Changes in sagittal balance in thoracolumbar posttraumatic kyphosis surgery / Alterações no equilíbrio sagital na cirurgia de cifose pós-traumática toracolombar / Cambios en el equilibrio sagital en la cirugía de cifosis postraumática toracolumbar

ABSTRACT: Objective: The analysis of the X-ray results of surgical treatment performed in patients with post-traumatic thoracolumbar kyphosis and identification of the compensatory mechanism for this deformity. Methods: The data of 140 patients surgically treated for painful post-traumatic kyphosis at the level of T12, L1, and L2 vertebrae was analyzed. Results: In the studied group, the initial kyphotic deformity was 23° to 81°, with a mean of 28.1°. All patients underwent staged surgical intervention in a single surgical session. Post-traumatic kyphosis (LK) was completely corrected, on average, to -0.25°. After kyphosis correction, increased thoracic kyphosis (TK) decreased lumbar lordosis (LL), including at the expense of low lumbar lordosis (LowLL), but no changes in pelvic balance parameters were observed. Statistically significant correlations of local kyphosis correction magnitude of 28.36±8.89°, with magnitudes of lumbar lordosis (LL), thoracic kyphosis (TK), low lumbar lordosis (LowLL) were obtained. The global sagittal and pelvic balance demonstrated no correlations with the magnitude of kyphosis correction. The X-ray parameters were studied in patients of Group I with no signs of initial sagittal imbalance and in Group II patients with signs of sagittal imbalance. The groups demonstrated statistically significant differences in global balance parameters and spinopelvic parameters both before and after correction surgery. Conclusion: The study revealed that the basic compensatory mechanism for post-traumatic thoracolumbar kyphosis is implemented by changes in the curves adjacent to kyphosis - a decrease in thoracic kyphosis and an increase in lumbar lordosis but not by changes in global or spinopelvic balance. Level of Evidence - III; A case-control study.

RESUMO: Objetivo: Análise dos resultados radiográficos do tratamento cirúrgico realizado em pacientes com cifose toracolombar pós-traumática e identificação do mecanismo compensatório dessa deformidade. Métodos: Foram analisados os dados de 140 pacientes tratados cirurgicamente por cifose pós-traumática dolorosa ao nível das vértebras T12, L1, L2. Resultados: No grupo estudado a deformidade cifótica inicial foi de 23° a 81°, média de 28,1°. Todos os pacientes foram submetidos à intervenção cirúrgica estadiada em uma única sessão cirúrgica. A cifose pós-traumática (LK) foi completamente corrigida, em média para -0,25°. Após a correção da cifose foi revelado aumento da cifose torácica (TK), diminuição da lordose lombar (LL), inclusive em detrimento da baixa lordose lombar (LowLL), mas não foram observadas alterações nos parâmetros de equilíbrio pélvico. Foram obtidas correlações estatisticamente significativas da magnitude de correção da cifose local de 28,36±8,89°, com magnitudes de lordose lombar (LL), cifose torácica (TK), lordose lombar baixa (LowLL). O equilíbrio sagital global e o equilíbrio pélvico não demonstraram correlações com a magnitude da correção da cifose. Os parâmetros radiográficos foram estudados nos pacientes do Grupo I sem sinais de desequilíbrio sagital inicial e naqueles do Grupo II com sinais de desequilíbrio sagital. Os grupos demonstraram diferenças estatisticamente significativas nos parâmetros de equilíbrio global e nos parâmetros espinopélvicos antes e após a cirurgia de correção. Conclusão: O estudo revelou que o mecanismo compensatório básico da cifose toracolombar pós-traumática é implementado por alterações nas curvas adjacentes à cifose - diminuição da cifose torácica e aumento da lordose lombar, mas não por alterações no equilíbrio global ou espinopélvico. Nível de Evidência III; Estudo caso controle.

RESUMEN: Objetivo: Análisis de los resultados radiológicos del tratamiento quirúrgico realizado a pacientes con cifosis toracolumbar postraumática e identificación del mecanismo compensador de esta deformidad. Métodos: Se analizaron los datos de 140 pacientes tratados quirúrgicamente por cifosis postraumática dolorosa a nivel de las vértebras T12, L1, L2. Resultados: En el grupo estudiado, la deformidad cifótica inicial osciló entre 23° y 81°, con un promedio de 28,1°. Todos los pacientes fueron sometidos a una intervención quirúrgica escalonada en una única sesión quirúrgica. La cifosis postraumática (LK) se corrigió completamente, en promedio a -0,25°. Después de la corrección de la cifosis, se reveló un aumento de la cifosis torácica (TK) y una disminución de la lordosis lumbar (LL), incluso a expensas de una lordosis lumbar baja (LowLL), pero no se observaron cambios en los parámetros del equilibrio pélvico. Se obtuvieron correlaciones estadísticamente significativas entre la magnitud de corrección de la cifosis local de 28,36±8,89°, con las magnitudes de lordosis lumbar (LL), cifosis torácica (TK), lordosis lumbar baja (LowLL). El equilibrio sagital global y el equilibrio pélvico no demostraron correlaciones con la magnitud de la corrección de la cifosis. Los parámetros radiológicos se estudiaron en pacientes del Grupo I sin signos de desequilibrio sagital inicial y en aquellos del Grupo II con signos de desequilibrio sagital. Los grupos demostraron diferencias estadísticamente significativas en los parámetros del equilibrio global y los parámetros espinopélvicos antes y después de la cirugía correctora. Conclusión: El estudio reveló que el mecanismo compensatorio básico de la cifosis toracolumbar postraumática se implementa mediante cambios en las curvas adyacentes a la cifosis (disminución de la cifosis torácica y aumento de la lordosis lumbar), pero no mediante cambios en el equilibrio global o espinopélvico. Nivel de Evidencia III; Estudio de casos y controles.

Risk Factors for Chronic Non-Communicable Diseases and Osteoporotic Fractures in a Middle and Elderly-Aged Population.

Aim. To study the associations of risk factors for chronic non-communicable diseases (CNCDs) and osteoporotic fractures (OFs) in a population sampling over 50 years. Materials and Methods. The data of a cross-sectional population-based study obtained in the Russian part of the international project HAPIEE (Novosibirsk) are analyzed. The present analysis comprised 7363 men and women aged 50-69 years old. We have assessed the frequency of OFs for the last 12 months and risk factors of CNCDs. Cross-sectional associations between OF history and potential determinants were analyzed using multivariable-adjusted logistic regression. Results. The frequency of OFs in the last 12 months was 3.6% (3.2% in men and 4.0% in women, p = 0.074). In men, the probability of OFs increased with an elevation of blood pressure (BP), high-density lipoprotein cholesterol (HDL-C), ethanol consumption, and reduced with increased body mass index (BMI). In women, the probability of a fracture increased with current smoking and an increased duration of post-menopause and reduced with an increase in triglycerides (TG) levels, independently of other factors. Conclusions. A syndemia of risk factors, both generally recognized for OFs (BMI, tobacco smoking, alcohol consumption, postmenopausal duration) and new factors associated with CNCDs (BP, HDL, TG), have been defined.

Progressive Scoliosis and Syringomyelia - Questions of Surgical Approach.

BACKGROUND: The rate of scoliosis in syringomyelia patients ranges from 25 to 74.4%. In turn, syringomyelia occurs in 1.2% to 9.7% of scoliosis patients. AIM: To evaluate outcomes of surgical correction of the scoliotic deformity in syringomyelia patients. MATERIALS AND METHODS: Between 1996 and 2015, 3120 patients with scoliosis of various etiologies were treated at the Clinic for Child and Adolescent Vertebrology of the Novosibirsk Research Institute of Traumatology and Orthopedics. We conducted a retrospective analysis of syringomyelia-associated scoliosis cases that required surgical correction. RESULTS: Syringomyelia was found in 33 patients (1.05%) out of 3120 patients with spinal deformities of various etiologies; in 21 patients (0.9%) with idiopathic scoliosis of 2334 patients. In identifying the neurological deficit, the recommended first step is to perform neurosurgery. Nineteen patients were operated using the CDI, 4 patients underwent correction VEPTR, in 1 case instrumentation could not be established, 9 patients are undergoing treatment in the department of neurosurgery at the moment. Worsening of neurological deficits was not observed in any patient. CONCLUSION: A comparison of the results of syringomyelia-associated scoliosis correction with the data of other authors was done. The choice of surgery tactics is strictly individual and depends on the size of the cavity. The result of surgical intervention is generally positive and the loss of correction by the end of follow-up is negligible.