[Risk factors for venous thromboembolic complications in elderly and senile patients with diabetes mellitus planned for spinal surgery.]

The search for literature sources in domestic and foreign databases showed the absence of works devoted to the study of risk factors for venous thromboembolic events (VTE) in patients of the older age group with diabetes mellitus who are planned to undergo surgical interventions on the spine, which was the impetus for this study. The aim of the study was to study the risk factors for VTE in elderly and senile patients with diabetes mellitus who are scheduled for spinal surgery. A single-center retrospective study included 119 elderly and senile patients (64 men, 55 women, mean age 74,2±6,5 years) who underwent various surgical interventions on the spinal column. According to the binary logistic regression model, the following parameters are statistically significantly associated with the development of VTEC in the studied group of respondents: age of patients over 75 years (p=0,048), HbA1C levels over 7,5% (p=0,007) and D-dimer over 0,5 mg /l FEU (p=0,034), as well as high risk (5 points or more) of VTE according to Caprini scale (p=0,012). In order to reduce the incidence of VTE in elderly and senile patients with diabetes mellitus who are planned to perform surgical interventions on the spine, it is necessary to verify the above clinical and laboratory parameters in the early stages of hospitalization.

[Facet joint distraction as a risk factor for poor clinical outcomes in older patients after anterior cervical discectomy and fusion.]

The search for literature sources in domestic and foreign databases showed the absence of works devoted to the study of the influence of the degree of distraction of the facet joints in elderly and senile patients who underwent anterior cervical discectomy and fusion (ACDF). The purpose of the study was to study the effect of the degree of facet joint distraction on clinical outcomes in patients of the older age group who underwent ACDF. A single-center retrospective study included 47 elderly and senile patients who underwent ACDF for radiculopathy due to degenerative diseases of the cervical spine. A statistically significant correlation was found between the differences in the value of the interfacet distance and the severity of pain in the cervical spine according to VAS (p<0,01). Patients with X-ray semiotics of facet distraction more than 0,55 mm 12 months after the operation were significantly more likely to experience increased pain in the cervical spine according to VAS (p=0,028) and significantly limited daily activities due to pain in the neck NDI (p=0,043). The choice of indications for ACDF in patients of the older age group should be based on a rigorous analysis of facet distraction, cervical sagittal parameters in combination with the functional status of patients.

[A validated new classification for intervertebral disk degeneration]. / Novaya validizirovannaya klassifikatsiya klassov degeneratsii mezhpozvonkovykh diskov.

OBJECTIVE: To develop a new validated classification of intervertebral disc degeneration. MATERIAL AND METHODS: A retrospective observational single-center study included medical records of patients with and without degenerative disease of lumbar intervertebral discs. The interval values of apparent diffusion coefficient (ADC) of intervertebral discs were grouped into degeneration classes. RESULTS: The study included medical records of 100 patients. A quantitative analysis of data showed that mean ADC has a significant correlation with severity of lumbosacral disc degeneration according to classification by Pfirrmann et al. Lumbar intervertebral discs with degeneration grade 3-4 were less homogeneous compared to grade 2-3. Among discs with degeneration grade 4, mean ADC was significantly higher in case of hernia (p=0.01). Conversely, mean ADC was significantly higher in the absence of hernia for discs grade 3 (p=0.04). Combination of all data is presented as original classification of lumbosacral disc degeneration based on mean ADC. CONCLUSION: The developed classification can be recommended for radiologists, neurologists and neurosurgeons.

[Risk factors of unsatisfactory outcomes after percutaneous laser decompression of lumbar intervertebral discs]. / Faktory riska neudovletvoritel'nykh rezul'tatov posle chreskozhnoi lazernoi dekompressii poyasnichnykh mezhpozvonkovykh diskov.

OBJECTIVE: To study the risk factors of unsatisfactory clinical results after percutaneous laser decompression of the lumbar intervertebral disc (PLDD). MATERIAL AND METHODS: A retrospective observational single-center study included medical records of patients who underwent lumbar PLDD for degenerative spine disease. We analyzed clinical and instrumental parameters potentially affecting the results of lumbar PLDD. RESULTS: Clinical study included 82 patients who underwent PLDD for lumbar intervertebral disc degenerative disease. Mean postoperative follow-up period was 30.8±13.3 months. In 22 (26%) patients, unsatisfactory clinical outcomes were observed. According to binary logistic regression model, comorbidities (p=0.03), duration of disease over 12 months (p=0.03), low preoperative quality of life according to ODI score (more than 50%) (p=0.04), high body mass index (over 25 kg/m2) (p=0.02), severe intervertebral disc (p=0.04) and facet joint degeneration (p=0.01) and intervertebral disc height decrease more than 50% (p=0.01) were significantly associated with unsatisfactory clinical outcomes after lumbar PLDD for degenerative spine disease. CONCLUSION: Identification of these risk factors of unsatisfactory clinical outcomes is important stage of preoperative preparation in patients scheduled for lumbar PLDD.

[Risk factors of adverse clinical outcomes in the elderly and senile patients with stroke-associated pneumonia.]

In the domestic and foreign specialized literature, there are no studies devoted to the study of risk factors of mortality in the older age patients with stroke-associated nosocomial pneumonia. The purpose of the study was to study the risk factors of adverse clinical outcomes in elderly and senile patients with stroke-associated nosocomial pneumonia. The study included 247 elderly and senile patients (139 men, 108 women, mean age -- 74,1±6,3 years) who were hospitalized with signs of ischemic or hemorrhagic stroke. According to the binary logistic regression model, the following parameters are statistically significantly associated with adverse clinical outcomes in the studied group of respondents: age over 75 years (p=0.011), degree of disability according to mRS ≥3 (p=0,009), and C-reactive protein levels over 100 mg/l (p=0,023) and urea more than 7 mmol/l (p=0,044). In order to reduce the incidence of adverse clinical outcomes in patients of the older age group with stroke-associated nosocomial pneumonia, it is necessary to verify the above clinical and laboratory parameters at the early stages of hospitalization.

[Effect of renin-angiotensin-aldosterone system inhibitors on functional activity of the spinal cord and nerve roots in patients with degenerative lumbar spine diseases]. / Vliyanie blokatorov renin-angiotenzin-al'dosteronovoi sistemy na funktsional'nuyu aktivnost' spinnogo mozga i ego koreshkov u patsientov s degenerativnymi zabolevaniyami poyasnichno-kresttsovogo otdela pozvonochnika.

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.

[Smoking as a risk factor of advanced heterotopic ossification in patients after lumbar total disk arthroplasty]. / Kurenie kak faktor riska uvelicheniya skorosti formirovaniya ochagov geterotopicheskoi ossifikatsii u patsientov posle vypolneniya total'noi artroplastiki poyasnichnykh mezhpozvonkovykh diskov.

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.

[The effectiveness of local application of vancomycin powder in the prevention of surgical site infections in spine surgery: a meta-analysis]. / Effektivnost' lokal'nogo primeneniya poroshka vankomitsina v profilaktike infektsii oblasti khirurgicheskogo vmeshatel'stva v spinal'noi khirurgii: metaanaliz.

OBJECTIVE: To perform a meta-analysis of studies examining the effectiveness of the local application of vancomycin powder for the prophylaxis of surgical site infections (SSIs) in spine surgery. MATERIAL AND METHODS: Retrospective cohort studies and prospective randomized clinical trials were searched for in the Pubmed, EMBASE, Cochrane Library and eLibrary databases published from 2008 to December 2018. For the resulting variables, the odds ratio and 95% confidence interval were calculated using random and fixed effects models. Estimation of the degree of heterogeneity is estimated using the coefficient I2. Statistically significant differences were considered differences p<0.05. RESULTS: The meta-analysis included 28 clinical studies that included the results of the local application of vancomycin powder in 17,469 patients after performing various spinal surgical interventions. Two publications had a prospective, randomized, controlled study design. Topical application of vancomycin powder reduces the incidence of SSIs after spine surgery (p<0.0001). The use of vancomycin powder reduces the incidence of SSIs in patients operated on with stabilizing implants (p=0.004). On the other hand, the topical application of vancomycin powder did not affect the prevalence of SSIs in respondents who were operated on without the use of stabilizing implants (p=0.12) or due to deformities of the spine (p=0.06). CONCLUSION: Topical application of vancomycin powder is highly effective in preventing the development of SSIs in patients after spinal surgical interventions.

[Quality of life after reconstructive procedures for esophageal strictures]. / Otsenka kachestva zhizni bol'nykh posle rekonstruktivnykh operatsii pri rubtsovykh suzheniyakh pishchevoda.

OBJECTIVE: To study the long-term results of reconstructive procedures for esophageal strictures and evaluate quality life after each type of esophageal repair using own criteria. MATERIAL AND METHODS: The study was conducted among patients who underwent esophageal repair with gastric transplant (172), colonic transplant (25), intestinal transplant (14) and repair of short cervical strictures (7). The age of patients ranged from 5 to 60 years. All patients underwent X-ray and endoscopic examination. Survey also included external respiration function and cardiac function, digestive function, measurement of height and weight, analysis of social aspects (work, study), female genital function. Five-score scale for quality of life assessment was developed. RESULTS: Long-term results were studied in 218 patients for the period from 3 months to 31 years (2002-2017). Excellent and good results were obtained in 180 patients. The best results were obtained after repair of short cervical strictures (4.42 scores), good results - after esophageal repair with gastric (4.14 scores) and intestinal (4.07 scores) transplants. Colonic repair was followed by satisfactory outcome (3.16 scores). CONCLUSION: Gastric and small bowel grafts are preferred for total esophageal repair due to better quality of life in long-term postoperative period.

[Risk factors for adverse clinical events after carotid arteries stenting in elderly and senile patients.]

The safety of the use of carotid arteries stenting (CAS) in elderly and senile patients remains a controversial issue. The reasons for the development of adverse events in this group of patients after CAS surgical procedure are unknown. The purpose of this study was to evaluate the risk factors for the development of adverse clinical events after CAS surgical procedure in elderly patients group. The study included 147 patients (94 men, 53 women, average age -- 72,1±3,5 years) of elderly and senile patients hospitalized to perform CAS for stenosis of the carotid arteries. According to the constructed model of binary logistic regression, the following parameters are statistically significantly associated with the development of complications after CAS: the presence of stroke in the anamnesis (p=0,013), symptomatic stenosis of the carotid arteries (p=0,011) and the degree of disability according to mRS (Modified Rankin Scale) ≥3 (p=0,002). In order to identify the identified risk factors and minimize the incidence of complications in elderly patients who underwent CAS surgery, a detailed preoperative assessment of their somatic status is necessary with an emphasis on the state of the cardiovascular system.

[Prevalence of Vitamin D Deficiency in Elderly Patients Planned for Spine Surgery.]

A decrease in bone mineral density is the most common cause of complications in the long-term period of postoperative observation. The purpose of the study was to study the prevalence of vitamin D deficiency in elderly patients who are planning to perform spine surgical procedures. The study included 63 elderly patients hospitalized in spine surgical clinics in order to perform planned surgical procedures for degenerative diseases of the cervical and lumbar spine (34 women, 29 men, average age 63,6±3,2 years). The construction of a binary logistic regression model showed that the following parameters are reliably associated with a deficiency of the active form of vitamin D in patients who are planning to perform surgical interventions on the spine: male gender, age (over 65 years), body mass index (more than 30 kg/m2) and diabetes. The identification of risk factors associated with the presence of vitamin D deficiency and the study of markers of bone metabolism represent the most important stage in the preoperative preparation of older patients who are planning to perform surgical interventions on the spine.

[COGNITIVE ABNORMALITIES IN POSTOPERATIVE PERIOD OF THYROID SURGERY].

An evaluation of cognitive functions was presented in 90 patients undergoing thyroid surgery. An attention deterioration, shot-term memory impairment and degradation were revealed after operation. It was shown that reduction of manifestations of cognitive dysfunction and stabilization of the haemodynamics indices were allowed due to application of cytoflavin during operation and in early postoperative period.

[RESULTS OF USAGE OF ETHANOL DESTRUCTION AND MAGNETIC IRRADIATION IN PATIENTS WITH BENIGN NODULAR THYROID TUMORS].

The article presents an experience of treatment of 67 patients with benign thyroid tumors with application of ethanol destruction using guidance of ultrasonic imaging. It was stated, that complementary application of therapeutic laser and magnetic actions allowed shortening the terms of reduction of nodular tumors and smoothing out the ethanol effects, decreasing the possibility of specific complications, shortening the terms of general treatment of the patients and minimizing general costs.