scholarly journals Facet Fixation Combined with Lumbar Interbody Fusion: Comparative Analysis of Clinical Experience and A New Method of Surgical Treatment of Patients with Lumbar Degenerative Diseases

2016 ◽  
Vol 71 (5) ◽  
pp. 375-384 ◽  
Author(s):  
V. A. Byvaltsev ◽  
A. A. Kalinin ◽  
A. K. Okoneshnikova ◽  
T. T. Kerimbaev ◽  
E. G. Belykh
Keyword(s):  
Comparative Analysis ◽  
Lumbar Spine ◽  
Postoperative Complications ◽  
Clinical Efficacy ◽  
Interbody Fusion ◽  
Channel Structure ◽  
New Method ◽  
Surgical Trauma ◽  
Degenerative Diseases

Background: For the treatment of patients with degenerative diseases of the lumbar spine the technique of pedicle fixation is widespread, when after open decompression channel structure locking screws are introduced into the vertebral body through the back vertebra legs. We first used a fundamentally new way of fixing the rear using the facet-boards Cage «Facet Wedge», when posterior fixation is done by closing the facet joints with minimally invasive, percutaneous method. We have not found data on the clinical efficacy of facet fixation in scientific literature.Aims: To compare the clinical efficacy of facet fixation combined with interbody fusion in the treatment of patients with degenerative lumbar spine disease.Materials and methods: The study included 145 patients who were divided into 2 groups. The study group with long-term observation included patients (n=100) who underwent a new method for lumbar fixation; the method comprises unilateral or bilateral implantation of titanium Cage «facet Wedge» in the joint space facet joint in combination with the anterior, lateral, and transforaminal interbody fusion. Clinical comparison group (n=45) included retrospectively recruited patients who were performed titanium pedicle screw installation after open decompression and interbody fusion posterior lumbar fixation. Dynamic observation and comprehensive evaluation of the treatment clinical results was carried out for 18 months after surgery.Results: Cage facet installation technology is quite simple, universal for the stabilization of the rear of the complex after interbody fusion from the front, side, and rear access; and does not require the intraoperative application of expensive high-tech equipment. Comparative analysis of the main group showed significantly better results in terms of the duration of the operation [CG 125 (90; 140) min, the CCG 205 (160; 220) min; p=0.01], the volume of blood loss [CG 80 (70; 120) ml, CCG 350 (300; 550) ml; p=0.008], activation time [CG 2 (1; 2) days, 4 CCG (3; 5) days; p=0.02], length of hospitalization [CG 9 (10; 11) days, the CCG 13 (12; 15) days; p=0.03], the level of pain on a visual analog scale [CG 3 (2; 4) mm, CCG 15 (12; 18) mm; p=0.001], quality of life (by index Oswestry) [CG 8 (6; 8) points, the CCG 23 (20; 28) points, p=0.003], and labor rehabilitation [CG 3 (2; 6) months, CCG 9 (6; 12) months; p=0.0001]. The number of postoperative complications in group 1 was 13%, in the 2nd ― 31,1% (p=0,0012). The new method involves fixing the back with considerably less surgical trauma of paravertebral soft tissue that results in early activation of patients, reduction of stay in hospital period, and better functional recovery of patients.Conclusions: The application of facet fixation combined with interbody fusion in the treatment of patients with degenerative diseases of the lumbar spine allows achieving the best clinical outcomes and fewer postoperative complications during the short and long-term follow-up if compared with the traditional method of transpedicular stabilization. The combination of low-impact and reliability facet fixation techniques for posterior stabilization of the operated segment creates favorable conditions for the restoration of a functional condition of patients, full social and physical rehabilitation.

scholarly journals Interrelation of tropism and angulation parameters of facet joints and results of stabilization surgeries for degenerative diseases of the lumbar spine

2018 ◽  
Vol 15 (4) ◽  
pp. 70-79
Author(s):  
V. A. Byvaltsev ◽  
A. K. Okoneshnikova ◽  
A. A. Kalinin ◽  
S. S. Rabinovich
Keyword(s):  
Surgical Treatment ◽  
Lumbar Spine ◽  
Clinical Outcomes ◽  
Interbody Fusion ◽  
Degenerative Diseases ◽  
Facet Joints ◽  
Group Iii ◽  
Group I ◽  
Transpedicular Stabilization

Objective. To clarify indications for dynamic and rigid stabilization based on the analysis of correlation between neuroimaging parameters of facet joints (FJ) and clinical outcomes of surgical treatment of patients with degenerative diseases of the lumbar spine. Material and Methods. A total of 141 patients with degenerative diseases of the lumbar spine were surgically treated. Patients were divided into three groups: patients of Group I (n = 48) underwent surgical intervention with artificial intervertebral disc prosthesis; those of Group II (n = 42) – with interbody fusion and combined transpedicular and transfacetal stabilization; and those of Group III (n = 51) – with interbody fusion and bilateral transpedicular stabilization. The correlation between long-term clinical outcomes (pain syndrome according to VAS, functional state according to ODI, and satisfaction with surgical result according to MacNab scale) and preoperative neuroimaging parameters of FJ (degenerative changes according to Fujiwara, facet angle magnitudes, and the presence of tropism) was analyzed. Results. A direct significant nonparametric correlation of neuroimaging parameters of facet angles and FJ tropism with long-term clinical outcomes of surgical treatment according to VAS and ODI was revealed. It was established that good clinical outcomes were achieved with the following preoperative parameters: in Group I, the facet angle was less than 60°, while the presence of tropism had no correlation dependence; in Group II, the facet angle – more than 60°, in the absence of FJ tropism; and in Group III, the facet angle – more than 60°, in the presence of FJ tropism. Conclusion. Objective neuroimaging parameters of the facet angle magnitude of less than 60°, regardless of the presence of tropism, allow performing total arthroplasty. If the facet angle is more than 60°, the rigid stabilization of the operated segment is indicated; in the absence of tropism, a contralateral transfacetal fixation is possible, and in its presence – a bilateral transpedicular stabilization is reasonable.

scholarly journals Comparison of the safety and efficacy of the new method of en-bloc and conventional monopolar transurethral resection in the management of primary non-muscle-invasive bladder cancer

2019 ◽  
Vol 15 (3) ◽  
pp. 102-112
Author(s):  
S. A. Krasny ◽  
I. L. Masanskiy
Keyword(s):  
Bladder Cancer ◽  
Postoperative Complications ◽  
New Method ◽  
Invasive Bladder Cancer ◽  
Muscle Invasive Bladder Cancer ◽  
En Bloc ◽  
Safety And Efficacy ◽  
Group A ◽  
Muscle Invasive

Objective: to comparе the safety and efficacy of the new method of en-bloc transurethral resection (TUR) and conventional TUR in management of primary non-muscle-invasive bladder cancer, and investigate long-term effects on tumour recurrence and progression.Materials and methods. A total of 914 patients with primary non-muscle-invasive bladder cancer were treated using TUR of bladder at the Minsk City Clinical Oncologic Dispensary in 2005 to 2016. For final analysis the data was underwent many-stage random sampling. Randomization was stratified according to sex and age, category T, tumour grade, EORTC risk groups. In total, 273 patients were selected: 136 in the new method of en-bloc TUR group (a study group) and 137 in the conventional TUR group (a control group). The new method of en-bloc TUR is based on using impulses of high-frequency current applied to the active electrode of the resectoscope. The impulse sequence and individual impulse duration within the interval from 0.1 to 1 second are controlled in the course of the operation. Five-year follow-up data of operative management were analyzed.Results. In event of the new method of en-bloc TUR there were no perioperative complications and no cases of conversion to conventional TUR. Postoperative complications were less frequently observed in the new method group compared with conventional TUR group. There were significant differences with major priority to the new method of en-bloc TUR in median time to recurrence (р = 0.032) and progression (р = 0.001), 5-year survival to recurrence (р = 0.0001) and progression (р = 0.001), 5-year cancer-specific survival (р = 0.033) and overall survival (р = 0.045) of patients.Conclusion. The new method of en-bloc TUR of non-muscle-invasive bladder cancer was more effective than conventional TUR in reducing rates of intraand postoperative complications, and at the same time was applicable in all clinical cases, regardless of the tumor location in the bladder lumen, its size, vascularization, and growth pattern. The new method of en-bloc TUR also significantly improved the long-term cancer treatment results in patients with primary non-muscle-invasive bladder cancer.

scholarly journals Laparoscopic Adrenalectomy: Preventive Principles in Intra- and Postoperative Complications

2021 ◽  
Vol 11 (4) ◽  
pp. 284-287
Author(s):  
S. P. Muzhikov ◽  
M. Iu. Eremenko ◽  
A. G. Baryshev
Keyword(s):  
Postoperative Complications ◽  
Laparoscopic Adrenalectomy ◽  
Length Of Hospital Stay ◽  
Operation Technique ◽  
Surgical Trauma ◽  
Satisfactory Condition ◽  
Post Surgery ◽  
Long Term Prognosis ◽  
Definition Of

Background. Laparoscopic adrenalectomy is the current surgery of choice in most adrenal tumours, with a nearly 11 % complication rate and below 1 % mortality. Laparoscopy combines the advantages of minimally invasive surgery with well-known long-term prognosis of a traditional open surgery, at the same time requiring the surgeon’s skill of knowing the technique and avoiding complication.Aim. Concept definition of safe laparoscopic adrenalectomy.Materials and methods. A total of 28 patients with adrenal neoplasms were rendered laparoscopic adrenalectomy by same surgical team under benchmark recommendations during 2016–2019.Results. All patients have been discharged in satisfactory condition, with no intra-, postoperative complications or lethal outcomes.Discussion. Th e evidence presented displays feasibility of using the benchmark principles in laparoscopic adrenalectomy surgery. Laparoscopic adrenalectomy is superior in reducing the recovery time, surgical trauma, complication incidence, length of hospital stay, treatment cost, the improvement of overall wellbeing post-surgery and patients’ quality of life. Th ese principles proved effective to avoid intra- and postoperative complications of laparoscopic adrenalectomy and facilitated revamping of the operation technique in left -sided adrenalectomy.Conclusion. Th e benchmark principles of laparoscopic adrenalectomy enable the procedure higher efficacy and safety and require further implementation and long-term assessment of the outcome.

scholarly journals Comparison of Results and Cost-Effectiveness of Minimally Invasive and Open Transforaminal Lumbar Interbody Fusion: A Meta-Analysis of Prospective Cohort Studies

2019 ◽  
Vol 74 (2) ◽  
pp. 125-135 ◽  
Author(s):  
Vadim A. Byvaltsev ◽  
Andrey A. Kalinin ◽  
Valeriy V. Shepelev
Keyword(s):  
Lumbar Spine ◽  
Minimally Invasive ◽  
Prospective Cohort ◽  
Interbody Fusion ◽  
Surgical Intervention ◽  
Meta Analysis ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Degenerative Diseases ◽  
Prospective Cohort Studies

Backgraund: Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is becoming the most popular treatment method in modern vertebrology. But at the same time, limited working space, significant intraoperative radiation exposure and high risks of developing perioperative complications associated with a long learning curve are constraints for the widespread use of this technology by most spinal surgeons. Aims: to conduct a meta-analysis based on the results of prospective cohort clinical studies that compare the results of the application of minimally invasive and open transforaminal interbody spinal fusion techniques in treating patients with degenerative lumbar diseases. Materials and methods: A search for randomized clinical trials was conducted in the Pubmed, EMBASE, eLibrary and Cochrane Library databases published from January 2008 to December 2018, which compared the results of minimally invasive (MIS-TLIF) and open (Open-TLIF) techniques transforaminal interbody fusion in treating patients with degenerative diseases of the lumbar spine. For dichotomous variables, the relative risk and 95% confidence interval were calculated; in turn, standardized difference of mean values and their 95% confidence intervals were used for continuous variables, using the random effects model. Results: The meta-analysis included 21 prospective cohort studies, three of which were randomized controlled clinical trials. The results of the surgical treatment of 1762 patients with degenerative diseases of the lumbar spine were evaluated in total. In the MIS-TLIF group, reliably smaller parameters of the duration of surgical intervention (p0.00001), the volume of intraoperative blood loss (p0.00001), the timing of postoperative inpatient treatment (p0.00001), the economic costs of treatment (p0.00001) and the number of perioperative adverse effects (p=0.006). At the same time, the duration of intraoperative fluoroscopy is registered significantly less in the Open-TLIF group (p0.00001). Conclusions: The MIS-TLIF method in comparison with the Open-TLIF method has significantly lower objective indicators characterizing the invasiveness of the surgical intervention, as well as the development of undesirable consequences, the associated shorter duration of hospitalization and financial costs for treating patients with degenerative diseases of the lumbar spine. At the same time, significantly more time of intraoperative irradiation was confirmed, due to the technical features of performing transcutaneous closed manipulations in the absence of direct visualization of the operated segment in the MIS-TLIF group.

Bilateral Ventriculocordectomy via Ventral Laryngotomy for Idiopathic Laryngeal Paralysis in 88 Dogs

2012 ◽  
Vol 48 (4) ◽  
pp. 234-244 ◽  
Author(s):  
Cynthia Zikes ◽  
Timothy McCarthy
Keyword(s):  
Postoperative Complications ◽  
Surgical Trauma ◽  
Short Term ◽  
Laryngeal Paralysis ◽  
Long Term Follow Up ◽  
Short And Long Term ◽  
Low Incidence ◽  
Results Of Surgery

Bilateral ventriculocordectomy through a ventral median laryngotomy was performed for the treatment of idiopathic laryngeal paralysis in 88 dogs. The purpose of this retrospective analysis was to provide long-term follow-up for a large number of dogs surgically managed with this technique. A combination of medical record and completed client questionnaire information provided short-term (14 days) follow-up for 88 dogs and long-term (>6 mo) follow-up for 42 dogs. Major short-term postoperative complications were identified in 3 of 88 (3.4%) patients. Major long-term complications were identified in 3 of 42 (7.1%) patients. The results of surgery were considered to be very satisfactory in 93% and unsatisfactory in 7%. Three dogs in this series developed aspiration pneumonia. Bilateral ventriculocordectomy through a ventral median laryngotomy is associated with a low incidence of both short- and long-term complications. Due to the ease of this procedure, the minimal surgical trauma to the patient, and the satisfactory results, this surgery should be considered an option for the treatment of idiopathic laryngeal paralysis in the dog.

Results of surgical treatment of degenerative diseases of the lumbar spine using dynamic interspinous stabilization in the long-term period

2018 ◽  
Vol 16 (10) ◽  
pp. 92-96
Author(s):  
T. A. Bikmullin ◽  
◽  
N. A. Kartashov ◽  
E. M. Khaliullin ◽  
◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Lumbar Spine ◽  
Degenerative Diseases

Long-term outcome of open surgery in CVI patients concerning postoperative complications, perioperative hemodynamics and clinical efficacy, Part I

2019 ◽  
Vol 70 (4) ◽  
pp. 399-411
Author(s):  
Misbah Shireen Ahmed ◽  
Stine Lutze ◽  
Movsar Tembulatow ◽  
Georg Daeschlein ◽  
Michael Jünger ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Clinical Efficacy ◽  
Open Surgery ◽  
Term Outcome ◽  
Long Term Outcome
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