RESUMEN
OBJECTIVE: To develop a new validated classification of intervertebral disc degeneration. MATERIAL AND METHODS: A retrospective observational single-center study included medical records of patients with and without degenerative disease of lumbar intervertebral discs. The interval values of apparent diffusion coefficient (ADC) of intervertebral discs were grouped into degeneration classes. RESULTS: The study included medical records of 100 patients. A quantitative analysis of data showed that mean ADC has a significant correlation with severity of lumbosacral disc degeneration according to classification by Pfirrmann et al. Lumbar intervertebral discs with degeneration grade 3-4 were less homogeneous compared to grade 2-3. Among discs with degeneration grade 4, mean ADC was significantly higher in case of hernia (p=0.01). Conversely, mean ADC was significantly higher in the absence of hernia for discs grade 3 (p=0.04). Combination of all data is presented as original classification of lumbosacral disc degeneration based on mean ADC. CONCLUSION: The developed classification can be recommended for radiologists, neurologists and neurosurgeons.
Asunto(s)
Degeneración del Disco Intervertebral , Desplazamiento del Disco Intervertebral , Disco Intervertebral , Humanos , Degeneración del Disco Intervertebral/diagnóstico , Desplazamiento del Disco Intervertebral/diagnóstico , Vértebras Lumbares/diagnóstico por imagen , Imagen por Resonancia Magnética , Estudios RetrospectivosRESUMEN
Hemorrhages into the structures of the central nervous system are the most life threatening among warfarin-associated complications. There are extremely few reports about spontaneous spinal epidural hematomas (SEH) associated with warfarin, methods of their timely diagnosis, treatment approaches. The authors present the first in the domestic literature case-report of warfarin-associated spontaneous SEH and the literature review.
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Hematoma Espinal Epidural/inducido químicamente , Hematoma Espinal Epidural/diagnóstico por imagen , Compresión de la Médula Espinal/diagnóstico por imagen , Compresión de la Médula Espinal/etiología , Warfarina/efectos adversos , Hematoma Espinal Epidural/complicaciones , Humanos , Imagen por Resonancia Magnética , Masculino , Médula Espinal/diagnóstico por imagen , Warfarina/administración & dosificaciónRESUMEN
BACKGROUND: Postoperative epidural fibrosis (EF) after lumbar discectomy is the most common and at the same time controversial issue. PURPOSE: The etiology and pathogenesis creates a lot of discussion and selection of methods of treatment and prevention continues. METHODS: LIV laminectomy with dura mater (DM) exposition was done in 24 rats, and then, 0.3 ml of elements of suspension of autologous intervertebral disk was implicated on DM. As autologous intervertebral disk, we used the intervertebral disk from amputated tail. In all the animals, incisions were closed with 3/0 Vicryl. EF was examined. Fibroblast cell density was calculated in each field at ×40 magnification: Grade 1 - fewer than 100 fibroblasts in each field; Grade 2 - 100-150 fibroblasts in each field; Grade 3 - more than 150 fibroblasts in each field. RESULTS: Based on histological results, we confirmed our model of experiment. On the 30th day of evaluation, there were significant histological evidences of postoperative epidural adhesions in experimental animals, which included the obliteration of epidural space, the presence of adhesions in the dura and nerve roots, the restructuring of the yellow ligament, bone sclerosis, excessive appearance of fibrous tissue around the autologous intervertebral disk tissue that applied on the DM. CONCLUSION: In our work, we describe a new experimental model, where the elements of autologous intervertebral disk play the role of inflammation trigger, which cause postoperative scar and EF.
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Described herein is the technique of performing assisting low-speed and high-speed extra-intracranial bypass, followed by a clinical case report concerning successful application of this technique in trapping of a giant aneurysm of the cavernous portion of the internal carotid artery in a female patient after endured transitory ischaemic attack during the test with temporary balloon-mediated occlusion of the internal carotid artery.
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Oclusión con Balón/métodos , Arteria Carótida Interna/cirugía , Revascularización Cerebral/métodos , Aneurisma Intracraneal/cirugía , Arteria Carótida Interna/diagnóstico por imagen , Angiografía Cerebral , Femenino , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Persona de Mediana EdadRESUMEN
UNLABELLED: Open transforaminal lumbar interbody fusion (TLIF) using transpedicular rods and interbody cage, which is used to treat segmental instability, is associated with a significant paravertebral muscle and ligament injury. A new rigid fusion method was introduced to improve the outcome of patients' treatment. OBJECTIVE: To conduct a comparative analysis of the effectiveness of minimally invasive fusion technique and TLIF to improve the treatment results in patients with symptomatic lumbar spine degeneration concomitant with moderate segmental instability of the lumbar spine. MATERIAL AND METHODS: The study involved 90 patients, which were divided into 2 groups. Transforaminal interbody fusion with Pezo-T PEEK cage was performed after spinal canal reconstruction in both groups. In the first group (n=45), interbody fusion was augmented by 4-point transpedicular rod fixation (Konmet, Russia); in the second group (n=45), by Coflex-F rigid interspinous spacer. Patients were followed up and the results were assessed within 24 months after surgery. RESULTS: The intergroup comparison of pain level using the visual analogue scale, the need for analgesics, and quality of life according to Oswestry Disability Index score during the early postoperative period demonstrated significantly better outcomes in the second group of patients due to lesser operative trauma of the paravertebral soft tissue. Interbody fusion was observed within 20-36 months in 95% of group I patients and 94% of group II patients (p>0.05). Postoperative complications were observed in 17.8% of patients in group I and in 2.2% of cases in group II (p<0.001). CONCLUSION: Stabilization by rigid interspinous spacer and transforaminal interbody cage provides better clinical outcomes and fewer postoperative complications as compared to the conventional TLIF technique with similar X-ray rate of bone block formation in patients with moderate segmental instability of the lumbar spine, thus optimizing the treatment of such patients.
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Inestabilidad de la Articulación/cirugía , Región Lumbosacra/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Dolor , Fusión Vertebral/efectos adversos , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/instrumentación , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Dolor/etiología , Fusión Vertebral/instrumentación , Fusión Vertebral/métodosRESUMEN
AIM: To study the density of bone tissue and parameters of electroneuromyography (ENMG) in patients with osteochondrosis of lumbar spine. MATERIAL AND METHODS: Authors examined 67 patients, mean age 41 years, diagnosed with unilateral lumbar ischialgia syndrome. RESULTS AND CONCLUSION: The changes in the density of bone tissue (osteopenia and osteoporosis) and marked disturbances of neuromuscular apparatus function were found in 79% of the patients. This finding suggests the relationship between the ENMG and densitometry parameters.
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Extremidad Inferior/diagnóstico por imagen , Extremidad Inferior/fisiopatología , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/fisiopatología , Osteocondrosis de la Columna Vertebral/diagnóstico por imagen , Osteocondrosis de la Columna Vertebral/fisiopatología , Adulto , Densidad Ósea , Densitometría , Electromiografía , Femenino , Humanos , Región Lumbosacra/diagnóstico por imagen , Región Lumbosacra/fisiopatología , Masculino , Osteoporosis/diagnóstico por imagen , Osteoporosis/fisiopatología , RadiografíaRESUMEN
Laser-induced changes in the intervertebral discs were studied by the method of atomic force microscopy. Alteration of the proximal caudal intervertebral discs was modeled in rats: puncture and exposure to diode laser (2, 3, or 5 W) in constant or pulse regimens or only puncture (control). Nanostructure of disc surface was estimated by surface skewness, root mean square and average roughness, and coefficient of kurtosis. Maximum positive effect and signs of regenerative changes in the surface microstructure of the intervertebral discs were found after exposure to laser (2-3 W) in constant or pulse regimens.
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Disco Intervertebral/efectos de la radiación , Disco Intervertebral/ultraestructura , Rayos Láser , Cicatrización de Heridas/fisiología , Animales , Disco Intervertebral/lesiones , Microscopía de Fuerza Atómica , Ratas , Ratas Wistar , Cicatrización de Heridas/efectos de la radiaciónRESUMEN
The most serious life-threatening warfarin-associated complications is hemorrhage in CNS structures. Reports of spontaneous spinal epidural hematomas in patients using warfarin, methods of diagnostics and treatment are but few. We describe the first case of warfarin-associated spontaneous spinal epidural hematoma in this country and a literature review of this issue.
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Anticoagulantes/efectos adversos , Hematoma Epidural Craneal/inducido químicamente , Compresión de la Médula Espinal/etiología , Warfarina/efectos adversos , Hematoma Epidural Craneal/complicaciones , Hematoma Epidural Craneal/diagnóstico , Hematoma Epidural Craneal/cirugía , Humanos , Masculino , Persona de Mediana Edad , Compresión de la Médula Espinal/diagnóstico , Compresión de la Médula Espinal/cirugíaRESUMEN
UNLABELLED: Extramedullary spinal cord tumors (ESCTs) are relatively rare neoplasms requiring surgical treatment. This paper presents a study of outcomes in patients with ESCTs treated at Irkutsk region hospitals with different facilities. AIM: To identify factors affecting the outcome of surgical treatment of ESCTs. MATERIAL AND METHODS: The disease stage before surgery was evaluated according to the I.Ya. Razdol'skiy and McCormick classifications. Features and extension of the approach, the extent of blood loss, surgery duration, and the equipment used were analyzed. Treatment outcomes were assessed according to the MacNub and McCormick neurological outcome scales. RESULTS: ESCTs were removed totally in 84 (95%) patients and subtotally in 4 (5%). Tumor recurrence was detected in 8 patients. No deaths were observed. No correlation was found between the treatment outcome, according to the McCormick scale, and factors such as gender, tumor location, histological type, tumor grade, disease duration, and type of a surgical approach and the equipment used. Factors having medium and high correlations with the disease outcome are a neurological disease phase and an initial neurological deficit: sensory deficit, r=0.32; motor deficit, r=0.33; pelvic disturbances, r=0.35; McCormick grade before surgery, r=0.74; disease phase r=0.41 (p<0.05). CONCLUSION: The disease phase is the most significant factor affecting the outcome of surgical treatment in patients with ESCTs. Despite this, important aspects of surgical treatment of ESCT include the approach that is adequate to the tumor size and localization, as well as combination of different surgical techniques.
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Neoplasias de la Médula Espinal/mortalidad , Neoplasias de la Médula Espinal/cirugía , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Recurrencia Local de Neoplasia , Neoplasias de la Médula Espinal/patologíaRESUMEN
Intraoperative specimens of lumbar intervertebral disc (IVD) on the various stages of degeneration was studied by the method of atomic-force microscopy using hardware complex (probe nanolaboratory with video microscope Ntegra Prima). New nanostructural data, characterizing the staging of degenerative changes of IVD were revealed.
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Degeneración del Disco Intervertebral/patología , Disco Intervertebral/ultraestructura , Vértebras Lumbares/ultraestructura , Adulto , Femenino , Humanos , Degeneración del Disco Intervertebral/cirugía , Masculino , Microscopía de Fuerza Atómica , Persona de Mediana EdadRESUMEN
The aim of this study was to analyze treatment results of patients who underwent cervical fusion using plate cage PCB Evolution during 2 year period. 37 hybrid cages (titanium plate and PEEK cage) were implanted to 34 patients with degenerative disease of cervical spine. Assessment of results was performed by neurologic examination, neurovisualization data, visual analogue pain scale and Neck Disability Index. Mean duration of surgery was 92 min., blood loss - 42 ml, length of hospital stay - 8 days. Substantial decrease of frequency and intensity of neck and arm pain was observed after surgery in 91% of patients. Single asymptomatic complication occurred due to improper implant position owing to loosening of the upper screw. When properly performed, anterior cervical interbody fusion applying PCB Evolution plate cage is a simple and effective method with low complication rate.
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Vértebras Cervicales/cirugía , Degeneración del Disco Intervertebral/cirugía , Cetonas , Polietilenglicoles , Prótesis e Implantes , Compresión de la Médula Espinal/cirugía , Fusión Vertebral/métodos , Titanio , Adolescente , Adulto , Benzofenonas , Discectomía/métodos , Femenino , Humanos , Disco Intervertebral/cirugía , Degeneración del Disco Intervertebral/complicaciones , Degeneración del Disco Intervertebral/epidemiología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Polímeros , Diseño de Prótesis , Compresión de la Médula Espinal/complicaciones , Compresión de la Médula Espinal/epidemiología , Fusión Vertebral/efectos adversos , Fusión Vertebral/instrumentación , Fusión Vertebral/estadística & datos numéricos , Resultado del Tratamiento , Adulto JovenRESUMEN
Assessment of treatment results using standardized questionnaires became a routine for clinical studies in all European spinal centers and in a number of Russian clinics. Questionnaires and scales that are commonly used in spine surgery are systemized in the present paper as follows: SF-6, SF-12, ODI, RDQ, QBPDQ, BPFS, VAS, NRS, CPGQ, MPQ, WLQ, Macnab, Prolo, LBOS. Recommendations on the analysis of data obtained with the help of these scale are presented.
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Evaluación de la Discapacidad , Índice de Severidad de la Enfermedad , Enfermedades de la Columna Vertebral/diagnóstico , Encuestas y Cuestionarios/estadística & datos numéricos , Humanos , Umbral del Dolor , Calidad de Vida , Enfermedades de la Columna Vertebral/fisiopatología , Enfermedades de la Columna Vertebral/terapia , Resultado del TratamientoRESUMEN
In the paper we describe a rare case of intraventricular recurrence of melanoma metastasis treated by endoscope-assisted surgery. Total resection was performed using microsurgical approach with endoscopic assistance. Full regression of neurological deficit, physical rehabilitation and recurrence-free 6-month follow-up was achieved in this case.
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Neoplasias del Ventrículo Cerebral/cirugía , Endoscopía , Melanoma/cirugía , Microcirugia , Recurrencia Local de Neoplasia/cirugía , Procedimientos Neuroquirúrgicos , Anciano , Neoplasias del Ventrículo Cerebral/diagnóstico por imagen , Neoplasias del Ventrículo Cerebral/secundario , Femenino , Humanos , Estado de Ejecución de Karnofsky , Melanoma/diagnóstico por imagen , Melanoma/secundario , Microcirugia/instrumentación , Microcirugia/métodos , Recurrencia Local de Neoplasia/diagnóstico por imagen , Recurrencia Local de Neoplasia/secundario , Procedimientos Neuroquirúrgicos/instrumentación , Procedimientos Neuroquirúrgicos/métodos , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Application of endoscopy in spinal neurosurgery is one of modern trends of minimally invasive neurosurgery. The aim of this study was to perform comparative analysis of effectiveness in 3 surgical groups with different approaches to lumbar diskectomy applied: microsurgical, endoscopic and endoscopic-assisted. Patients' quality of life concerning ODI, severity of postoperative pain, length of incision, duration of surgery and hospital stay were assessed. We observed no significant differences in three groups according to postoperative ODI index and Macnub and Nurick outcome scales. Endoscopic diskectomy allowed to decrease postoperative pain by discharge, to minimize approach and improve cosmetic effect of surgery. Advantages and disadvantages of different methods are discussed in the paper.
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Endoscopía/métodos , Desplazamiento del Disco Intervertebral/cirugía , Vértebras Lumbares/cirugía , Microcirugia/métodos , Adulto , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Dolor Postoperatorio/etiologíaRESUMEN
Chordoma is a rare tumor from embryonic notochordial remains. It is predominantly located in the skull base and sacrum. It rarely occurs in the vertebrae. A rare case of chordoma of the lumbar vertebrae, diagnosed by fine needle aspiration, has been described.
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Cordoma/patología , Neoplasias de la Columna Vertebral/patología , Biopsia con Aguja Fina , Cordoma/metabolismo , Cordoma/cirugía , Diagnóstico Diferencial , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Columna Vertebral/metabolismo , Neoplasias de la Columna Vertebral/cirugíaRESUMEN
Comparative analysis of results of conservative treatment of pain syndrome after diskectomy was performed. Analyzed patients were divide into 2 groups (main and control). In the first group barotherapy was used along with the standard conservative treatment. Preliminary results of comparative analysis of 2 groups demonstrated significant advantages of this method. Excellent and good results dominated in the main group over control group with difference 8.9% (p = 0.046). Oxidative status of organism was studied to verify our results. We relied on changes in parameters of peroxide oxidation lipids--antioxidation system to indicate effectiveness of hyperbaric oxygenation. Calculation of quantitative index of inflammatory activity was suggested to predict results of surgical treatment. Finally, the authors made a conclusion that barotherapy combined with standard conservative treatment is effective and pathogenetically reasonable method for treating patients with recurrent radicular pain after microdiskectomy.
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Dolor de Espalda/terapia , Discectomía , Oxigenoterapia Hiperbárica , Desplazamiento del Disco Intervertebral/cirugía , Microcirugia , Dolor Postoperatorio/terapia , Adolescente , Adulto , Dolor de Espalda/tratamiento farmacológico , Dolor de Espalda/prevención & control , Terapia Combinada , Interpretación Estadística de Datos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/prevención & control , Recurrencia , Resultado del Tratamiento , Adulto JovenRESUMEN
Antarctic permafrost soils have not received as much geocryological and biological study as has been devoted to the ice sheet, though the permafrost is more stable and older and inhabited by more microbes. This makes these soils potentially more informative and a more significant microbial repository than ice sheets. Due to the stability of the subsurface physicochemical regime, Antarctic permafrost is not an extreme environment but a balanced natural one. Up to 10(4) viable cells/g, whose age presumably corresponds to the longevity of the permanently frozen state of the sediments, have been isolated from Antarctic permafrost. Along with the microbes, metabolic by-products are preserved. This presumed natural cryopreservation makes it possible to observe what may be the oldest microbial communities on Earth. Here, we describe the Antarctic permafrost habitat and biodiversity and provide a model for martian ecosystems.
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Biodiversidad , Exobiología , Microbiología del Suelo , Regiones Antárticas , Hielo , AguaRESUMEN
Degenerative diseases of the spine are one of the main social problems having important economical aspect since this pathology is mostly peculiar to people of young and middle age making the major part of able-bodied citizens. Diagnostics of lumbar vertebras displacement is one of the less studied problems of radiology. Instability - displacement of vertebras as one of the forms of dysfunction of motor segment becomes a cause of pain syndrome and following neurological disturbances.