[Early postoperative stabilometric training in patients with spinal diseases who underwent decompressive-stabilizing interventions]. / Stabilometricheskii trening v rannem posleoperatsionnom periode u patsientov s zabolevaniiami pozvonochnika, perenesshikh dekompressivno-stabiliziruiushchie vmeshatel'stva.

AIM: To study the impact of rehabilitation measures on the dynamics of pain syndrome and on the state of postural muscle balance in the early postoperative period in patients with degenerative-dystrophic diseases of the lumbar spine who have undergone decompressive-stabilizing interventions. MATERIAL AND METHODS: This paper comparatively analyzed the level of pain syndrome in the lumbar spine and lower extremities, the stabilometric indicators characterizing the amplitude of center-of-pressure oscillations in patients who had undergone decompressive-stabilizing operations at 7±2 days after surgical treatment for degenerative-dystrophic diseases of the lumbar spine. Two groups of 60 people in each were formed: rehabilitation measures were implemented, starting on day 2 of an early postoperative period (the duration of the latter was 7±2 days after surgery); the basic complex was supplemented with stabilometric training in Group 1 (a study group); only the basic complex was used in Group 2 (a comparison group). RESULTS: In the study group, the frequency of rehabilitation outcomes with an achieved excellent result depending on the level of pain syndrome in the lower extremities and spine on a visual analogue scale was 62.5 and 88.9%, respectively; which significantly statistically exceeds the proportion of patients with the same outcome in the comparison group (37.5 and 11.1%; p<0.01 in both cases). There was a statistically significant more pronounced decrease in the level of pain syndrome in the lumbar spine (p=0.0001) and lower limbs (p=0.003) in the patients of the study group in the early postoperative period. Intergroup comparison revealed a statistically significant decrease in all the indicators monitored in the study, which characterize the amplitude of the center-of-pressure oscillations. Moreover, the value of the oscillation area parameter between the patient groups differed by 1.76 and 1.83 times during Romberg's test with the eyes open or closed, respectively (p=0.0001). CONCLUSION: The findings suggest that the comprehensive treatment supplemented with stabilometric training in the early postoperative period improves the state of postural muscle balance. There was a statistically significant predominance of compliance with normative values in patients of the study group during Romberg's test with the eyes open or closed (p=0.007 and p=0.00002, respectively), which contributes to a more marked decrease in the level of pain syndrome in the lumbar spine (p=0.001) and lower extremities (p=0.003).

[Evidence-based medicine: opportunities of the Propensity Score Matching (PSM) method in eliminating selection bias in retrospective neurosurgical studies]. / Dokazatel'naia meditsina: vozmozhnost' ispol'zovaniia metoda podbora bol'nykh po indeksu sootvetstviia (PSM) dlia ustraneniia sistematicheskoi oshibki otbora v retrospektivnykh neirokhirurgicheskikh issledovaniiakh.

To date, a large amount of retrospectively collected data about treatment of neurosurgical pathology have been accumulated. Modern methods of medical statistics are necessary for correct interpretation of the data. The article purpose is to demonstrate application of one of the modern methods, Propensity Score Matching (PSM), in neurosurgery. The use of PSM avoids misinterpretation of retrospectively collected data and obviates errors in planning further prospective studies. For the past 10 years, the number of published international PSM-based studies has increased more than 10-fold, with the number of articles by Russian authors accounting for less than 0.2%. In line with the tendencies of international studies, application of PSM in analysis of retrospectively collected data will enable testing of a number of hypotheses and correct planning of prospective randomized studies.

[Results of surgical treatment for lumbar spine segmental instability]. / Rezul'taty khirurgicheskogo lecheniia nestabil'nosti pozvonochno-dvigatel'nogo segmenta poiasnichnogo otdela pozvonochnika.

AIM: To perform a comparative analysis of outcomes in patients with lumbar spine segmental instability who underwent surgical treatment using transforaminal lumbar interbody fusion (TLIF) and direct lateral interbody fusion (DLIF) techniques. MATERIAL AND METHODS: The multicenter study involved 209 patients who underwent surgery for lumbar spine segmental instability. Long-term outcomes (up to 2 years) were studied in 134 patients: patients of the first group (98 patients) underwent traditional transforaminal lumbar interbody fusion (TLIF) and transpedicular stabilization of vertebral segments; patients of the second group (36 patients) underwent direct lateral interbody fusion (DLIF) in combination with transpedicular stabilization of the lumbar vertebral segments. We used standard checkpoints for monitoring the patients' condition: before surgery, at discharge, at 3, 6 and, 9 months, and at 1 and 2 years after surgery. To follow-up the patients, we used the Visual Analogue Scale, Oswestry Disability Index, and Goal Attainment Scaling. RESULTS: A comparative analysis of the two interbody fusion techniques was enabled by the developed Vertebrologic Registry profile (http://spineregistry.ru/Register_treatment.php) that was designed for entering data of Russian and foreign experts to analyze clinical characteristics, evaluate outcomes, and follow-up patients with degenerative lumbosacral spine diseases. In both groups of patients, a significant decrease in the pain intensity in the lumbar spine and lower extremities (VAS) occurred in the immediate postoperative period, which persisted in the long-term period. There were no differences in the disability level (Oswestry index) in both groups of patients (p<0.05). An analysis of treatment goal attainments one year after surgery revealed the best result in patients of the second group who underwent DLIF. CONCLUSIONS: 1. Indirect decompression using direct lateral interbody fusion (DLIF) minimizes the risks of intraoperative injury to the dura mater and neural structures. Kawabata class I outcomes (good) were achieved in 89% of patients who underwent direct lateral spinal fusion (DLIF) and in 81% of patients who underwent transforaminal interbody stabilization in combination with transpedicular fixation.

[Postoperative applications of the fast track technology in patients with herniated intervertebral discs of the lumbosacral spine]. / Primenenie tekhnologii bystrogo vosstanovleniya posle khirurgicheskikh vmeshatel'stv u patsientov s gryzhami mezhpozvonkovykh diskov poyasnichno-kresttsovogo otdela pozvonochnika.

TOPICALITY: The fast track technology means a complex of targeted measures involving rational preoperative preparation, minimally invasive surgery, regional anesthesia and short-acting anesthetics, and early postoperative rehabilitation. Elucidating the possibility of applying the fast track technology in neurosurgery, in particular in spinal surgery, is extremely topical. This is associated with the epidemiological data and the fact that minimally invasive techniques used in neurosurgery are highly expensive. AIM: The study objective was implementation of the fast track technology and subsequent analysis of its use after surgery in patients with herniated intervertebral discs of the lumbosacral spine. MATERIAL AND METHODS: The fast track technology following spinal surgery was implemented at the Clinical Hospital of the Presidential Administration of the Russian Federation and the Neurosurgical Department of the Clinical Hospital № 1 of the Presidential Administration of the Russian Federation using an algorithm of technology application. The study included 48 patients who underwent surgical treatment for herniated intervertebral discs of the lumbosacral spine between January and July 2015. RESULTS: An analysis of pain severity using the Visual Analog Scale demonstrated a slight decrease (10%) in a group of patients who were subjected to the fast track technology, at discharge and at 1 month after surgery; there was no difference in longer follow-up. An analysis of the functional status using the Oswestry index and Roland-Morris scale demonstrated that patients of the study group had faster and more efficient recovery and an improvement of the functional activity by 20% (p<0.05) compared to those in the control group. An analysis of patient-reported assessment of treatment quality revealed that indicators, such as awareness and pain control, in the study group were highest and amounted to 95% and higher. An analysis of the hospital stay duration showed a decrease in the number of bed-days in an integrated group by 39%, which saved 34 bed-days. CONCLUSION: The fast track technology reduces the degree of surgical aggression, increases surgery safety, and decreases the number of intraoperative complications and hospital stay duration.

[Pain syndrome relapse following herniated disc surgery (diagnosis and treatment)].

The aim of this study was to improve results of treatment of patients with degenerative disc disease at the long-term period after microdiscectomy by developing unique algorithm for diagnosis and treatment of persisting pain syndrome. Patients were divided into two groups. First one included 198 patients with reflex-pain syndromes. In the main subgroup (97 patients) consecutive denervation of spinal facet joints and intervertebral discs was performed to detect referred-pain syndromes. The second group included 64 patients who suffered recurrent nerve-root compression. The main cause was relapse of disc herniation. We used anterior retroperitoneal approach in 34 patients to remove herniated disc and stabilize the segment. Surgery results were assessed by visual-analogue scale and Oswestry index. Consecutive chemical denervation of spinal facet joints and intervertebral discs allowed not only to discover referred-pain syndromes, but enabled to control them. Stepwise surgical treatment resulted in clinical recovery and better outcome in 88.7% of our patients. Decompressive-stabilizing surgery with anterior interbody fusion is a pathogenetic and technically adequate treatment. The long-term follow up results of surgical treatment were better at the group of our patients operated with anterior retroperitoneal approach and anterior foraminotomy. Excellent and good results were obtained at 79.3% cases.

[Results of decompressive-stabilizing procedures via unilateral approach in lumbar spinal stenosis].

Aim of this study was to investigate the capabilities, advantages and limitations of bilateral decompression via unilateral approach in decompressive-stabilizing procedures in patients with degenerative lumbar spine disease, and to develop the technology and its technical performance. The controlled study included 372 patients (age range was 27-74 years). All of them were operated due to clinical manifestation of lumbar spinal stenosis. The main group consisted of 44 patients who underwent bilateral decompression via unilateral approach with stabilization of involved segments. The control group included 328 patients who were operated using standard bilateral technique with stabilization. A total of 52 segments were treated in the first group and 351 in the second one. In all patients with neurogenic intermittent claudication symptoms relieved after decompressive-stabilizing surgery. Analysis of duration of surgery (considering 1 segment) demonstrated that less invasive technique requires as much time as conventional. However mean intraoperative blood loss in the first group was twice as low as the second. Neither patient from the first group required hemotransfusion while in the second group in 57 (17.4%) cases hemotransfusion was performed due to blood loss. In the early postoperative period in both groups intensity of pain (according to VAS) gradually decreased. Mean hospital stay was 9.9 +/- 3.1 day in the main group and 14.7 +/- 4.7 days in the control group. Bilateral spinal canal decompression via unilateral approach decreases surgical trauma, blood loss, complication rate and hospital stay. Postoperative results are comparable with conventional technique.

[Long-term results of surgical treatment for lumbar spine degenerative. Disease in patients above 60 of age].

UNLABELLED: Aim of this study was to assess results of surgical treatment of patients with degenerative lumbar spine disease. MATERIAL AND METHODS: We analyzed 68 patients 65-82 years old. Clinical neurological examination, questionnaires, X-rays, multispiral CT scans were used for evaluation. RESULTS: After decompressive (group A) and decompressive-stabilizing surgery (group B) we observed significant decrease of low back pain intensity according to visual analogue scale (chi2 = 10.0; p = 0.024; p < 0.05) and leg pain intensity (chi2 = 24.4; p = 0.001; p < 0.05). However, Oswestry disability index (ODI) 4-6 years after decompressive-stabilizing surgery remained substantially low in comparison with decompressive procedures. ODI after surgery also remained significantly lower in comparison with preoperative level in both groups (chi2 = 71.4; p = 0.001; p < 0.05), however, after decompressive-stabilizing procedures positive dynamics of ODI was more prominent. Complex assessment of treatment outcomes discovered significant difference in rates of good and poor results between two groups. Good postoperative results in group A reached 38.7% while in group B--67.6% (z = 2.2; p = 0.032; p < 0.05); poor results in groups A and B were 29.0% and 2.7%, respectively (z = 2.7, p = 0.007, p < 0.05). CONCLUSION: Decompressive-stabilizing procedures are the most effective in treatment of degenerative lumbar spine disease.