256. Surgical intervention is associated with improvements in the ASIA impairment scale in gunshot induced spinal injuries of the thoracic and lumbar spine

Background.Foundation of specialised centres or units of acute spinal surgery in general acute hospitals is to be considered a tendency of much importance in development of metropolitan systems for management of trauma victims with spinal injuries.Objective. To analyse size and structure of the patient inflow, contents and outcomes of treatment of trauma victims with thoracic and lumbar spine injuries in a setting of a specialised centre for acute spinal surgery located in a major city in our country.Material and methods. 1,760 trauma victims with thoracic and lumbar spine injuries admitted to an urban centre for acute spinal surgery of St. Petersburg in 2010 through 2016: 1,204 (68.4%) – isolated neurologically intact, 410 (23.3%) – isolated with spinal cord injury, 146 (8.3%) – spinal injuries in polytraumatised patients. An analysis of health administrative and clinical data was performed using non-parametric statistics.Results.During the period the centre worked, the number of annually admitted trauma victims increased 3.44 times, while notably, in the annual structure of the inflow, of which a fraction of isolated neurologically intact injuries decreased from 75.4% to 64.5%, there was an increase in fractions of persons with isolated spine and cord injuries (from 20.2 to 25.0%; р=0.2878) and with spinal injuries and polytrauma (from 4.4 to 10.5%; р=0.0718). The surgical rate was observed to increase from 69.3% to 81.9% (р = 0.0036), especially in trauma victims with unstable isolated neurologically intact injuries. In the annual structure of surgical work, a fraction of early procedures constantly increased (from 27.8 to 91.6%; р=0.0001), the increase rate appearing most stable in neurologically intact patients with isolated injuries. The treatment outcomes showed high values by all measures.Conclusion.The setting of a specialised secondary care centre for acute spinal surgery of a major city delivers high effectiveness and favourable outcomes of treatment of trauma victims with spinal injuries owing to the centralisation of their inflow, broad use of modern medical technology, and the tactic of early surgery.

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Analysis of surgical treatment of patients with primary tumors of the thoracic and lumbar spine

TRAUMA ◽

10.22141/1608-1706.1.22.2021.226410 ◽

2021 ◽

Vol 22 (1) ◽

pp. 33-41

Author(s):

V.O. Radchenko ◽

A.I. Popov ◽

K.O. Popsuishapka ◽

V.O. Kutsenko ◽

O.V. Perfiliev

Keyword(s):

Surgical Treatment ◽

Lumbar Spine ◽

Surgical Intervention ◽

Tumor Resection ◽

World Health ◽

Spinal Tumors ◽

Primary Tumors ◽

Supporting Function ◽

Thoracic And Lumbar Spine ◽

Tumor Like Lesions

Oncological radicalism (the scope of surgical treatment) and restoration of the supporting function of the spine remain the most pressing issues of surgical treatment for tumors. Purpose of the work: to analyze the outcomes of surgical treatment of patients with primary tumors of the thoracic and lumbar spine based on the appropriate rating scales. Materials and methods. Forty-three patients, 22 women and 21 men aged 18 to 72 years, with benign and malignant primary tumors and tumor-like lesions of the spine were examined; they were treated at the Department of vertebrology of the Sytenko Institute of Spine and Joint Pathology of the National Academy of Medical Sciences of Ukraine. Localization of the lesions was as follows: cervical spine — 5 patients, thoracic — 17, lumbar — 19, sacrum — 2. According to the pathomorphological classification of primary tumors and tumor-like lesions of the World Health Organization, the patients were divided into those with benign (n = 26) and malignant (n = 17) tumors. The results of surgical treatment for primary spinal tumors were analyzed using the American Spinal Injury Association (ASIA) scale, Spinal Instability Neoplastic Score (SINS), Bilsky scale; the localization of tumors in different segments of the spinal column was considered as well. Results and discussion. We evaluated the outcomes of surgical treatment of spinal tumors for the following indications: radical surgery, the presence of complications, the dynamics of neurological and orthopedic disorders, the presence of tumor recurrence and the life expectancy of patients. Radical tumor resection within healthy tissues was performed in 17 of 19 patients, who had indications for the use of this method. Twenty-four patients underwent surgical treatment in the form of decompression of the spinal canal and partial tumor resection to restore the supporting function of the spine. In 2 cases, ablasticity was not achieved. Conclusions. According to the ASIA, SINS, Birsky scales, it was found that surgical intervention in primary tumors of the spine is justified, it prevents neurological complications, significantly reduces existing neurological disorders, and prolongs the life of patients. The choice of the scope of surgical intervention aimed at restoration of the supporting function of the spine according to these scales is not shown. Treatment of primary tumors of the spine should include both radical removal of atypical tissues within the healthy tissues and palliative treatment if indicated. It is important to restore the supporting function of the spine in the area of its damaged segments.

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Dynamics of biochemical and immunological parameters in patients with malignant and benign tumors of the thoracic and lumbar spine

ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS ◽

10.15674/0030-59872017230-34 ◽

2017 ◽

Vol 0 (2) ◽

pp. 30-34

Author(s):

Mykola Korzh ◽

Volodymyr Radchenko ◽

Frieda Leontyeva ◽

Volodymyr Kutsenko ◽

Bogdan Shevtsov ◽

...

Keyword(s):

Lumbar Spine ◽

Benign Tumors ◽

Immunological Parameters ◽

Thoracic And Lumbar Spine ◽

Malignant And Benign Tumors

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Thoracic and Lumbar Spine Trauma: Clinical Presentation and Diagnosis

10.28962/01.3.117 ◽

2017 ◽

Author(s):

F.C. Oner

Keyword(s):

Lumbar Spine ◽

Clinical Presentation ◽

Spine Trauma ◽

Thoracic And Lumbar Spine

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Thoracic and lumbar spine pedicle morphology in Japanese patients

Surgical and Radiologic Anatomy ◽

10.1007/s00276-021-02707-8 ◽

2021 ◽

Author(s):

Kohei Morita ◽

Hiroki Ohashi ◽

Daichi Kawamura ◽

Satoshi Tani ◽

Kostadin Karagiozov ◽

...

Keyword(s):

Lumbar Spine ◽

Japanese Patients ◽

Thoracic And Lumbar Spine ◽

Pedicle Morphology

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Rating the incidence of iatrogenic vascular injuries in thoracic and lumbar spine surgery as regards the approach: A PRISMA-based literature review

European Spine Journal ◽

10.1007/s00586-021-06956-4 ◽

2021 ◽

Author(s):

Alice Giotta Lucifero ◽

Cristian Gragnaniello ◽

Matias Baldoncini ◽

Alvaro Campero ◽

Gabriele Savioli ◽

...

Keyword(s):

At Risk ◽

Lumbar Spine ◽

Spine Surgery ◽

Iliac Vein ◽

Lumbar Spine Surgery ◽

Common Iliac Vein ◽

Suture Repair ◽

Vascular Injuries ◽

Mesh Terms ◽

Thoracic And Lumbar Spine

Abstract Purpose To assess the rate, timing of diagnosis, and repairing strategies of vascular injuries in thoracic and lumbar spine surgery as their relationship to the approach. Methods PubMed, Medline, and Embase databases were utilized for a comprehensive literature search based on keywords and mesh terms to find articles reporting iatrogenic vascular injury during thoracic and lumbar spine surgery. English articles published in the last ten years were selected. The search was refined based on best match and relevance. Results Fifty-six articles were eligible, for a cumulative volume of 261 lesions. Vascular injuries occurred in 82% of instrumented procedures and in 59% during anterior approaches. The common iliac vein (CIV) was the most involved vessel, injured in 49% of anterior lumbar approaches. Common iliac artery, CIV, and aorta were affected in 40%, 28%, and 28% of posterior approaches, respectively. Segmental arteries were injured in 68% of lateral approaches. Direct vessel laceration occurred in 81% of cases and recognized intraoperatively in 39% of cases. Conclusions Incidence of iatrogenic vascular injuries during thoracic and lumbar spine surgery is low but associated with an overall mortality rate up to 65%, of which less than 1% for anterior approaches and more than 50% for posterior ones. Anterior approaches for instrumented procedures are at risk of direct avulsion of CIV. Posterior instrumented fusions are at risk for injuries of iliac vessels and aorta. Lateral routes are frequently associated with lesions of segmental vessels. Suture repair and endovascular techniques are useful in the management of these severe complications.

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