[The impact of spinopelvic parameters on the rate of adjacent segment instability after short-segment spinal fusion]. / Vliianie pozvonochno-tazovykh parametrov na chastotu razvitiia nestabil'nosti smezhnogo segmenta pri monosegmentarnoi fiksatsii v poiasnichnom otdele.

AIM: The objective of this study is to determine the impact of postoperative spinopelvic parameters on the development of adjacent segment instability after single-level lumbar fusion. MATERIAL AND METHODS: A total of 116 patients with degenerative spine conditions after lumbar fusion were enrolled in this study and subdivided into two groups. Group I consisted of 24 patients with signs of adjacent segment instability; Group II included 92 patients without signs of instability. The minimal follow-up period was 24 months. RESULTS: The mean postoperative lumbar lordotic (LL) angle in both groups was within the normal range (-60.9±12); no statistically significant intergroup differences were revealed (56.6±12.1 and 58.4±11.2 for Groups I and II, respectively; p=0.314). In Group I patients, the mean pelvic incidence (PI) angle differed significantly from the mean PI values in Group II patients (70.4±7.6 and 53.2±8.4, respectively; p=0.006) and from the normal PI values (51.9±10). Therefore, the mean difference between PI and LL (PI-LL) angles in the Group I patients was significantly higher than in Group II (16.2±5.4 and 4.8±8.6, respectively; p=0.004). Significant PI-LL mismatch (PI-LL ≥10°) was observed in 22 (91.7%) patients in Group I and in 11 (11.95%) patients in Group II. According to regression analysis data, the PI-LL mismatch was identified as a risk factor for adjacent segment instability; the odds ratio =4.2; 95% confidence interval 1.46-12.25; and p=0.007. CONCLUSION: Patients with the high PI value and low LL value have a significantly higher risk of adjacent segment instability after short-segment spinal fusion.

[The effect of spinal deformity correction on the quality of life of elderly patients]. / Vliyanie korrektsii deformatsii pozvonochnika na kachestvo zhizni pozhilykh patsientov.

AIM: At present, there is no consensus on the approach to treatment of patients older than 60 years of age who have spinal deformity and clinical symptoms. The article describes the effect of two different types of surgery on the quality of life of elderly patients with deformities. MATERIAL AND METHODS: A prospective study included 58 patients operated on at the Verden Russian Research Institute of Traumatology and Orthopedics in the period between 2007 and 2010. The inclusion criteria were as follows: patients older than 60 years of age, having spinal deformity (sagittal modifiers of grade 2(+) and higher according to the SRS-Schwab classification), radicular syndromes, and back pain. The patients were examined in accordance with a general algorithm, including general clinical and neurological examinations and an X-ray examination with evaluation of deformity, spinopelvic relationships, and sagittal imbalance. We compared two groups of patients. The first group included 28 patients who underwent decompressive foraminotomy. The second group consisted of 30 patients who underwent decompressive foraminotomy and deformity correction. The patients were evaluated using the following scales: VAS, ODI, and SRS-24 before surgery and after 3, 6 months, 1, 2, and 5 years. RESULTS: Preoperatively, there was no difference between the groups. We found no differences between the groups 1 year after surgery. After 5 years, the group with isolated decompression had poorer results. CONCLUSION: Spinal deformity correction is a more aggressive surgical procedure compared to isolated decompression. However, the efficacy of the former operation is higher.

[Prevention of blood loss during resection of hypervascular spinal tumors with the use of preoperative embolization and local hemostatic agents].

Currently there is no consensus how to reduce the risk of hemorrhage in spinal decompression surgery of hypervascu- lar spinal tumors. A retrospective study of 128 patients oper- ated in our institute was held in the period between 2003 and 2014. There were 80 male and 48 female patients with extradural hypervascular spinal tumor. The study included 71 patients with metastases of renal cell carcinoma, 28 - with multiple myeloma, 18 - with plasmacytoma and 11 - with aggressive hemangioma. The first group included 59 patients who underwent preoperative tumor embolization. The second group consisted of 69 patients who were treated surgically using intraoperative local hemostatic agents. We performed 2 types of treatment options: palliative decompression and total spondylectomy. We did not get evidence that embolization was more effective than using local hemostatic agents for patients with hypervascular spinal tumors who underwent palliative decompression. In the same time efficiency of embolization for patients with total spondylectomy was significantly higher.