Degenerative-dystrophic Diseases Research Articles

Problems of total temporomandibular joint prosthesis in oncologic patients: literature review

The most common cause of total temporomandibular joint (TMJ) prosthesis is the terminal stage of degenerative dystrophic diseases. Patients with oncologic pathology usually undergo extended surgical interventions with TMJ exarticulation which in contrast to non-tumor pathology are characterized by resection of the whole ligamentous apparatus of the joint, the ramus of the mandible, and surrounding structures. Due to various causes, the use of traditional systems of open-type joint prosthesis (without fixation of the joint head in the glenoid fossa) frequently leads to loosening, luxation, and eventual dislocation of the joint head from the glenoid fossa. Currently, multiple different TMJ prosthetic systems have been proposed but only 2 are routinely used: TMJ Concepts (USA) and TMJ Biomet (USA). It should be noted that these systems are also open. We have studied the used constructions of total TMJ endoprostheses and haven’t found any that solve the problem of the condyloid component dislocation from the glenoid fossa after extended resections due to tumors of the TMJ. Moreover, analysis of the clinical outcomes after the use of such systems showed that even in cases of relatively limited resections of TMJ structures (11–30 %), joint prosthesis elements dislocation still occurs. Therefore, a promising solution for the problem of the joint head dislocation can be development of a closed total endoprosthesis with joint head fixation and preservation of joint mobility in all planes.

Aspects of the use of modern injection disease-modifying therapy in real clinical practice in patients with osteoarthritis and (or) back pain

The results of a study on the effectiveness of the injectable chondroprotector Ambene® Bio in the treatment of patients with degenerative-dystrophic diseases of the spine and pain in the lower back are presented. The program involved 30 patients diagnosed with osteoarthritis and/ or spondyloarthritis, facet syndrome, osteochondrosis in the acute stage (severe symptoms: pain according to VAS 40–90 mm). All patients were prescribed the chondroprotector Ambene® Bio in the regimen of 2 ml every other day No. 10.Results. During treatment with the injectable chondroprotector Ambene® Bio for 20 days, it was possible to significantly reduce the manifestations of the target nosologies, restore the ability to move and self-care, improve the psycho-emotional state of patients, while reducing the need for NSAIDs.Conclusions. A short course of therapy with Ambene® Bio contributed to the effective treatment of study participants due to the synergism of the unique composition of biologically active substances. The study demonstrated a high safety profile and good tolerability of the therapy.

Современные стратегии лечения дегенеративно-дистрофических заболеваний позвоночника: Обзор литературы

Currently, there is a wide range of methods for the treatment of herniated intervertebral disc, such as: conservative treatment, the use of epidural injections, therapeutic spinal blockades, methods of molecular therapy and genetic engineering, various methods of surgical treatment.The purpose of this review is to study the currently existing treatment methods for degenerative diseases of the spine, including their advantages and disadvantages.Level I studies have shown the advantages of surgical treatment methods. In the application of the surgical approach, there is currently a wide range of techniques (minimally invasive surgeries using endoscopy, interbody spondylodesis using various grafts and cages, including those using cellular technologies), which also complicates the task of choosing a particular treatment tactic. Surgical treatment options for intervertebral disc disease are controversial, with a medium- to low-quality evidence base supporting each modality: decompression, discectomy, spondylodesis formation, and interbody disc replacement. Surgical interventions carry certain risks and complications and should be offered after conservative measures have failed to improve the patient's quality of life. In general, the goal of all types of spinal surgeries for the pathology under study is to provide definitive treatment to the patient for long-term pain relief, reduce the incidence of complications and reoperations, and ensure good patient satisfaction. Recent advances in regenerative and reconstructive treatment strategies for degenerative-dystrophic spine diseases in molecular science in the areas of cell, gene therapy and intervertebral disc growth factor therapy are evolving in the hope of disc repair and regeneration, have some challenges but also show promising results. Surgery is the last option, with the choice of surgical treatment tactics being a matter of debate among physicians.Keywords: degenerative-dystrophic diseases of the spine, interbody fusion, cage, lumbar spine, treatment.

Immune privilege in the subretinal space and prospects of retinal pigment epithelium transplantation in degenerative diseases of the retina

Damage of the retinal pigment epithelium (RPE) underlies the pathogenesis of degenerative-dystrophic diseases of the retina, in particular, age-related macular degeneration (AMD) — one of the leading causes of irreversible loss of central vision, blindness and elderly population disability. Advanced AMD treatment options are limited to angiogenesis inhibitors in the wet form of the disease; there is no effective treatment for geographic atrophy, since RPE cells are unable to regenerate. The advances of biomedicine and the progress of vitreoretinal surgery gave rise to searching new high-technology methods of degenerative retinal disease treatment, aimed at restoring RPE. Replacement transplantation with induced pluripotent stem cells (iPSCs) specifically oriented at RPE seems to be the most promising approach for replacing damaged retinal elements and improving visual acuity, while, as some researchers believe, the fact that the eye is an immune-privileged organ ensures relatively safe conditions for subretinal administration of iPSC-RPE. The review systematizes the literature data on immune privilege in the posterior eye segment, as well as the results of studies in the field of subretinal stem cells transplantation. The conditions and possible mechanisms that trigger graft rejection, methods aimed at preventing tissue incompatibility reactions are also discussed.

Evaluation of fatigue life and osseointegration parameters of carbon-carbon composite material for medical applications

The aim of the present work is to study the strength characteristics Carbon fibre-reinforced Carbon (CFRC) material as an osteoimplant under its stepwise loading and to estimate the parameters of osseointegration at the bone-implant interface from the position of histological analysis and mathematical modeling. Fatigue life estimation of materials for implantation and endoprosthesis is based on the study of its "behavior" and determination of the degree of microstructure transformation under different types of cyclic loading using a system for the analysis of acoustic emission under loading. The key parameter in studying the strength of samples from carbon fiber reinforced composite materials under stepwise loading is the determination of the moment of transition of the controlled object into a pre-destructive state. We propose to use the ratio of degree in the equation defining the relationship between the number of acoustic emission events depending on the loading conditions as a key factor in studying the strength of samples made of CFRC under staged loading. When assessing the properties of implant materials, in addition to the study of strength parameters, an important aspect is the determination of the major biomedical characteristics, in particular, the study of bone tissue regeneration processes at the border of the implant-bone block. The osteoinductive activity of materials for plasty of bone tissue defects and endoprosthetics is one of the parameters of the success of reconstructive measures. In this regard, the use of modern methods of histological analysis and mathematical modeling of osseointegration processes of CFRC specimens will allow to predict the effectiveness of their application in clinical practice when replacing bone tissue defects of different localization and in therapy of patients with degenerative-dystrophic diseases requiring endoprosthesis.

Complex neuroimaging study of the proximal segment after rigid fixation and dynamic stabilization in patients with degenerative lumbar disease

Background. The development of the adjacent level syndrome and, as a consequence, adjacent segment degenerative disease are currently the most common complications of decompression and stabilization surgery with the development of segmental instability. The aim of the study. To conduct a comprehensive neuroimaging assessment of the proximal adjacent segment after rigid fixation and dynamic stabilization in degenerative lumbar disease. Materials and methods. We conducted a prospective multicenter study of the results of surgical treatment of 274 patients with degenerative-dystrophic diseases of the lumbar spine, who underwent monosegmental decompression and stabilization surgery using the TLIF (transforaminal lumbar interbody fusion) technique and open transpedicular rigid fixation, as well as open hemilaminectomy with stabilization of the operated segments with nitinol rods. The study included radiography, diffusion-weighted magnetic resonance imaging and computed tomography (dualenergy mode) of intervertebral discs and isolated facet degeneration of the upper adjacent level. Results and discussion. Combination of the initial proximal segment degeneration in the form of facet joints degeneration (density of cartilaginous plate – 163.5 ± 14.2 HU, density of external facet – 709.35 ± 13.6 HU, density of internal facet – 578.1 ± 12.1 HU), Pfirrmann III, IV grade degeneration of intervertebral disc and a measured diffusion coefficient of less than 1300 mm2/s cause high risks of developing adjacent segment degenerative disease, which regulates the use of monosegmental dynamic fixation with nitinol rods, or preventive rigid fixation of the adjacent segment. Conclusion. Using complex neuroimaging in the preoperative period makes it possible to predict the results of surgical treatment, take timely measures to prevent degenerative diseases of the adjacent segment, and to carry out dynamic monitoring of processes in the structures of the spinal motion segment.

Stenosing ligamentitis of the annular ligaments in hand figers (Nott’s disease): a modern approach to diagnosis and treatment

The morbidity structure related to degenerative-dystrophic diseases of connective tissue structures in the upper limb includes a distinct category known as stenoses of bone-firous canals. These conditions are polyetiological, meaning they result from various causes and involve the compression of anatomical elements within specifi canals due to a size mismatch between the canal and its contents. One of the most prevalent connective tissue diseases within this category is stenosing ligamentitis, which affects the annular ligaments of the figers.

Degenerative disc disease: pathophysiology, diagnosis, and classification

Degenerative-dystrophic disease (DDD) and its complications is the most common condition in spinal neurosurgery. It affects about 80 % of all people over 80 and is the most common cause of disability in the middle-aged population. The main symptoms include mechanical back pain, symptoms of radiculitis and limping, limited mobility, and poor quality of life. Determining the pathophysiology, causes of DDD pain, as well as diagnostic tools and expected changes is paramount to improve patient care and satisfaction. In this paper, we present an overview of DDD pathophysiology, classification, and diagnosis.

Anterior spinal fusion through a minimally invasive retroperitoneal approach in the treatment of patients with pseudoarthrosis after decompression and stabilization surgeries for degenerative-dystrophic diseases of the lumbar spine

Objective. To analyze the clinical efficacy of anterior fusion through a minimally invasive retroperitoneal approach in the treatment of patients with pseudoarthrosis after decompression and stabilization surgery for degenerative spinal stenosis.Material and Methods. Twenty six patients with previously performed decompression and stabilization surgeries for degenerative spinal canal stenosis underwent repeated surgical interventions using anterior/anterolateral fusion due to clinical and radiographic signs of pseudoarthrosis resistant to complex conservative therapy for at least 12 weeks. The outcomes of surgical treatment were analyzed based on the assessment of clinical and radiological characteristics before and after surgery.Results. At a follow-up examination 12 months after surgery, leg pain aggravated after exercise bothered 5 patients (19.2 %). According to CT data, 16 (61.5 %) patients had signs of the formation of grade 1 interbody bone block. In 2 (7.7 %) patients, instability of the fixation system developed and there were no signs of union, which required repeated surgical interventions.Conclusion. Anterior interbody fusion in the treatment of patients with pseudoarthrosis allows safe removal of the preinstalled interbody implant and creation of optimal conditions for the formation of interbody fusion. Despite clinical improvement, significant functional disorders persist in most patients.

A comparative study of human endogenous retrovirus <i>HERV-E λ 4-1</i> activation in autoimmune pathology

Considering the presence of immunomodulatory properties of human endogenous retroviruses, namely (i) the ability to activate the innate immune response by HERVs nucleic acids; (ii) the antigenicity of transcriptionally competent endogenous retroviruses envelope protein molecule, which causes polyclonal activation of lymphocytes; (iii) the absence of HERVs expression and protein production in the thymus during the immune tolerance formation, which allows us to consider these proteins as autoantigens or neoantigens, it seemed relevant to investigate the association of replication-competent human endogenous retrovirus HERV-E λ 4-1 with course of some of autoimmune diseases, such as multiple sclerosis, rheumatoid arthritis and systemic lupus erythematosus. The aim of this work was a comparative study of the human endogenous retrovirus HERV-E λ 4-1 activation frequency in blood mononuclear cells in multiple sclerosis, rheumatoid arthritis, systemic lupus erythematosus, as well as in chronic nervous system non-progressive diseases and the degenerative-dystrophic disease of the musculoskeletal system. The peripheral blood mononuclear cells were isolated by the venous blood centrifugation on Ficoll density gradient of 1.078 g/cm3. Expression of the HERV-E λ 4-1 envelope gene was detected by reverse transcriptase polymerase chain reaction. It was found that the HERV-E λ 4-1 envelope gene expression frequency in the chronic non-progressive diseases of nervous system, as well as in degenerative-dystrophic joint disease, is comparable to the expression frequency in conditionally healthy individuals. However, the HERV-E λ 4-1 envelope gene expression frequency in autoimmune diseases significantly exceeded that in conditionally healthy individuals and in non-inflammatory diseases. The maximum values of expression frequency were observed in active multiple sclerosis, significantly higher than in systemic lupus erythematosus and rheumatoid arthritis in the acute stage. Moreover, the expression frequency in the remission stage of multiple sclerosis was significantly lower than in the acute stage of the relapsing-remitted course, as well as in the progredient course. Estimation of HERV-E λ 4-1 envelope gene expression frequency at different severity levels of multiple sclerosis revealed its maximum rates at III and IV-V severity levels, both in relapsing-remitting and progressive course of multiple sclerosis. Thus, activation of the human endogenous retrovirus HERV-E λ 4-1 is associated with the course of autoimmune diseases, namely multiple sclerosis, rheumatoid arthritis, and systemic lupus erythematosus; it positively correlates with the activity and severity of multiple sclerosis.

New pharmaconutraceutical Chondroguard®TRIO for the prevention of musculoskeletal diseases and nutritional support for patients with osteoarthritis and nonspecific back pain: an assessment of clinical options. Resolution of the Multidisciplinary Expert Council

In recent decades, there has been an increase in the prevalence and medical and social burden of osteoarthritis (OA) and nonspecific back pain in all countries of the world. The First Multidisciplinary Bilateral Russia-Uzbekistan Expert Council presented innovations in the prognosing, personalized prevention and adjuvant therapy of degenerative-dystrophic diseases of the joints and spine, the evidence base for the effectiveness and safety of the use of drugs that modify the course of OA (Disease-modifying osteoarthritis drugs, DMOADs): chondroitin sulfate, glucosamine sulfate, undenatured type II collagen for adjuvant pharmaconutraceutical support – prevention and adjuvant therapy (treatment) of OA and nonspecific lumbosacral pain. The expert counsil resolution presents an optimized algorithm for the management, prevention and adjuvant therapy of OA and non-specific back pain, maintaining the function of healthy joints after intense physical activity with the inclusion of the drug Chondroguard solution for intra-articular and intramuscular administration (INN – chondroitin sulfate) and a new pharmaconutraceutical from the DMOADs group – TRIO trademark Chondroguard® (Chondroguard®TRIO).

Pharmaconutraceutical Chondroguard®TRIO – a new ideology for the prevention of musculoskeletal diseases and nutritional support for patients with osteoarthritis and nonspecific back pain: an assessment of clinical options. Resolution of the First Multidisciplinary Bilateral Russia – Uzbekistan Expert Council

On April 1, 2023, experts presented a resolution of the First Multidisciplinary Bilateral Russia–Uzbekistan Expert Council, dedicated to innovations in the prediction and personalized prevention of degenerative-dystrophic diseases of the joints and spine, and the possibilities of using the new pharmaconutraceutical Chondroguard®TRIO, the components of which (chondroitin sulfate, glucosamine sulfate, undenatured collagen type II – NK-II type) can be attributed to active compounds that modify the course of the disease (Disease-modifying osteoarthritis drugs, DMOADs) through structure-modifying and immune-mediated mechanisms of action. The evidence base for the efficacy and safety of the use of the main components of the new pharmaconutraceutical Chondroguard®TRIO (chondroitin sulfate, glucosamine sulfate, type NK-II) for the prevention and adjunctive therapy of osteoarthritis and nonspecific back pain is presented in the clinical recommendations of foreign specialized associations: Osteoarthritis Research Society International (OARSI), European Alliance of Associations for Rheumatology (EULAR), European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO), American College of Rheumatology (ACR), Russian Clinical Guidelines of the Russian Ministry of Health, as well as in numerous interventional and observational clinical studies.

Revision Reconstruction of the Cervical Spine in a Patient With Early Deep Surgical Site Infection Complicated by Angular Kyphosis: Case Report and Review

Background. Deep surgical site infection (DSSI) is one of the most severe complications in spinal surgery. The timing and nature of DSSI are the determining criteria in the choice of treatment tactics. The uniqueness of the clinical observation is the combination of early DSSI, epidural abscess and angular kyphotic deformity formed after a course of conservative antibacterial therapy in a patient who underwent surgery for degenerative-dystrophic disease of the cervical spine. Correction of angular kyphosis, removal of fractured vertebrae, interbody implants and three-column cervical reconstruction were performed in one surgical session.
 Case presentation. A 57-year-old patient was admitted to the clinic after staged surgical interventions on the cervical spine for multilevel degenerative stenosis of the spinal canal. The primary surgical interventions were complicated by DSSI in the early period after the second surgery with formation of angular kyphosis of the cervical spine. The patient underwent revision one-stage reconstructive intervention to correct the deformity, decompress the spinal canal, and three-column reconstruction of C3-7 segments. Long-term follow-up showed persistent reduction of pain syndrome, improved quality of life and absence of recurrence of DSSI.
 Conclusion. The presented case illustrates the possibilities of one-stage revision three-column cervical spine reconstruction for correction of sagittal profile, decompression of intracanal neural structures and ensuring stability of operated segments. Use of DSSI treatment algorithms based on Prinz V. and Vajkoczy P. classification contributes to the selection of the optimal tactics of patient management.

Experience of using Artro-Patch in the stage II knee osteoarthritis treatment and the need for prior aspiration of arthritic fluid

Considering the high frequency of degenerative-dystrophic diseases of the joints and the constant growth of morbidity, the improvement of treatment conservative approaches is an urgent task of modern medicine.
 Background: to evaluate the effectiveness of using Artro-Patch (3 % hyaluronic acid solution, 3 ml) in patients with stage II knee osteoarthritis and the need to perform preliminary aspiration of arthritic fluid before intraarticular injection.
 Materials and methods. 60 patients with stage II knee osteoarthritis who were treated with the use of Artro-Patch (3 % hyaluronic acid solution, 3 ml) were examined. The average age is 45.56 ± 8.61 years. The group includes 38 (63.33 %) women and 22 (36.67 %) men. Among them 2 groups were formed. Patients of group 1 (n = 30) received intra-articular injection of Artro-Patch. Patients of group 2 (n = 30) were injected with Artro-Patch with prior aspiration of arthritic synovial fluid. Clinical outcomes were assessed using the WOMAC questionnaire at admission, 30 days, and 90 days after the procedure. The StatSoft STATISTICA 13 program was used for statistical analysis. The probability of an error-free forecast was set at p < 0.05.
 Results. As a result of using Artro-Patch in patients with stage II knee osteoarthritis, it was possible to achieve a reliable improvement of all clinical indicators determined by the WOMAC questionnaire. It has been proven that performing a preliminary aspira-tion of arthritic fluid before intra-articular injection of Artro-Patch leads to the development of a more stable and better clinical result at 30 days, with subsequent positive dynamics up to 90 days of observation.
 Conclusions. Thus, the high effectiveness of using Artro-Patch drug in the treatment of stage II knee osteoarthritis has been proven. To achieve a stable and better clinical result, it is recommended to perform a preliminary aspiration of arthritic fluid before intra-articular injection of the drug.

Influence of comorbid diseases in the elderly on the efficiency complex conservative of pain in efficacy of treatment of back pain in the elderly with comorbidities

The aim of the study: to determine the structure of dorsalgia and comorbid diseases and the possibilities of rehabilitation in elderly patients with degenerative-dystrophic diseases of the spine (DDSD). The results of observation of 120 elderly patients who received sanatorium treatment in the Urgench sanatorium during 2020-21, aged 60-74 years, were analyzed, including 71 women, 49 men. All patients underwent a neurological examination, X-ray, CT or MRI of the spine, to identify comorbid diseases - ECG, ultrasound of internal organs, consultations with a general practitioner, urologist or gynecologist. According to the literature data and the results obtained, when selecting elderly patients with dorsalgia for treatment, it is necessary to take into account the “red flags” and refer such patients to specialized specialists. In addition, other comorbid diseases are identified in the elderly, which may limit the treatment of drug and physiotherapy (rehabilitation) therapy, which must be considered. Finally, in the elderly, it is necessary to take into account the so-called “yellow flags” - cognitive and depressive manifestations that affect the subjective sensation of pain.

Factors of local conversion of iodothyronines correlate with indicators of hormonal, biochemical, and hematological profiles in patients with spinal canal and dural sac stenosis of the lumbar spine

In order to find out the mechanisms of pathogenesis of degenerative-dystrophic diseases of the spine, it is of particular interest to search for body parameters which are directly or indirectly interrelated with the key factors of peripheral conversion of nidus iodothyronines and constitute a system of network interactions, affecting metabolic indicators at the local and systemic level.The aim. To search for correlations of local key factors of peripheral conversion of Ligamentum flavum iodothyronines with indicators of biochemical, hematological and hormonal blood profiles of patients with stenosing processes of the spinal canal and dural sac in the lumbar spine.Materials and methods. 33 patients (15 males, 18 females) with stenosing processes of the spinal canal and dural sac in the lumbar spine were examined (mean age – 45.73 ± 1.95 years). The expression of deiodinase genes and other candidate genes was determined in Ligamentum flavum biopsies collected during surgical treatment. Biochemical, hematological and hormonal parameters were determined in peripheral blood. The resulting data array was processed in order to find correlations between the parameters of systemic and local metabolism.Results. The relationships of deiodinases with the expression of GDF5, MMP1, MMP3 and TIMP1 in Ligamentum flavum (p < 0.05) were found. Of the hormonal profile of the blood serum, the most significant indicators were thyreotropin, free triiodothyronine and thyroperoxidase antibodies. In the biochemical profile, levels of direct bilirubin, total cholesterol, HDL and LDL cholesterol and triglycerides changed along with the expression of deiodinases. Correlative relationships with the expression of deiodinases were found for the following hematological analytes of whole peripheral blood: hemoglobin, mean corpuscular hemoglobin concentration, numbers of granulocytes, lymphocytes, eosinophils, monocytes, band neutrophils, red cell distribution width and platelet crit. The data obtained indicate the involvement of peripheral conversion factors in the pathogenetic process and provide information to form a new view on the pathogenesis of degenerative-dystrophic processes in the Ligamentum flavum of patients with stenosing processes of the spinal canal and the dural sac in the lumbar spine.

Changes in the immunological reactivity in patients with coxarthrosis and the factors that determine them

Background. The participation of immune responses in the pathogenesis of degenerative-dystrophic diseases of the synovial joints determines the feasibility of using more rational approaches to assessing the immune status of patients with this pathology. Despite the ongoing immunological studies in patients with degenerative-dystrophic diseases of the hip joint, there are questions related to the functioning of the immune system as a whole, which require additional research.The aim of the study was to establish the features of the relationship between the indicators of the immune status and to identify the factors that determine the nature and severity of immunological disorders in patients with coxarthrosis.Material and methods. The study is based on the results of immunological parameters in 73 patients (mean age – 45.3 ± 2.56 years) with stage III dysplastic coxarthrosis. The data obtained using cluster analysis made it possible to distribute patients into two groups. The first clinical group included 46 patients, the second one – 27 patients. The control group consisted of 28 clinically healthy individuals. Mathematical processing of the results was carried out using the Statistica 6.0 software package (StatSoft Inc., USA) and the mathematical package Mathcad 2001 Pro (MathSoft Inc., USA).Results. The levels of CD4+ and CD8+ cells and IgA were determined as the classification features that make the greatest contribution to the division of the studied groups. Model experiments have shown that a specific combination of the magnitude of each of the noted factors with a certain degree of probability makes it possible to assess the state of the initial immunological reactivity and verify the nature and severity of immunological disorders.Conclusion. The information obtained is of great importance, since it allows predicting the course of the recovery period after surgery and assessing the risk of developing possible postoperative complications in patients with severe articular pathology.

Evaluation of radiological indices of the spine and pelvis ratios in children with a severe form of slipped capital femoral epiphysis

BACKGROUND: Slipped capital femoral epiphysis is one of the most severe diseases of the hip joint in children and is characterized by the displacement of the proximal femoral epiphysis, occurring as a result of a decrease in the mechanical strength of its growth plate. Some pathological processes in the hip joints and lumbosacral spine cause changes in the position (vergence) of the pelvis in the sagittal plane and the development of degenerative dystrophic diseases. The analysis of the spinepelvis relationships in children with slipped capital femoral epiphysis may provide the basis for the development of new approaches to the surgical correction of the deformity of the hip component of the affected joint.
 AIM: To assess the radiological parameters of the frontal and sagittal spinepelvis relations in children with proximal femur deformity in slipped capital femoral epiphysis.
 MATERIALS AND METHODS: The study included 30 patients (30 hips) aged 1114 years with a severe form of slipped capital femoral epiphysis characterized by the presence of a posterior displacement of the epiphysis of 60 combined with the downward displacement of no more than 10 in one of the joints and absence of displacement (pre-slip stage) in the other. Patients underwent clinical and radiological examinations. The radiographs taken in the standing position were used to assess the values of thoracic kyphosis and lumbar lordosis, pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), sagittal vertical axis (SVA), and spinesacral angle (SSA). The obtained data were subjected to statistical processing.
 RESULTS: The patients had pelvic retroversion (decreased values of the PI and SS indices and increased PT index) and formed hypolordotic type of vertical posture according to P. Roussouly classification. In addition, thoracic hyperkyphosis occurred, and the SVA shifted to the front, which can be considered a mechanism of trunk balance compensation for the existing pelvic retroversion and reduction of lumbar lordosis to maintain the ability to move in an upright position.
 CONCLUSIONS: Children with this severe form of slipped capital femoral epiphysis are characterized by pelvic retroversion, decreased lumbar lordosis and increased thoracic kyphosis, positive trunk imbalance, and PT toward the affected limb. Planning and reconstructive restorative interventions on the affected hip joint should consider existing pathological changes to restore the correct spinepelvis relationships and prevent degenerative dystrophic processes in the lumbosacral spine.

Translational methods for the treatment of chronic back pain

Background. Up to 83 % of the working population has a high level of social adaptation disorder due to the pain in the lumbosacral spine. The development of translational approaches in the treatment of degenerative diseases of the spine is becoming increasingly important. The key methods in the differentiated approach to the treatment are laser vaporization of the intervertebral disc and radiofrequency denervation of the facet joints in the case when the pain syndrome is facet-like.Objective. To evaluate the effectiveness of a differentiated approach in the use of minimally invasive surgical methods in patients with discogenic and vertebrogenic pain syndrome based on an analysis of the immediate results of treatment.Design and methods. A retrospective analysis of examination and treatment data of 101 patients with degenerative-dystrophic diseases of the lumbar spine, accompanied by pain, was carried out. In 29 (28.7 %) patients, laser vaporization of the intervertebral disc was performed; in 72 (71.3 %) cases, radiofrequency denervation of the facet joints of the lumbosacral spine was used.Results. Positive outcomes after laser vaporization were observed in 27 patients. A positive result was noted in 67 patients after radiofrequency destruction of the sinuvertebral nerve.Conclusions. Differentiated use of minimally invasive puncture methods for the treatment of osteochondrosis of the spine and adequate selection of patients for these procedures often lead to the positive result.

Comprehensive analysis of the results of surgical treatment of patients with degenerative diseases of the lumbar spine using rigid fixation systems

Introduction. According to the literature, the development of adjacent-level syndrome 10 years after posterior rigid stabilization is noted in 6.7–80 % of patients, of which 24 % require revision surgery.The aim: to conduct a comprehensive analysis of the results of surgical treatment of patients with degenerative diseases of the lumbar spine using rigid fixation systems.Materials and methods. A multicenter retrospective study of the results of surgical treatment of 268 patients with degenerative-dystrophic diseases of the lumbar spine, who underwent mono- or bisegmental decompression-stabilizing intervention with the implementation of the TLIF (Transforaminal Lumbar Interbody Fusion) technique and open transpedicular rigid fixation, was conducted. The study included radiography, MRI and CT (in 2-energy mode) of intervertebral discs and isolated facet degeneration of the upper adjacent level.Results and discussion. The combination of the initial degeneration of the adjacent spinal motion segment in the form of disc degeneration of grade III and higher according to Pfirrmann with threshold values of the density of the outer cartilaginous plate from 161.7 ± 18.8 to 164.8 ± 14.2 HU, the density of the outer facet – from 702.43 ± 12.3 to 713.65 ± 13.6 HU and the density of the inner facet – from 580.5 ± 11.6 to 582.1 ± 15.1 HU, as well as with signs of segmental instability of the adjacent segment can be considered as risk factors for the development of its degeneration. With the progression of degeneration of the upper intervertebral disc, revision interventions were performed within 12–60 months after surgery.Conclusion. Bisegmental stabilization with signs of initial degeneration in the intervertebral disc and facet joints in the upper segment has proven its clinical and instrumental effectiveness in the period of 36 months and reduces the risks of developing degenerative disease of the adjacent disc.