reported.Conclusion. Thus, the performed  study  and observed outcomes indicate  the rationale for performing a full deformity correction by transpedicular fixation and bone cement, applying all the required  methods  and techniques of osteotomy. This approach  allows to maximally  quickly  achieve  the  desired  treatment outcomes  in mid-and long-term follow up period and to avoid complications and revisions