neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.17650/1683-3295-2021-23-2-25-33neurosurgery-1029Research ArticleОРИГИНАЛЬНАЯ РАБОТАORIGINAL REPORTОтдаленные клинико-рентгенологические исходы тотальной артропластики межпозвонковых дисков на уровне пояснично-крестцового переходаLong-term clinical and radiological outcomes after total lumbar disc replacement at the lumbosacral junctionhttps://orcid.org/0000-0001-9039-9147СтепановИ. А.StepanovI. A.

Иван Андреевич Степанов

664003 Иркутск, ул. Красного Восстания, 1; 664025 Иркутск, ул. Горького, 8

Ivan Andreevich Stepanov

1 Krasnogo Vosstaniya St., Irkutsk 664003; 8Gorkogo St., Irkutsk 664025

stepanovivanneuro@gmail.comhttps://orcid.org/0000-0002-3299-1924БелобородовВ. А.BeloborodovV. A.

664003 Иркутск, ул. Красного Восстания, 1

1 Krasnogo Vosstaniya St., Irkutsk 664003

СаакянЗ. С.SaakyanZ. S.

677005 Якутск, ул. П. Алексеева, 83а

83a P. Alekseeva St., Yakutsk 677005

ТомашовИ. И.TomashovI. I.

672038 Чита, ул. Коханского, 7

Kokhanskogo St., 7, Chita 672038

ТрепезниковВ. Г.TrepeznikovV. G.

353915 Новороссийск, ул. Революции 1905 года, 30

30 Revolutsii 1905goda St., Novorossiysk 353915

ФГБОУ ВО Иркутский государственный медицинский университет Минздрава России; Харлампиевская клиника, ОООРоссияIrkutsk State Medical University; Kharlampiev ClinicRussian FederationФГБОУ ВО Иркутский государственный медицинский университет Минздрава РоссииРоссияIrkutsk State Medical UniversityRussian FederationГБУЗ РС(Я) Республиканская больница № 2РоссияRepublican Hospital № 2Russian FederationГУЗ Краевая клиническая больницаРоссияRegional Clinical HospitalRussian FederationГБУЗ Городская клиническая больница № 1РоссияCity Clinical Hospital № 1Russian Federation2021100620212322533Copyright © Степанов И.А., Белобородов В.А., Саакян З.С., Томашов И.И., Трепезников В.Г., 20212021Степанов И.А., Белобородов В.А., Саакян З.С., Томашов И.И., Трепезников В.Г.Stepanov I.A., Beloborodov V.A., Saakyan Z.S., Tomashov I.I., Trepeznikov V.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/1029

Цель исследования - провести анализ отдаленных клинико-рентгенологических исходов тотальной артропластики межпозвонковых дисков на уровне пояснично-крестцового перехода.

Материалы и методы

Материалы и методы. Выполнено многоцентровое ретроспективное наблюдательное когортное исследование. Данные получены из медицинских карт 93 пациентов (38 мужчин, 55 женщин, средний возраст 39,9 ± 7,5 года), у которых выполнена тотальная артропластика межпозвонковых дисков на уровне пояснично-крестцового перехода. Оценивались как клинические параметры, так и результаты инструментальных исследований. Средняя длительность послеоперационного наблюдения составила 33,4 ± 9,5 мес.

Результаты

Результаты. Выраженность болевого синдрома в поясничном отделе позвоночного столба статистически значимо уменьшилась с 7,3 ± 2,5 до 1,9 ± 2,2 см по визуально-аналоговой шкале (р <0,001). Индекс Освестри (Oswestry Disability Index) статистически значимо снизился с 43,4 ± 17,6 до 18,9 ± 16,0 % (р <0,001), а качество жизни по шкале SF-36 (Short Form-36), включая ментальный и физический компоненты, повысилось c 30,8 ± 8,5 % до 52,3 ± 12,4 % (р <0,001). Через 12 мес после операции амплитуда движений в оперированном позвоночно-двигательном сегменте статистически значимо уменьшилась с 5,3 ± 3,2° до 4,1 ± 3,6° (р <0,009), амплитуда движений в смежном позвоночно-двигательном сегменте изменилась незначимо - с 8,6 ± 4,1° до 7,8 ± 3,8° (р >0,05). Общий угол поясничного лордоза после установки протеза межпозвонкового диска на уровне пояснично-крестцового перехода статистически значимо увеличился с 49,1 ± 4,8° до 55,6 ± 5,5° (р <0,001). Протезы межпозвонковых дисков с углом лордоза 10° статистически значимо положительно коррелируют с увеличением значений сегментарного лордоза, в отличие от имплантатов с углом 6° (rS = 0,86, р = 0,04). Выраженность болевого синдрома в поясничном отделе позвоночника по визуально-аналоговой шкале статистически значимо отрицательно коррелировала с амплитудой движений в оперированном сегменте на поздних сроках послеоперационного наблюдения (24 и 36 мес, rS = -0,74, р = 0,015).

Заключение

Заключение. Методика тотальной артропластики поясничных межпозвонковых дисков - эффективный способ хирургического лечения пациентов с дегенеративным заболеванием позвоночника на уровне пояснично-крестцового перехода.

The study objective is to analyze long-term clinical and radiological outcomes in patients after performing total lumbar disc replacement at the level of the lumbosacral junction.

Materials and methods

Materials and methods. A multicenter retrospective observational cohort study was performed. The study included medical records of patients who underwent total lumbar disc replacement at the level of the lumbosacral junction. Both clinical and instrumental parameters were assessed. According to the eligibility criteria, 93 patients were included in the study (38 men, 55 women, mean age 39.9 ± 7.5 years). The average postoperative observation period for the respondents was 33.4 ± 9.5 months.

Results

Results. The severity of pain in the lumbar spine on a visual analogue scale significantly decreased (from 7.3 ± 2.5 to 1.9 ± 2.2 cm, p <0.001). The indicators of the quality of life according to the Oswestry Disability Index and according to the Short Form-36 scale (including the mental and physical components) of the studied group of respondents significantly improved (from 43.4 ± 17.6 to 18.9 ± 16.0 %, р <0.001 and from 30.8 ± 8.5 to 52.3 ± 12.4 %, p <0.001, respectively). From the 12th month of observation of the respondents, a significant decrease in the values of the range of motions of the operated segment was noted from 5.3 ± 3.2° to 4.1 ± 3.6° (p <0.009). Also, from the 12th month of postoperative observation, a slight decrease in the values of the range of motions of the adjacent segment from 8.6 ± 4.1° to 7.8 ± 3.8° (p >0.05) was verified. The value of global lumbar lordosis after the installation of a lumbar intervertebral disc prosthesis at the level of the lumbosacral junction significantly increased from 49.1 ± 4.8° to 55.6 ± 5.5° (p <0.001). Intervertebral disc prostheses with a lordotic angle of 10° reliably positively correlate with an increase in the values of segmental lordosis, in contrast to implants with an angle of 6° (rS = 0.86, p = 0.04). The severity of pain in the lumbar spine according to visual analogue scale and the range of motion of the operated segment has a significant negative correlation in the late periods of postoperative follow-up (24 and 36 months, rS = -0.74, p = 0.015).

Conclusion

Conclusion. The total lumbar disc replacement technique is an effective method of surgical treatment of patients with degenerative diseases of the intervertebral discs of the lumbosacral spine, including at the level of the lumbosacral junction.

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The authors declare that there are no conflicts of interest present.