neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.63769/1683-3295-2017-0-4-65-73neurosurgery-501Research ArticleОРИГИНАЛЬНАЯ РАБОТАORIGINAL REPORTРЕЗУЛЬТАТЫ ПОВТОРНЫХ ВМЕШАТЕЛЬСТВ ПОСЛЕ ИНСТРУМЕНТАЛЬНОЙ ФИКСАЦИИ ПОЗВОНОЧНИКА ПРИ ДЕГЕНЕРАТИВНО-ДИСТРОФИЧЕСКОМ ЗАБОЛЕВАНИИ ПОЯСНИЧНОГО ОТДЕЛА ПОЗВОНОЧНИКАRESULTS OF REPEATED SURGICAL INTERVENTIONS AFTER INSTRUMENTAL FIXATION OF VERTEBRAL COLUMN IN PATIENTS WITH DEGENERATIVE-DYSTROPHIC DISEASE OF LUMBAR SPINEЕвсюковА. В.EvsyukovA. V.

Евсюков Алексей Владимирович — к.м.н., врачнейрохирург спинального нейрохирургического отделения.

 

a_evsyukov@neuronsk.ruКлимовВ. С.KlimovV. S.

Климов Владимир Сергеевич — к.м.н., заведующий спинальным нейрохирургическим отделением.

Новосибирск.

v_klimov@neuronsk.ruЛопаревЕ. А.LoparevE. A.

Лопарев Евгений Александрович — к.м.н., врачнейрохирург спинального нейрохирургического отделения.

Новосибирск.

e_loparev@neuronsk.ruФГБУ Федеральный Центр Нейрохирургии.Russian Federation201721042018046573Copyright © Евсюков А.В., Климов В.С., Лопарев Е.А., 20182018Евсюков А.В., Климов В.С., Лопарев Е.А.Evsyukov A.V., Klimov V.S., Loparev E.A.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/501Цель

Цель: изучить результаты хирургического лечения пациентов, ранее оперированных по поводу дегенеративно-дистрофического заболевания поясничного отдела позвоночника с использованием имплантатов.

Материалы и методы

Материалы и методы. Проанализированы результаты повторного хирургического лечения 96 пациентов, ранее оперированных по поводу дегенеративно-дистрофического заболевания с использованием инструментальной фиксации. Из них 36 (37,5%) мужчин и 60 женщин (62,5%). Средний возраст 53,8±13,3 года. Пяти (5,2%) пациентам хирургическое вмешательство было выполнено в нашей клинике. Пациентам выполняли МРТ, МСКТ, рентгенографию позвоночника с оценкой стабильности сегментов, баланса позвоночника. Функциональную активность и оценку качества жизни определяли по индексу Освестри и SF36 до операции, через 6 и 12 мес. Исходы лечения оценивали по шкале MаcNab [11].

Результаты

Результаты. Пациенты разделены на 2 группы — с недостаточным первичным вмешательствм (43 пациента) и с прогрессированием заболевания на смежном уровне (53 пациента). Описаны основные хирургические методики. Катамнез отслежен в течение 1 года, проведен анализ результатов вмешательств и причин, потребовавших повторного лечения, разобраны осложнения, возникшие в результате хирургического лечения. Положительные результаты дифференцированного лечения получены у 74,2% пациентов.

Заключение

Заключение. Синдром поражения смежного уровня является основной причиной повторных хирургических вмешательств (55,2% больных). Наиболее часто причиной хирургического лечения оперированного сегмента является псевдоартроз, который был выявлен у 30 (69,8%) пациентов. Результаты хирургического вмешательства достоверно хуже (p=0.03) после хирургического лечения больных с патологией оперированного уровня, чем при лечении поражения смежных сегментов.

Objective

Objective: to examine the results of surgical treatment of patients who had previous operations with the usage of implants because of degenerative disease of lumbar spine.

Material and methods

Material and methods. The results of repeated surgical treatment of 96 patients who had previous operations with the usage of implants because of degenerative disease of lumbar spine are analyzed, among them 36 (37,5%) male and 60 female (62,5%) patients with the average age 53,813,3 years old. 5 (5,2%) patients underwent first operation in authors’ department. Preoperative examination included MRI, CT and X-ray examination of lumbar spine with the evaluation of segments stability and vertebral balance. Functional activity and life quality were assessed using Oswestry disability index and SF36 before operation as well as in 6 and 12 months postoperatively. Treatment outcomes were estimated using MаcNab scale [11].

Results

Results. Patients were divided into 2 groups — with insufficient primary surgical intervention (43 patients) and with disease progression on adjacent level (53 patients). The main surgical techniques are described. Follow-up period was for 1 year/ The analysis of the treatment outcomes and causes for repeated surgery was conducted as well as the occurred complications were examined. The favorable outcomes of differentiated treatment were achieved in 74,2% patients.

Conclusion

Conclusion. The syndrome of adjacent vertebra level is the main cause for repeated surgery (55,2% patients). The most often cause for repeated surgery on operated vertebral segment is pseudarthrosis which was revealed in 30 (69,8%) patients. The surgical treatment outcomes are significantly worse (p=0,03) after interventions on previously operated segment comparing with the adjacent segments.

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