scholarly journals THERAPY FOR COMPLICATED DEGENERATIVE STENOSIS OF THE LUMBOSACRAL SPINE SEGMENT IN ELDERLY PATIENTS

2018 ◽  
Vol 4 (2) ◽  
pp. 56-60
Author(s):  
Yu. N. Zakrevskij ◽  
A. V. Peretechicov ◽  
D. M. Zavyalov ◽  
A. S. Volkov
Keyword(s):  
Surgical Treatment ◽  
Elderly Patients ◽  
Cauda Equina ◽  
Lower Limbs ◽  
Neurological Deficits ◽  
Lumbosacral Spine ◽  
Degenerative Spine ◽  
Thoracic And Lumbar Spine ◽  
Cauda Equina Roots ◽  
Spine Segment

The paper present a retrospective analysis of surgical treatment of 22 elderly patients aged 60 to 80 years who had complicated degenerative stenosis of lower thoracic and lumbar spine segments associated with neurological deficits ranging from mild peripheral manifestations to severe unilateral and bilateral paresis. The severity of degenerative spine lesions and compressive stenosis of spinal channel contents correlated with patients’ age and culminated in the maximal degenerative stenotic alterations, up to 5,5±0,9 cm, at the L3 to L5 level at the age of 76,5±1,4 years. Surgery performed to decompress the spinal channel and cauda equina roots and to stabilize the spine with Stryker and Fixpain transpedicular inner fixation and correction devices resulted in the regress of neurological deficits and restoration of lower limbs motor functions up to the capability of unassisted locomotion in old age.

scholarly journals Comparison of Nitinol and Titanium Nails Effectiveness for Lumbosacral Spine Fixation in Surgical Treatment of Degenerative Spine Diseases

2019 ◽  
Vol 25 (2) ◽  
pp. 59-70
Author(s):  
S. V. Kolesov ◽  
A. I. Kazmin ◽  
V. V. Shvets ◽  
A. O. Gushcha ◽  
E. N. Poltorako ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Spinal Canal ◽  
Spinal Canal Stenosis ◽  
Lower Limbs ◽  
Lumbosacral Spine ◽  
Adjacent Segment ◽  
Rigid Fixation ◽  
Degenerative Spine ◽  
Canal Stenosis ◽  
Spine Diseases

Relevance. Surgical decompression and decompression with stabilization are highly effective for treatment of spinal canal stenosis at the level of lumbar spine. However, complications developing after application of rigid fixation systems resulted in active introduction of dynamic implants into clinical practice.Purpose of the study — to compare effectiveness of nitinol and titanium nails for lumbosacral fixation in surgical treatment of degenerative spine diseases.Materials and methods. 220 patients who underwent surgeries in 4 hospitals were randomized into two groups, each consisting of 110 patients (1:1 ratio): a group of patients who underwent stabilization of the vertebral motor segments with rods of nitinol with the required volume of decompression at the operation level and a group of patients who underwent stabilization of the vertebral motor segments with standard rods of titanium with the required volume of decompression at the intervention level. Patients suffered clinically significant spinal canal stenosis in one or two adjacent segments: from L3 to S1. Outcomes were evaluated during three years postoperatively by VAS scale for spine and lower limbs, and by ODI and SF-36 scales.Results. All scales demonstrated better values in both groups of patients, namely, significant decrease of pain syndrome and improvement in mental and physical health. X-ray examination of all patients during the study period demonstrated restoration of lumbar lordosis. Group of patients with dynamic nails featured less complications rate related to metal implants including adjacent segment disease.Conclusion. Transpedicular fixation of lumbosacral spine by nitinol nails is an effective technique allowing to preserve motion along with stable fixation.

Tactics of Surgical Treatment for Degenerative-Dystrophic Diseases of Lumbosacral Spine in Elderly and Senile Patients

2009 ◽  
Vol 16 (2) ◽  
pp. 40-46
Author(s):  
G M Kavalerskiy ◽  
S K Makirov ◽  
M D Chenskiy ◽  
M V Boev ◽  
V G Cherepanov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Elderly Patients ◽  
Treatment Outcomes ◽  
Daily Activity ◽  
Life Quality ◽  
Lumbosacral Spine ◽  
Analog Scale ◽  
Surgical Interventions ◽  
Pathologic Process ◽  
Different Types

Surgical treatment outcomes on 87 patients aged 60-83 years operated on for degenerative-dystrophic diseases of lumbosacral spine have been presented. Depending on the stage of pathologic process and compressive factor direction, different types of decompressive stabilizing surgical interventions were performed in compliance with the elaborated tactics of surgical treatment. Evaluation of the results showed significant decrease in pain sensations (by Visual Analog Scale) and increase in the indices of daily activity (by Oswestry Disability Index) both in early (under 3 months) and late (up to 36 months) postoperative periods, that led to significant improvement of the life quality in elderly patients. The achieved results confirmed the efficacy of the elaborated differentiated approach to surgical treatment of that group of patients.

scholarly journals PERIARTICULAR CYSTS OF FACET JOINTS: ETIOPATHOGENESIS, DIAGNOSIS, METHODS OF SURGICAL TREATMENT. A CLINICAL EXAMPLE

2018 ◽  
Vol 3 (4) ◽  
pp. 61-68 ◽  
Author(s):  
V. A. Byvaltsev ◽  
V. A. Sorokovikov ◽  
A. A. Kalinin ◽  
A. K. Okoneshnikova
Keyword(s):  
Surgical Treatment ◽  
Cauda Equina ◽  
Facet Joints ◽  
Medical Databases ◽  
Current State ◽  
Relevant Topic ◽  
Post Traumatic ◽  
Cauda Equina Roots ◽  
The Right ◽  
Significant Factors

Background. Periarticular cysts (PC) of facet joints is a rare pathology in neurosurgical practice. The concept of PC is applicable for all cysts that are located either pararticularly in the region of facet joints, or start from them.Material and methods. A systematic search was performed in medical databases: Medline, RINC, EMedicine, UMKB, Pubmed on the relevant topic in Russian and English. The search query includes  words: arcuate joint, periarticular cyst, clinic, diagnosis, surgical  treatment. One of the significant factors of PC development is the  instability of the vertebralmotor segment of both degenerative and post-traumatic character.Results. The result of the literature review was the writing of a clinical lecture, the current state of the issue of etiopathogenesis, diagnosis and management of patients with  periarticular cysts of facet joints was studied. The article gives a  clinical example of surgical treatment of a patient with a periarticular cyst at the level of LIV-LV on the right.Conclusion. Periarticular cysts of facet joints are one of the factors of compression of cauda equina roots, with surgical treatment being  a radical and effective way of treatment. A detailed study of this  pathology is a promising direction in spinal neurosurgery. Further  research is required on comparative analysis of clinical and  instrumental efficacy of various methods of surgical treatment of periarticular cysts of facet joints.

Posterior epidural migration of herniated lumbar disc fragment

2011 ◽  
Vol 14 (3) ◽  
pp. 313-317 ◽  
Author(s):  
Ahmet Sengoz ◽  
Kadir Kotil ◽  
Erol Tasdemiroglu
Keyword(s):  
Surgical Treatment ◽  
Cauda Equina Syndrome ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Case Series ◽  
Rare Condition ◽  
Neurological Deficits ◽  
Lumbar Region ◽  
Duration Of Symptoms ◽  
First Choice

Object Posterior epidural migration of a free disc fragment in the lumbar region is a very rare condition that has only been reported in isolated cases to date. Patients with this condition present with radiculopathy or major neurological deficits. Difficulties in diagnosis and the choice and timing of surgical treatment are important in these cases. In this clinical case series, features of cases with posterior epidural migration of free lumbar disc fragments accompanied by cauda equina syndrome are discussed. Methods Eight cases (0.27%) of posterior epidural migration of disc fragments were detected among 2880 patients surgically treated for lumbar disc herniation between 1995 and 2008. Seven of these patients had cauda equina syndrome. The mean duration of symptoms in the 8 cases was 4.2 days (range 1–10 days). The group included 6 men and 2 women, with a mean age of 48 years (range 34–72 years). The sequestered disc fragments were at the L3–4 level in 6 patients (75%) and the L4–5 level in 2 (25%). Magnetic resonance imaging showed tumor-like ring contrast enhancement around sequestered fragments in 5 patients. The patients' motor, sensory, sexual, and urological functions were evaluated postoperatively, and modified Odom criteria and a visual analog scale were used in the assessment of postoperative outcomes. Results A microsurgical approach was used in all cases. Sequestrectomy with minimal hemilaminotomy and removal of the free segments were performed. The patients were followed up for a mean period of 28.5 months. Three patients (37.5%) had excellent results, 3 (37.5%) had good results, 1 patient (12.5%) had fair results, and only 1 patient had poor results according to the Odom criteria. The main factors affecting the long-term outcomes were the presence of cauda equina syndrome and the time period between onset of symptoms and surgery. Conclusions Patients with posterior migration of a disc fragment present with severe neurological deficits such as cauda equina syndrome. Because the radiological images of disc fragments may mimic those of other more common posterior epidural space–occupying lesions, definite diagnosis of posteriorly located disc fragments is difficult. All of these lesions can be completely removed with hemilaminotomy and sequestrectomy, and early surgical treatment is important as a first choice to prevent severe neurological deficits.

scholarly journals Ganglioglioma of Conus Medullaris—A Rare Case

2019 ◽  
Vol 08 (03) ◽  
pp. 216-218
Author(s):  
Sushil Kumar ◽  
Rajneesh Misra ◽  
Kundan Kumar ◽  
Sandeep Sharma
Keyword(s):  
Rare Case ◽  
Surgical Intervention ◽  
Cauda Equina ◽  
Conus Medullaris ◽  
Lower Limbs ◽  
Histopathologic Examination ◽  
Total Excision ◽  
Postoperative Course ◽  
Cauda Equina Roots ◽  
Progressive Weakness

Abstract Gangliogliomas favor the temporal lobe. They are rarely reported in the spinal cord. Ganglioglioma of the conus medullaris is very rare. An 11-year-old boy presented with progressive weakness of bilateral lower limbs. Clinical examination and radiologic investigations revealed a lesion in the conus medullaris with an exophytic component involving the cauda equina roots. The lesion was excised near totally. Its histopathologic examination revealed it to be a ganglioglioma. Gangliogliomas of the conus medullaris are rare lesions. Subtotal or near-total excision with preservation of the function should be the aim of the surgical intervention. Because preoperative function largely dictates the postoperative course, it is advisable to intervene early at the first hint of neurologic compromise.

DYNAMICS OF TEMPERATURE-PAIN SENSITIVITY IN DERMATOMES OF THE CAUDA EQUINA ROOTS IN THE DISTANT PERIOD AFTER SURGICAL TREATMENT OF SPONDYLOLISTHESIS IN ADULTS

2020 ◽  
Author(s):  
Никита Сергеевич Гвоздев ◽  
Елена Николаевна Щурова
Keyword(s):  
Surgical Treatment ◽  
Pain Sensitivity ◽  
Cauda Equina ◽  
Adult Patients ◽  
Number Of Patients ◽  
Long Term Follow Up ◽  
Cauda Equina Roots

Проведено исследование динамики температурно-болевой чувствительности в дерматомах корешков конского хвоста у взрослых больных со спондилолистезом I и II степенях смещения в отдаленные сроки после хирургического лечения. Показано, что в отдаленный период наблюдения уменьшилась доля больных с гипестезией тепла и боли, термоанестезией, увеличилось количество больных с нормальными порогами. Наиболее уязвимым является Lдерматом, где регистрируется наименьший процент больных с нормальными порогами болевой чувствительности. The dynamics of temperature and pain sensitivity in the dermatomes of cauda equina roots in adult patients with spondylolisthesis of I and II degrees of displacement in the long term after surgical treatment was conducted in the paper. It is shown that in the long-term follow-up period, the proportion of patients with heat and pain hypesthesia and thermoanesthesia decreased, and the number of patients with normal thresholds increased. The most vulnerable is L5 dermatome, where the lowest percentage of patients with normal thresholds of pain sensitivity is registered.

scholarly journals Thermovision analysis of the surface of the lower limbs in patients with symptomatic lumbosacral discopathy before and after surgery

2021 ◽  
Author(s):  
Monika Patrycja Wideł ◽  
Wilhelm Masarczyk ◽  
Sławomir Grzegorczyn
Keyword(s):  
Surgical Treatment ◽  
Temperature Distribution ◽  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Lower Limbs ◽  
Control Group ◽  
Lumbosacral Spine ◽  
Before And After ◽  
The Subject ◽  
Maximum Minimum

Introduction: The subject of the study is analyzing of the temperature distribution on the lower limbs in patients with discopathy of the lumbosacral spine requiring surgery. Aim: The answer to the question whether surgical treatment reduces temperature differences on the lower limbs of patients undergoing surgery. Material and methods: Thermograms of the lower limbs were performed before and on the second day after microdiscectomy or microdiscectomy with posterior lumbar interbody fusion. The study group consisted of 37 patients of the Neurosurgery Department, while the control group consisted of 18 healthy people. Comparative analyzes of temperatures on the lower limb with pain with the temperatures on the lower healthy limb in the same patient indicate significant statistical differences in temperature distribution. Based on the thermograms, two region of interest’s (ROI) of the same area were determined on the thigh and the lower leg. The maximum, minimum and average temperatures were determined for those areas. Results and discussion: Comparative analyzes showed statistically significant differences for both areas and all temperatures between healthy and affected limbs in the group of patients before surgery. In turn, after surgery, no statistically significant differences were observed between the respective limb temperatures for both ROI areas. The analysis of the temperature parameters determined for analogous ROIs in the control group did not show statistically significant differences for all measured temperatures. Conclusions: After selective surgical treatment of lumbar discopathy by microdiscectomy previous significantly statistical temperature differences between the lower limbs in analogical ROIs in those patients decreased to not statistically significant differences.

Neurosurgical intervention in penetrating spinal trauma with associated visceral injury

1989 ◽  
Vol 70 (4) ◽  
pp. 514-518 ◽  
Author(s):  
Benjamin H. Venger ◽  
Richard K. Simpson ◽  
Raj K. Narayan
Keyword(s):  
Neurological Outcome ◽  
Cauda Equina ◽  
Neurological Deficits ◽  
Neurological Injury ◽  
Infection Prophylaxis ◽  
Associated Injuries ◽  
Visceral Injury ◽  
Surgical Exploration ◽  
Significant Difference ◽  
Neurosurgical Intervention

✓ Associated injuries to the neck, chest, or abdomen are found in approximately one-quarter of all civilians with penetrating spinal cord or cauda equina injuries. While the value of and indications for general surgical exploration and repair of these injuries are fairly self-evident, the value of neurosurgical intervention in terms of neurological outcome and infection prophylaxis remains the subject of debate. To study this issue, 160 civilian patients with penetrating spinal injuries and neurological deficits were retrospectively reviewed. Associated injuries of the esophagus, trachea, bronchi, or bowel were seen in 107 individuals (67%); 33 (31%) of these patients had abdominal injuries, 25 (23%) had neck injuries, 23 (21%) had thoracic injuries, and 26 (24%) had injuries occurring at multiple sites. Of these 107 patients, 67 (63%) had complete neurological injuries and the remaining 40 (37%) demonstrated incomplete deficits. All 107 patients underwent surgical exploration and repair of their visceral injuries; in 19 of them a neurosurgical procedure was also performed for decompression of the neural elements and/or debridement of the wound. Regardless of the presence of associated visceral injuries, the mechanism of injury, and the extent of the neurological deficit, no statistically significant difference in neurological outcome was found in patients with or without neurosurgical intervention. Complications associated with neurological injury were reported in 17 (11%) of the total group of 160 patients. Four (21%) of the 19 patients who had neurosurgical intervention suffered a related complication, compared to only six (7%) of the 88 patients who were managed conservatively (p < 0.05). Within the limitations of a retrospective review, the results of this study do not clearly support the value of routine neurosurgical intervention as an adjunct to general surgical repair in cases of spinal injury associated with penetrating visceral trauma.

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