RESULTS OF REPEATED SURGICAL INTERVENTIONS AFTER INSTRUMENTAL FIXATION OF VERTEBRAL COLUMN IN PATIENTS WITH DEGENERATIVE-DYSTROPHIC DISEASE OF LUMBAR SPINE
Abstract
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. 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. 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. 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.
About the Authors
A. V. Evsyukov
ФГБУ Федеральный Центр Нейрохирургии.
Russian Federation
Russian Federation
V. S. Klimov
ФГБУ Федеральный Центр Нейрохирургии.
Russian Federation
Russian Federation
E. A. Loparev
ФГБУ Федеральный Центр Нейрохирургии.
Russian Federation
Russian Federation
References
1. Andersen T. Biomed Research International received July 2013/ Degenerative Spondylolisthesis Is Associated With Low Spinal Bone Density: A Comparative Study Between Spinal Stenosis And Degenerative Spondylolisthesis.
2. Bridwell K., Marchetti P. / The Textbook Of Spinal Surgery, 2nd Edn. Lippincott-Raven, Philadelphia, (1997) Pp 1211— 1254. Classification Of Spondylolisthesis As A Guideline For Treatment.
3. Dede O. et al. Revision surgery for lumbar pseudarthrosis. The Spine Journal 2015;15(5):977-982.
4. Glassman S.D. et al. Clinical outcomes in older patients after posterolateral lumbar fusion. The Spine Journal 2007;7(5):547551.
5. Hдkkinen A. et al. Reoperations after first lumbar disc herniation surgery; a special interest on residives during a 5-year follow-up. BMC musculoskeletal disorders 2007; 8(1): 1.
6. Hanley S., Osti O. Radiology Of Intervertebral Cages In Spinal Surgery. Clin. Radiol. 1999; 54:201-206.
7. Hilibrand A.S., Robbins M. Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion? The Spine Journal 2004;4(6): S190-S194.
8. Hongli W. et al. Bmc Musculoskeletal Disorders 2016/ Analysis Of The Correlative Factors In The Selection Of Interbody Fusion Cage Height In Transforaminal Lumbar Interbody Fusion.
9. Kalakoti P. et al. Inpatient outcomes and postoperative complications after primary versus revision lumbar spinal fusion surgeries for degenerative lumbar disc disease: a national (nationwide) inpatient sample analysis, 2002—2011. World neurosurgery 2016; 85:114-124.
10. Lalane L.B., Marcuson K.W. Adjacent segment disease of the lumbar spine: genetic versus biomechanical theories. Coluna Columna 2008;7(3):276-280.
11. Levin D.A. et al. Adjacent segment degeneration following spinal fusion for degenerative disc disease. Bulletin-Hospital for Joint Diseases New York 2007;65(1):29.
12. Macnab I. A. N. Negative disc exploration. J Bone Joint Surg Am 1971; 53(5): 891-903.
13. Martin B.I. et al. Expenditures and health status among adults with back and neck problems. Jama 2008; 299(6):656664.
14. Melloh M. et al. The international spine registry SPINE TANGO: status quo and first results. European Spine Journal 2008;17(9):1201-1209.
15. Modic M.T. et al. Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology 1988;166(1):193-199.
16. Modic M.T. Modic type 1 and type 2 changes. Journal of neurosurgery. Spine 2007;6(2): 150.
17. Okuyama K. Posterior Lumbar Interbody Fusion: A Retrospective Study Of Complications After Facet Joint Excision And Pedicle Screw Fixation In 148 Cases. Acta Orthop Scand 1999; 70(4):329-334.
18. Omidi-Kashani F., Hasankhani E. G., Ashjazadeh A. Lumbar spinal stenosis: who should be fused? An updated review. Asian spine journal 2014;8(4):521-530.
19. Pfirrmann C.W.A. et al. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine 2001; 26(17):1873-1878.
20. Phillips F.M. et al. Lumbar spine fusion for chronic low back pain due to degenerative disc disease: a systematic review. Spine 2013;38(7): E409-E422.
21. Saavedra-Pozo F.M., Deusdara R.A.M., Benzel E.C. Adjacent segment disease perspective and review of the literature. The Ochsner Journal 2014;14(1):78-83.
22. Santos E. R. G. et al. Revision lumbar arthrodesis for the treatment of lumbar cage pseudoarthrosis: complications. Journal of spinal disorders & techniques 2008; 21(6): 418421.
23. Schizas C. et al. Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images. Spine 2010; 35(21):1919-1924.
24. Schwab F. et al. Adult spinal deformity—postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery. Spine 2010; 35(25):2224-2231.
25. Schwab F. et al. Scoliosis research society—Schwab adult spinal deformity classification: a validation study. Spine 2012; 37(12):1077-1082.
26. Schwab F.J. et al. Does one size fit all? Defining spinopelvic alignment thresholds based on age. The Spine Journal 2014; 14(11): S120-S121.
27. Steib J., Bogorin L. French. Results Of Lumbar And Lumbosacral Fusion: Clinical And Radiological Correlations In 113 Cases Reviewed At 3.8 Years. Chir Orthop Reparatrice Appar Mot 2000; 86:127-135.
28. Terence Verla A. Clinical Implication Of Complications On Patient Perceived Health Status Following Spinal Fusion Surgery. Journal Of Clinical Neuroscience 2015;22: 342— 345.
29. Wang H. et al. Analysis of the correlative factors in the selection of interbody fusion cage height in transforaminal lumbar interbody fusion. BMC musculoskeletal disorders 2016; 17(1):1.
30. Weishaupt D. et al. MR imaging and CT in osteoarthritis of the lumbar facet joints. Skeletal radiology 1999;28(4): 215219.
31. White A.A. Clinical Biomechanics of the Spine. A.A. White, M.M. Panjabi. — Philadelphia, J.B. Lippincott, 1978. — 314 pp.
Review
For citations:
Evsyukov A.V., Klimov V.S., Loparev E.A. RESULTS OF REPEATED SURGICAL INTERVENTIONS AFTER INSTRUMENTAL FIXATION OF VERTEBRAL COLUMN IN PATIENTS WITH DEGENERATIVE-DYSTROPHIC DISEASE OF LUMBAR SPINE. Russian journal of neurosurgery. 2017;(4):65-73. (In Russ.)
Views:
642
Email this article 