[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.

[The outcomes of arthroplasty in degenerative lesions in the lumbar spine].

STUDY DESIGN: A retrospective study. OBJECTIVE: To investigate the safety and effectiveness of total intervertebral disc replacement with a Maverick prosthesis in patients with discogenic pain in the lower lumbar spine. SUMMARY OF BACKGROUND DATA: Lumbar disc arthroplasty has been developed as an alternative to rigid interbody fusion for patients with pathology in the lower lumbar discs. According to the developers, motion preservation in the operated segment should prevent secondary pathology of the adjacent segments. MATERIAL AND METHODS: From November 2007 to date, 41 patients have been operated on and 42 disc prostheses have been placed. All patients underwent surgery in the same hospital by the same surgeon. The clinical and radiological results of treatment of 35 patients were studied. The patients were examined before surgery, immediately after surgery and then in the intervals of 3-6, 6-12, 12-24, and 36-48 months. The longest follow-up was 61 months. Mean follow-up was 30 months. RESULTS: Patients operated on using total intervertebral disc prosthesis demonstrated a significant improvement compared to their preoperative status. A significant reduction of back and leg pain intensity was observed. The quality of life significantly improved. The intervertebral disc space height, the sagittal balance and the balance in the adjacent levels were restored and preserved after correction. The motion in the implanted segment was preserved. CONCLUSIONS: Total lumbar disc replacement with a Maverick prosthesis has proved to be an effective and safe technique. The clinical and radiological methods showed the significant improvement of the patients' status.