Outcome of late surgical treatment in patients with incomplete paraplegia due to spinal degenerative diseases

Objective. To clarify indications for dynamic and rigid stabilization based on the analysis of correlation between neuroimaging parameters of facet joints (FJ) and clinical outcomes of surgical treatment of patients with degenerative diseases of the lumbar spine. Material and Methods. A total of 141 patients with degenerative diseases of the lumbar spine were surgically treated. Patients were divided into three groups: patients of Group I (n = 48) underwent surgical intervention with artificial intervertebral disc prosthesis; those of Group II (n = 42) – with interbody fusion and combined transpedicular and transfacetal stabilization; and those of Group III (n = 51) – with interbody fusion and bilateral transpedicular stabilization. The correlation between long-term clinical outcomes (pain syndrome according to VAS, functional state according to ODI, and satisfaction with surgical result according to MacNab scale) and preoperative neuroimaging parameters of FJ (degenerative changes according to Fujiwara, facet angle magnitudes, and the presence of tropism) was analyzed. Results. A direct significant nonparametric correlation of neuroimaging parameters of facet angles and FJ tropism with long-term clinical outcomes of surgical treatment according to VAS and ODI was revealed. It was established that good clinical outcomes were achieved with the following preoperative parameters: in Group I, the facet angle was less than 60°, while the presence of tropism had no correlation dependence; in Group II, the facet angle – more than 60°, in the absence of FJ tropism; and in Group III, the facet angle – more than 60°, in the presence of FJ tropism. Conclusion. Objective neuroimaging parameters of the facet angle magnitude of less than 60°, regardless of the presence of tropism, allow performing total arthroplasty. If the facet angle is more than 60°, the rigid stabilization of the operated segment is indicated; in the absence of tropism, a contralateral transfacetal fixation is possible, and in its presence – a bilateral transpedicular stabilization is reasonable.

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The recovery of damaged paraspinal muscles by posterior surgical treatment for patients with lumbar degenerative diseases and its clinical consequence

Journal of Back and Musculoskeletal Rehabilitation ◽

10.3233/bmr-150455 ◽

2017 ◽

Vol 30 (4) ◽

pp. 801-809 ◽

Cited By ~ 1

Author(s):

Jae-Ryong Cha ◽

Yong-Chan Kim ◽

Wan-Keun Yoon ◽

Won-Gyu Lee ◽

Tae-Hwan Kim ◽

...

Keyword(s):

Surgical Treatment ◽

Clinical Consequence ◽

Degenerative Diseases ◽

Paraspinal Muscles ◽

Lumbar Degenerative Diseases

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Evaluation of outcomes of surgical treatment for degenerative diseases of the spine

Hirurgiâ pozvonočnika ◽

10.14531/ss2017.4.85-94 ◽

2017 ◽

Vol 14 (4) ◽

pp. 85-94 ◽

Cited By ~ 2

Author(s):

Artem O. Gushcha ◽

Adilya R. Yusupova

Keyword(s):

Surgical Treatment ◽

Degenerative Diseases

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DEGENERATIVE SPINE DISORDERS COMPLICATED BY RADICULAR SYNDROME IN CHILDREN: AN EPIDEMIOLOGICAL AND CLINICAL ANALYSIS OF A 17-YEAR REGIONAL COHORT STUDY

Hirurgiâ pozvonočnika ◽

10.14531/ss2019.1.38-47 ◽

2019 ◽

Vol 16 (1) ◽

pp. 38-47 ◽

Cited By ~ 1

Author(s):

V. P. Snishchuk ◽

A. Yu. Mushkin

Keyword(s):

Surgical Treatment ◽

Conservative Treatment ◽

Clinical Manifestations ◽

Clinical Analysis ◽

Leningrad Region ◽

Operating Table ◽

Degenerative Diseases ◽

Epidemiological Analysis ◽

Radicular Syndrome ◽

Conservative And Surgical Treatment

Objective.To analyze epidemiological and clinical features of degenerative disease of the spine complicated by radicular syndrome in children, as well as the effectiveness of its treatment on the example of one of the largest regions of the Russian Federation.Material and Methods.Design of the study corresponds to a retrospective cohort clinical and epidemiological study for 17 years. The study included 201 patients aged 10–17 years with degenerative changes in the spine complicated by radicular syndrome. An epidemiological analysis included the assessment of the regional incidence of degenerative diseases of the spine in children, and clinical analysis – the effectiveness of conservative and surgical treatment. The age and sex structure of the cohort, the level of pathology, the effectiveness of surgical treatment, and age-related features of early spinal discosis in children as compared with degenerative lesions of the spine in adults were analyzed.Results.The epidemiological frequency of degenerative diseases accompanied by clinical manifestations and requiring special treatment in the Leningrad Region was assessed as 8.7 per 100 thousand children aged 10–17 years. Conservative treatment was effective in 172 patients, and 29 patients were treated with surgery. Surgical results were followed up for 1 to 16 years after surgery and were evaluated as excellent, good, and satisfactory respectively in 4 (14 %), 20 (69 %), and 5 (17 %) cases. Complications were reported in two cases: migration of the interbody stabilizing implant and positional neuropathy of the peroneal nerve associated with the position on the operating table.Conclusion. The epidemiological analysis conducted on a regional cohort of the Leningrad Region can be used in assessing the potential need for conservative and surgical treatment of children with degenerative pathology in other regions of Russia. Conservative treatment of this pathology is quite effective, and surgical decompression of nerve roots was required only in 14.4 % of cases.

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A meta-analysis of prospective studies comparing the results of laminoplasty and laminectomy with instrumental fixation in the surgical treatment of patients with multilevel degenerative cervical spine diseases

Annals of the Russian academy of medical sciences ◽

10.15690/vramn1160 ◽

2020 ◽

Vol 75 (1) ◽

pp. 54-68

Author(s):

Vadim A. Byvaltsev ◽

Andrey A. Kalinin ◽

Marat A. Aliev ◽

Valeriy V. Shepelev ◽

Bobur R. Yusupov ◽

...

Keyword(s):

Clinical Trials ◽

Cervical Spine ◽

Surgical Treatment ◽

Perioperative Complications ◽

Controlled Trial ◽

Meta Analysis ◽

Random Effect ◽

Cochrane Library ◽

Continuous Variables ◽

Degenerative Diseases

Background: Dorsal decompressive-stabilizing techniques laminotomy with laminoplasty (LP) and laminectomy with instrumental fixation (LF) are effective methods for surgical treatment of patients with multi-level degenerative diseases of the cervical spine. At the same time, there is currently no priority in determining the optimal method for posterior decompression and stabilization. Aim: conduct a comparative analysis of intraoperative parameters, clinical outcomes, radiological results and complications of LP and LF in the treatment of patients with multilevel degenerative diseases of the cervical spine. Methods: A meta-analysis of prospective cohort clinical trials was carried out, the primary sources were searched using the databases PubMed, CNKI, eLibrary and the Cochrane Library, published until March 2019, which compared the results of applying the LP and LF methods in the treatment of patients with multilevel degenerative diseases of the cervical spine. For dichotomous variables, the relative risk and the 95% confidence interval were calculated; in turn, for the continuous variables, the standardized difference of the mean values and their 95% confidence intervals were used, using random effect models and a fixed effect. Resuts: The meta-analysis included 6 prospective clinical trials, one of which was a randomized controlled trial. In total, the results of surgical treatment of 493 patients with multilevel degenerative diseases of the cervical spine were evaluated. In the group of drugs, statistically significantly smaller parameters of the duration of surgical intervention were verified (p 0.00001). At the same time, comparable parameters of cervical lordosis after surgery, the level of pain in the cervical spine, functional status according to NDI and JOA after surgery, the frequency of perioperative complications (p = 0.17, p = 0.05, p = 0.94, p = 0.96, p = 0.24, respectively). Conclusions: A meta-analysis showed that the functional outcomes of LP and LF, as well as instrumental results in the treatment of multilevel degenerative diseases of the cervical spine, are not clinically significant. In this case, the LP technique can be performed in a shorter period of time compared with LF.

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