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The implementation of information technologies into treatment practice of modern health care significantly increases efficiency of diagnosis and treatment of dorsopathies. The purpose of the study is to develop software module to evaluate post-urological status of patients with spine dorsopathy to optimize diagnostic process and treatment planning. The article describes application of original software module to assess the post-urological status of patients with spine dorsopathy. The proposed software module is designed for objective assessment of post-urological status of patients with spine dorsopathy based on photographic images of examined patient. The most important advantage of software module is built-in forecasting function that is implemented by calculation of severity of pain perceptions and movement disorders using generated regression equations. The possibility to record data obtained during measurements permits to store information in single system. The implementation of software module into clinical practice will contribute to qualitative improvement of diagnostic processes, simplify work of osteopath and reduce the time spent on examination.
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Programas Informáticos , Humanos , Tecnología de la Información , Medicina Osteopática/métodos , Enfermedades de la Columna Vertebral/diagnóstico , Enfermedades de la Columna Vertebral/terapiaRESUMEN
The purpose of the study was a comparative analysis the effectiveness of microsurgical discectomy and minimally invasive transforaminal lumbar interbody fusion in the treatment of disk herniation adjacent to the anomaly of the lumbosacral junction segment in elderly patients. The study included 80 elderly patients (over 60 years old), divided into two groups: the 1st-(n=39) who underwent microsurgical discectomy; the 2nd- patients (n=41) operated on using minimally invasive transforaminal interbody fusion and percutaneous transpedicular stabilization (MI-TLIF). For the comparative analysis, we used gender characteristics (gender, age), constitutional characteristics (BMI), degree of physical status according to ASA, intraoperative parameters of interventions and the specificity of postoperative patient management, clinical data, and the presence of complications. Long-term outcomes were assessed at a minimum follow-up of 3 years. As a result, it was found that the use of MI-TLIF allows achieving better long-term clinical outcomes, fewer major complications in comparison with the microsurgical discectomy technique in the treatment of disc herniation adjacent to the anomaly of the lumbosacral junction segment in elderly patients.
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Discectomía , Desplazamiento del Disco Intervertebral , Vértebras Lumbares , Microcirugia , Procedimientos Quirúrgicos Mínimamente Invasivos , Fusión Vertebral , Humanos , Masculino , Femenino , Fusión Vertebral/métodos , Fusión Vertebral/efectos adversos , Desplazamiento del Disco Intervertebral/cirugía , Desplazamiento del Disco Intervertebral/diagnóstico , Discectomía/métodos , Discectomía/efectos adversos , Anciano , Vértebras Lumbares/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Microcirugia/métodos , Persona de Mediana Edad , Resultado del Tratamiento , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/diagnósticoRESUMEN
Currently, there are no standards in surgical treatment of dumbbell-shaped tumors of lumbo-foraminal region. OBJECTIVE: To evaluate the effectiveness and long-term results of minimally invasive resection of dumbbell-shaped lumbar schwannomas Eden type 2 and 3 combined with transforaminal lumbar interbody fusion and transpedicular stabilization. MATERIAL AND METHODS: A retrospective study included 13 patients (8 men and 5 women) with lumbar dumbbell tumors Eden type 2 and 3 who underwent minimally invasive facetectomy through posterolateral anatomical corridor, microsurgical tumor resection and MI TLIF. We analyzed intraoperative parameters, neurological functions (ASIA scale), clinical characteristics (ODI, SF-36), and complications. Resection quality and area of the multifidus muscle were assessed according to MRI data. All patients were followed-up throughout at least 3-year. RESULTS: Surgery time was 147 min, blood loss - 118 ml, hospital-stay - 7 days. Clinical parameters significantly improved in the follow-up period: ODI score decreased from 72 to 12 (p=0.004), SF-36 PCS increased from 26.24 to 48.51 (p=0.006) and MCS score increased from 29.13 to 53.68 (p=0.002). According to MRI data, no tumor recurrences and severe muscle atrophy (>30%) were observed after 3 years in all cases. Superficial wound infection occurred in 1 (7.7%) case. There were normal neurological functions (ASIA type E) in all patients. CONCLUSION: Minimally invasive facetectomy through posterolateral approach with MI TLIF technology can be used for safe and effective resection of dumbbell-shaped schwannomas Eden type 2 and 3.
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Neurilemoma , Fusión Vertebral , Masculino , Humanos , Femenino , Estudios de Seguimiento , Estudios Retrospectivos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Resultado del Tratamiento , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/cirugía , Fusión Vertebral/métodos , Neurilemoma/diagnóstico por imagen , Neurilemoma/cirugíaRESUMEN
The management of patients with hemorrhagic stroke is an important problem in modern neurology and neurosurgery. The proportion of hemorrhagic stroke is only 15% of all cases of acute cerebrovascular accident, but mortality reaches 50% (and with intraventricular hemorrhages up to 80%), and disability is over 75%. Minimally invasive methods are being developed to reduce intraoperative damage to brain and improve the prognosis for the patient. One of them is ventricular external drainage (EVD) in combination with local fibrinolysis (LF). Intraventricular injection of thrombolytics allows the acceleration of the process of lysis and evacuation of blood. In this clinical observation, a 52-year-old female patient was admitted to the clinic with intracerebral hematoma and intraventricular hemorrhage, complicated by acute occlusive hydrocephalus. In the case of this patient, the use of external ventricular drainage in combination with local fibrinolysis made it possible to quickly resolve occlusive hydrocephalus, reduce the risk of death and increase the patient's rehabilitation potential.
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Accidente Cerebrovascular Hemorrágico , Hidrocefalia , Accidente Cerebrovascular , Femenino , Humanos , Persona de Mediana Edad , Hemorragia Cerebral/complicaciones , Encéfalo , Hidrocefalia/cirugíaRESUMEN
3D exoscopy based on Video Telescope Operating Monitor (VITOM) technology provides good visualization quality and portability. There are few data on comparison of extracorporeal telescoping with microsurgical techniques in spinal surgery. OBJECTIVE: To compare the effectiveness of VITOM 3D exoscopy and microsurgical techniques in spinal surgery. MATERIAL AND METHODS: A prospective study included 80 patients (54 men and 26 women). Two groups were distinguished: group 1 (ES, n=40) - VITOM 3D exoscopy, group 2 (SM, n=40) - Pentero 900 surgical microscope. We analyzed surgery time, postoperative rehabilitation, hospital-stay and complications. ES and microsurgical technique were compared using the questionnaire by Takahashi S. and rapid upper limb assessment (RULA). RESULTS: Conventional microsurgical technique was characterized by less surgery time (p<0.05) and morbidity (p=0.02). Postoperative rehabilitation and hospital-stay were similar (p=0.26 and p=0.39, respectively). Image quality in ES was comparable to microsurgical technique in shallow accesses and manipulations perpendicular to skin incision. Availability of neurosurgical instruments at different depths of the wound channel was comparable in both groups. The limitation of ES was length of skin incision, depth of the wound and its visualization at certain angle. These features required expansion of surgical approach or conversion of intervention. In general, surgeons rated intraoperative posture comfort as comparable in both groups that was consistent with the RULA scale. CONCLUSION: VITOM 3D exoscopy is an alternative to traditional microscopy and more ergonomically beneficial in spinal surgery in case of manipulations perpendicular to skin incision and shallow wide accesses. There are several important limitations of this device including difficult manipulations in narrow deep wounds and visualization under certain angle.
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Telescopios , Masculino , Humanos , Femenino , Estudios Prospectivos , Procedimientos Neuroquirúrgicos/métodos , Microcirugia/métodosRESUMEN
The purpose of the study was to compare the clinical and radiological efficacy of 2-level anterior cervical discectomy and fusion (ACDF) and 1-level anterior cervical corpectomy and fusion (ACCF) in the treatment of two-segment degenerative stenosis of the cervical spine in elderly patients. The retrospective study included 74 elderly patients (over 60 years old), two cohorts were identified: the 1st (n=38) - patients who underwent staged 2-level ACDF; the 2nd (n=36) - patients operated on using the technique of 1-level ACCF. For comparative analysis, we used general information about patients (gender, age, body mass index, physical status according to ASA), characteristics of surgical interventions (time of surgery, volume of blood loss), features of the postoperative period, clinical data, radiological outcomes, and the presence of complications. Analysis of the results was carried out in a minimum period of 36 months. As a result, it was found that 2-level ACDF in the treatment of two-segment degenerative stenosis of the cervical spine in older patients is associated with less blood loss and the level of local pain syndrome. At the same time, better clinical outcomes and fewer revision interventions after 1-level ACCF were recorded in the long-term postoperative period.
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Fusión Vertebral , Espondilosis , Humanos , Anciano , Estudios Retrospectivos , Resultado del Tratamiento , Constricción Patológica/complicaciones , Espondilosis/complicaciones , Espondilosis/cirugía , Fusión Vertebral/efectos adversos , Fusión Vertebral/métodos , Vértebras Cervicales/diagnóstico por imagen , Vértebras Cervicales/cirugía , DescompresiónRESUMEN
Currently, there is no information on the combined effect of body mass index (BMI), age, gender, main spinal-pelvic parameters and parameters of adjacent functional spinal unit (FSU) degeneration according to magnetic resonance imaging on development of adjacent segment degenerative disease (ASDd). OBJECTIVE: To evaluate the effect of preoperative biometric and instrumental parameters of adjacent FSU on the risk of ASDd after transforaminal lumbar interbody fusion and determine personalized neurosurgical approach. MATERIAL AND METHODS: We retrospectively studied patients after single-level transforaminal lumbar interbody fusion (group I, n=54), single-level transforaminal lumbar interbody fusion and interspinous stabilization of adjacent level (group II, n=55), preventive rigid fusion of adjacent segment (group III, n=56). Preoperative parameters and long-term clinical outcomes were assessed. RESULTS: Paired correlation analysis established the main predictors of ASDd. Regression analysis determined absolute values of these predictors for each type of surgical intervention. CONCLUSION: Surgical intervention at the level of asymptomatic proximal adjacent segment is recommended as interspinous stabilization for moderate degenerative lesions, BMI <25 kg/m2, difference between pelvic index and lumbar lordosis 10.5-15°, segmental lordosis 6.5-10.5°. In case of severe degenerative lesions, BMI 25.1-31.1 kg/m2, significant deviations of spinal-pelvic parameters (segmental lordosis 5.5-10.5°, difference between pelvic index and lumbar lordosis 15.2-20°), preventive rigid stabilization is indicated.
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Lordosis , Fusión Vertebral , Humanos , Lordosis/diagnóstico por imagen , Lordosis/cirugía , Lordosis/etiología , Estudios Retrospectivos , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/cirugía , Fusión Vertebral/efectos adversos , Fusión Vertebral/métodos , Factores de Riesgo , Resultado del TratamientoRESUMEN
Personalization of gastric cancer (GC) treatment is an urgent problem because of the clinical heterogeneity and aggressive course of the disease. Four GC subtypes were isolated based on molecular characteristics by The Cancer Genome Atlas researchers in 2014: Epstein-Barr virus positive (EBV^(+)), microsatellite unstable (MSI), chromosomally unstable (CIN), and genomically stable (GS). There is no unified method to detect the CIN and GS subtypes today, while MSI and EBV status assessments are used routinely and are of great clinical importance. A total of 159 GC samples were tested for MSI, EBV DNA, and somatic mutations in codons 12-13 (exon 2), 61 (exon 3), and 146 (exon 4) of the KRAS gene; codons 597-601 (exon 15) of the BRAF gene; and codons 542-546 (exon 9), 1047-1049 (exon 20) of the PIK3CA gene. EBV^(+) GC was detected in 8.2% of samples; and MSI, in 13.2%. MSI and EBV+ were found to be mutually exclusive. The mean ages at GC manifestation were 54.8 and 62.1 years in patients with EBV^(+) and MSI GCs, respectively. EBV^(+) GC affected men in 92.3% of cases, 76.2% of the patients were older than 50 years of age. Diffuse and intestinal adenocarcinomas were diagnosed in 6 (46.2%) and 5 (38.5%) EBV^(+) cases, respectively. MSI GC equally affected men (n = 10, 47.6%) and women (n = 11, 52.4%). The intestinal histological type was the most prevalent (71.4%); the lesser curvature was affected in 28.6% of the cases. The E545K variant of PIK3CA was observed in one EBV^(+) GC case. A combination of clinically significant variants of KRAS and PIK3CA was found in all MSI cases. The BRAF V600E mutation, which is specific to MSI colorectal cancer, was not detected. The EBV^(+) subtype was associated with better prognosis. The five-year survival rates were 100.0 and 54.7% for MSI and EBV^(+) GCs, respectively.
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Neoplasias Colorrectales , Infecciones por Virus de Epstein-Barr , Neoplasias Gástricas , Femenino , Humanos , Masculino , Fosfatidilinositol 3-Quinasa Clase I/genética , Neoplasias Colorrectales/genética , Neoplasias Colorrectales/patología , Infecciones por Virus de Epstein-Barr/genética , Herpesvirus Humano 4/genética , Inestabilidad de Microsatélites , Repeticiones de Microsatélite , Mutación , Proteínas Proto-Oncogénicas B-raf/genética , Proteínas Proto-Oncogénicas p21(ras)/genética , Neoplasias Gástricas/genética , Neoplasias Gástricas/patologíaRESUMEN
Cauda equina syndrome (CES) associated with acute disc extrusion or spinal stenosis often requires emergency surgery. Analysis of the Pubmed, Medline and eLibrary databases revealed a few studies devoted to long-term postoperative outcomes in patients with CES caused by degenerative spine disease. OBJECTIVE: To evaluate long-term postoperative results and predictors of clinical and neurological outcomes in patients with CES caused by degenerative lumbar spine disease. MATERIAL AND METHODS. D: Ecompressive and decompressive-stabilizing procedures were performed in 211 patients with CES caused by degenerative lumbar spine disease between 2000 and 2020. Long-term clinical parameters were available in 174 patients with mean follow-up period of 7 years. Sixty-eight patients had unsatisfactory postoperative outcomes. We assessed postoperative clinical and neurological outcomes in patients with CES and predictors of these outcomes. RESULTS: We identified the following predictors of clinical and neurological outcomes using binary logistic regression model: period between clinical manifestation and surgery >48 hours, preoperative neurological impairment, spinal canal diameter, surgical procedure, dimension of herniated disc, ASA score and long-term postoperative analgesia with narcotic analgesics. CONCLUSION: Preoperative planning and possible correction of the above-mentioned risk factors will potentially improve postoperative outcomes in patients with CES caused by degenerative lumbar spine disease.
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Síndrome de Cauda Equina , Cauda Equina , Desplazamiento del Disco Intervertebral , Enfermedades de la Columna Vertebral , Estenosis Espinal , Humanos , Síndrome de Cauda Equina/cirugía , Síndrome de Cauda Equina/complicaciones , Desplazamiento del Disco Intervertebral/cirugía , Estenosis Espinal/cirugía , Vértebras Lumbares/cirugíaRESUMEN
The aim of the study was to evaluate the results of surgical treatment and the effectiveness of clinical recovery in elderly patients with cauda equina syndrome (CES) caused by degenerative spinal canal stenosis after isolated open and minimally invasive decompression. A retrospective analysis of the results of surgical treatment of 50 patients over 60 years of age who underwent isolated open (n=21) and minimally invasive (n=29) decompressive interventions for CES caused by lumbar spinal stenosis was performed. For comparative analysis, we used the technical features of the intervention, the specificity of postoperative management of patients, clinical parameters, and the number of perioperative complications. As a result, the advantages of minimally invasive isolated decompression compared to open decompression due to a smaller volume of blood loss and duration of hospitalization, low need for postoperative pain relief, a minimum number of perioperative surgical complications, as well as the dynamics of neurological symptoms, better efficiency of clinical recovery of functional state indicators according to ODI and quality life according to SF-36 in the late postoperative period.
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Estenosis Espinal , Caballos , Animales , Estenosis Espinal/complicaciones , Estenosis Espinal/diagnóstico , Estudios Retrospectivos , Descompresión Quirúrgica/efectos adversos , Descompresión Quirúrgica/métodos , Vértebras Lumbares/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Resultado del TratamientoRESUMEN
BACKGROUND: The absence of a unified diagnostic approach and heterogeneous treatment strategies in patients with lumbosacral transitional vertebra contribute to registration of contradictory data on postoperative outcomes in these patients. OBJECTIVE: A retrospective analysis of postoperative outcomes in patients with degenerative lumbar spine diseases associated with lumbosacral junction anomalies and causes of unfavorable results. MATERIAL AND METHODS: Lumbosacral transitional vertebra was preoperatively verified and classified according to Castellvi A.E. in 352 cases between 2007 and 2017. Full-time examination, phone and e-mail survey covered 314 (89.2%) patients throughout 5.2-year follow-up period. There were unfavorable clinical outcomes in 42 cases. We analyzed the causes of these results and relationship of surgical strategy with the type of lumbosacral junction anomaly. RESULTS: Lumbosacral transitional vertebra Castellvi type IIA (30.9%) and IIIA (34.9%) prevailed. Unfavorable outcomes occurred in 7 cases after percutaneous interventions, in 12 patients after decompression surgery and in 23 patients after decompression and stabilization procedures. In all cases (n=42), redo surgery was performed: rigid fixation or extension of stabilization system in 16 cases, additional intracanal decompression in 10 patients, foraminal/extraforaminal decompression in 8 patients. Seven patients underwent repeated laser denervation. Of these, 5 patients underwent dorsal decompression without discectomy due to ineffective denervation. Correlation analysis showed the relationship between unfavorable outcomes after percutaneous procedures with LV transverse process dysplasia and sacralization, decompressive interventions with additional articular joints and lumbarization, decompression/stabilization procedures with LV transverse process dysplasia and sacralization. CONCLUSION: Unfavorable outcomes occurred after percutaneous interventions for anomaly type IB and IIIB, decompressive procedures for anomaly type IIA, IIB and IV, decompression/ stabilization procedures for types IA and IIIA. It is the first report devoted to analysis of relationships between unsatisfactory postoperative outcomes, surgical technique and type of lumbosacral dysgenesis.
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Vértebras Lumbares , Enfermedades de la Columna Vertebral , Discectomía , Humanos , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/cirugía , Región Lumbosacra/diagnóstico por imagen , Región Lumbosacra/cirugía , Estudios RetrospectivosRESUMEN
A series of dialkylaminostyrylhetarene dyes constructed from electron-rich and electron-deficient moieties of various structures connected via vinylene π-bridges are introduced as temperature-sensitive luminophores. The temperature dependent emission of the dyes in the acidified dichloromethane solutions derives from temperature-induced shift of the equilibrium between neutral and protonated forms of the dyes. The heating-induced blue shift and intensification of emission of neutral form of the dyes make them a promising basis for development of nanoparticles exhibiting temperature-sensitivity in aqueous solutions at pH typical of biological liquids. Hydrophobicity-driven incorporation of the water insoluble dyes into L-α-phosphatidylcholine(PC)-based bilayers allows to obtain water dispersible dye-PC aggregates, and to follow their emission in the aqueous solutions. Structure of the dyes has strong impact on the efficacy of the dyes incorporation into the PC-based bilayers, temperature sensitivity of emission of the dye-PC aggregates and its reversibility under the heating/cooling cycles. This enables structural optimization of the dyes in order to obtain the dye-PC species demonstrating maximal temperature dependence and reversibility of their luminescence in aqueous solutions. The selected leader exhibits low cytotoxicity exemplified for M-HeLa and Chang Liver cell lines, while the efficient cell internalization of the dye, manifested in the staining of the cell cytoplasm, opens further opportunities for biosensing applications.
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Colorantes , Fosfolípidos , Colorantes Fluorescentes , Fosfatidilcolinas , Temperatura , AguaRESUMEN
OBJECTIVE: To conduct a comprehensive clinical-neurological assessment and to study the results of functional recovery of professional athletes after minimally invasive lumbar interbody fusion. MATERIALS AND METHODS: The retrospective study included 27 patients-professional athletes who were operated on using minimally invasive decompression and stabilization techniques in the period 2010 to 2019. Clinical-neurological effectiveness was assessed when returning to previous sports activity was 14 (9; 17) weeks and 4 (3; 5) years after surgery. RESULTS: The follow-up showed a significant improvement in clinical and neurological parameters: persistent elimination of radicular and muscular-skeletal symptoms, a decrease in the level of pain according to a visual analogue scale in the lumbar spine from 68 (61; 85) mm to 3 (2; 11) mm (p=0.002) and in the lower extremities from 84 (78; 91) mm to 1 (0; 3) mm (p=0.001), change in the physical component of health from 26.18 (23.58; 28.37) to 49.82 (49.03; 53.04) (p=0.002) and the psychological component of health from 27.87 (26.22; 29.29) to 52.18 (49.12; 55.66) (p=0.001), significant improvement in the perception of physical activity according to the Borg RPE Scale from 17 (16; 18) points to 9 (8; 9) (p<0.001). In one case (3.7%), the patient did not return to his previous sports career. CONCLUSION: The use of minimally invasive rigid stabilization in the overwhelming majority of professional athletes made it possible in the shortest possible time to achieve regression of neurological symptoms, reduce pain, improve the quality of life, restore the functional state and return to previous sports activities.
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Calidad de Vida , Fusión Vertebral , Atletas , Humanos , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
The aim of the study was to evaluate the effectiveness of the accelerated recovery program for patients with polysegmental degenerative diseases of the lumbar spine. Materials and Methods: This prospective study included 53 patients who underwent two-level transforaminal interbody fusion in the LII-SI segments. Two groups were identified: in group 1 (n=24), operations were performed using the accelerated recovery program; in group 2 (n=29), open rigid stabilization was used under traditional intravenous anesthesia. The end-point parameters were the number of bed-days spent in the hospital after the operation, the number of perioperative surgical complications and adverse effects of anesthesia, and the number of re-hospitalizations within 90 days. We also recorded the time of patient activation, the level of pain around the operated zone (using a visual analogue scale), and the quality of life in the long-term postoperative period (median 18 months); the latter was assessed using the SF-36 questionnaire (physical and psychological components of health). Results: Patients under the accelerated recovery program were found to have a shorter duration of surgery and anesthesia, less blood loss, lower amounts of injected opioids, faster verticalization, and a reduced period of inpatient treatment (p<0.05 for all parameters). As compared to group 2, patients in group 1 had a lower level of pain in the surgery zone (p<0.05), better long-term indicators of the physical and psychological components of health (p<0.05), a lower number of anesthesia-associated adverse events (p<0.05), and a lower rate of postoperative complications (p<0.05). During the 90-day postoperative observation, four patients of group 2 (13.8%) were urgently referred to a medical institution for additional medical care. Conclusion: The accelerated recovery program for two-level interbody fusion showed its safety and high clinical efficiency in the treatment of patients with polysegmental degenerative diseases of the lumbar spine. The program can be used in any center for spine surgery where effective interaction between polyvalent medical and nursing teams is maintained.
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Calidad de Vida , Fusión Vertebral , Humanos , Vértebras Lumbares/cirugía , Estudios Prospectivos , Fusión Vertebral/efectos adversos , Resultado del TratamientoRESUMEN
Professional athletes have a high basic level of physical fitness and significant motivation for returning to previous rhythm of functional activity within the shortest period after trauma without deterioration of baseline level of sportsmanship. Despite the well-presented results of lumbar spine fusion in general population, these data among professional athletes are not well understood. OBJECTIVE: To analyze the results of minimally invasive lumbar fusion in professional athletes. MATERIAL AND METHODS: A retrospective study included 27 athletes (19 men and 8 women) aged 29 (26; 34) years after minimally invasive lumbar spine decompression and fusion via anterior, lateral and posterior approaches. Total lumbar lordosis, degenerative changes in adjacent segment, area of multifidus muscle, perioperative complications and timing of sports rehabilitation were analyzed within 3-5 (mean 4) years after surgery. RESULTS: We found an increase of total lumbar lordosis from 35.2° to 44.1° (p=0.02), no significant muscle atrophy (<30%) and degeneration of adjacent segment (p>0.05). There were 5 perioperative complications (18.5%). Mean period of sports rehabilitation was 14 (9; 17) weeks. One (3.7%) patient did not return to his previous sports career. CONCLUSION: Minimally invasive short-segment lumbar interbody fusion in professional athletes is characterized by low risk of fixation element failure, no significant degeneration of adjacent level and postoperative muscle atrophy. This procedure ensures early rehabilitation and returning to sports.
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Vértebras Lumbares , Fusión Vertebral , Atletas , Femenino , Humanos , Vértebras Lumbares/cirugía , Masculino , Procedimientos Quirúrgicos Mínimamente Invasivos , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
OBJECTIVE: To compare the clinical efficacy of laser and radiofrequency denervation in patients with primary trigeminal neuralgia. MATERIAL AND METHODS: The study included 50 patients with primary trigeminal neuralgia who were operated on by laser (group I, n=25) or radiofrequency denervation (group II, n=25) in the period from 2018 to 2019. To assess the clinical efficacy, we analyzed the dynamics of the pain syndrome level according to the scale of facial pain and the quality of life according to the Short Form Medical Outcomes Study (SF-36), as well as patient satisfaction with the operation according to the Macnab scale, the presence of postoperative surgical complications and adverse effects of anesthesia. RESULTS: In the postoperative period, according to the scale of facial pain, a decrease in its intensity was noted in both study groups (p<0.001). Comparative analysis showed a comparable level of pain in the early postoperative period: at discharge (p=0.43) and 6 months after surgery (p=0.07). At the same time, after 12 months, lower scores on the scale of facial pain were noted in patients of group I (p=0.02). According to SF-36, a significant improvement in the physical and psychological components of health was determined in group I (p<0.001) and group II (p<0.05). Comparison of SF-36 scores in the long-term postoperative period revealed the best indicators in group I (p=0.02 and p=0.01, respectively). Comparative analysis verified a greater subjective satisfaction with the operation in group I, compared with group II (p<0.001). A comparable number of adverse effects of anesthesia was determined in both groups. Comparative analysis revealed a significantly greater number of postoperative surgical complications in group II (p=0.0017). CONCLUSION: Laser denervation and radiofrequency denervation are highly effective methods of minimally invasive treatment of primary trigeminal neuralgia.
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Neuralgia del Trigémino , Desnervación , Humanos , Rayos Láser , Calidad de Vida , Resultado del Tratamiento , Neuralgia del Trigémino/cirugíaRESUMEN
The article analyzes the level of import dependence of Russian industry in relation to the supply of intermediate consumption products from China and in general from all countries of the world. The study was carried out during the period of the increasing spread of coronavirus infection in order to determine the industries that are potentially the most vulnerable to possible disruption of foreign trade. The information base for calculations is the official data on the volume and structure of Russia's foreign trade and the input-output tables of the WIOD. As a result of calculations using several alternative models, it was found that Russian industry, even with significant integration into the world production chains, remains sufficiently resistant to local supply shocks. The analysis of import dependence in terms of imported raw materials and components can be used in the study of any shocks in foreign trade, it makes it possible to more accurately assess the effects of trade agreements or sanctions, as well as the effect of the devaluation of the national currency.
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Minimally invasive procedures reduce the trauma of spine surgery. However, they are associated with high complexity of manipulations, long learning curve, need for expensive equipment for intraoperative navigation and significant irradiation. Various options for surgical approaches are being developed to reduce irradiation of medical staff and patients, surgery time and the number of drugs administered for general anesthesia. Simultaneous surgical interventions (SiSI) is one of these options. OBJECTIVE: To compare the effectiveness of simultaneous and staged minimally invasive dorsal decompression-stabilization procedures in patients with lumbar spine degenerative diseases. MATERIAL AND METHODS: A prospective study included 67 patients (41 men and 26 women) aged 48 (34; 56) years who underwent a single-level minimally invasive spinal root decompression and transforaminal interbody fusion via Wiltse posterior-lateral approach. Two study groups were distinguished: group I (simultaneous surgical interventions, SiSI) (n=29), in which guide spokes and transpedicular screws were installed simultaneously by two surgeons within one x-ray session from two sides; group II (staged surgical interventions, StSI) (n=38), in which staged transpedicular stabilization was performed (decompression side followed by contralateral side). Mean follow-up was 14 months in group I and 20 months in group II. We considered intraoperative fluoroscopy and irradiation dose, duration of surgery and anesthesia with calculation of doses of opioid drugs, blood loss, time of activation, hospital-stay and perioperative morbidity. Clinical outcomes were studied in long-term postoperative period. RESULTS: Simultaneous approach ensured less time of intraoperative fluoroscopy (p=0.029) and irradiation dose (p=0.035), duration of surgery (p=0.01) and anesthesia (p=0.02), amount of opioid drugs during anesthesia (p=0.017). Blood loss, duration of activation and hospitals-stay were similar in both groups (p=0.35, p=0.12 and p=0.57, respectively). There was comparable improvement in VAS score of pain in the lumbar spine and lower extremities in both groups (p=0.63 and p=0.31, respectively). According to SF-36 questionnaire, there was no between-group difference in physical and psychological components (p=0.44 and p=0.72, respectively). There was significantly greater number of adverse effects of anesthesia in the StSI group (26.2% vs. 6.8%, p=0.003). At the same time, the number of surgical postoperative complications was similar in both groups (3.4% vs. 5.3%, p=0.62). CONCLUSION: Simultaneous minimally invasive dorsal decompression-stabilization procedures have some significant advantages over staged approach regarding intraoperative parameters and adverse effects of anesthesia in patients with lumbar spine degenerative diseases. Nevertheless, there were similar clinical data and small incidence of surgical perioperative complications.
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Fusión Vertebral , Descompresión , Femenino , Humanos , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/cirugía , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos , Estudios Prospectivos , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
The aim of the study was to analyze the results of the use of laser destruction of the articular branch of the obturator nerve in elderly and senile patients with degenerative coxarthrosis. The results of treatment of 34 patients over 65 years of age with symptomatic degenerative diseases of the hip joint (HJD) and somatic contraindications for total hip arthroplasty have been prospectively studied. In the study group, in the period from 2017 to 2019, laser destruction of the articular branch of the obturator nerve (970 nm, frequency 9 Hz and power 3 W in a total dose of 100 J) was carried out. The average follow-up was 12 months. To assess the effectiveness of surgical treatment, the dynamics of the pain syndrome in the hip joint was analyzed according to the visual analogue scale, the quality of life according to the SF-36 questionnaire, the functional state of the hip joint according to the W.H.Harris scale and the presence perioperative surgical complications. As a result, it was found that the use of laser destruction of the articular branch of the obturator nerve in degenerative coxarthrosis in elderly and senile patients (if total hip arthroplasty was not possible) made it possible to significantly reduce the level of preoperative pain syndrome, restore the quality of life and improve the functional state of patients with low risks of surgical complications.
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Nervio Obturador , Osteoartritis de la Cadera , Anciano , Articulación de la Cadera/cirugía , Humanos , Rayos Láser , Nervio Obturador/cirugía , Osteoartritis de la Cadera/diagnóstico , Osteoartritis de la Cadera/cirugía , Calidad de VidaRESUMEN
AIM: The purpose of the study was to demonstrate the possibilities and efficacy of endovascular interventions in patients with visceral artery aneurysms. PATIENTS AND METHODS: From 2013 to June 2020, we performed 15 embolizations of visceral artery aneurysms in 15 patients (8 men and 7 women). The technical success rate was 100%. The patients' age varied from 32 to 71 years. In 8 cases, the aneurysm was located in the basin of the splenic artery, in 3 cases in the gastroduodenal artery, in 2 cases in the superior mesenteric artery and in 2 cases in the renal artery. Three aneurysms were classified as false, and 12 as true. All aneurysms were saccular, with their diameter ranging from 6 to 32 mm. In 2 patients aneurysms were detected after endured infective endocarditis, in 8 during examination in abdominal pain syndrome, and in 5 cases as an incidental finding while performing computed tomography of abdominal organs. One patient was subjected to embolization of the afferent vessel, two underwent implantation of stent grafts into the aneurysmal neck area, and eleven underwent aneurysmal sac embolization with microcoils. In 9 cases, embolization was performed using microcoils only in 1 case using microcoils with balloon assistance, and in 2 cases using microcoils with stent assistance. We used from 1 to 12 microcoils, with a diameter of from 2 to 30 mm. RESULTS: During endovascular embolization of visceral artery aneurysms there were no target-organ infarctions, haemorrhagic complications, nor lethal outcomes. In the early postoperative period, 7 patients developed pain syndrome. In 1 case pain syndrome was relieved by narcotic analgesics, in 4 cases by spasmolytics, and in 2 cases by a combination of spasmolytics and non-narcotic analgesics. CONCLUSION: Endovascular treatment of visceral arterial aneurysms is an efficient and safe method.