Transpedicular Fixation Research Articles

Risk analysis and nursing countermeasures for spinal tumor patients during total en bloc spondylectomy and spine reconstruction

Objective To retrospectively summarize the risk factors in 6 spinal tumor patients during primary total en bloc spondylectomy (TES) , to give risk warning, and to propose nursing countermeasures. Methods Totally 6 spinal tumor patients received primary TES and transpedicular screw system fixation in the First Affiliated Hospital of Zhengzhou University between September 2014 and September 2016. In response to high risk factors such as spinal cord injury, massive hemorrhage, tumor cell planting and metastasis and infection as seen in the operation, nursing interventions included protecting spinal cord function, intraoperative blood pressure control, strict surgical isolation techniques, and soaking surgery field with distilled water and diluted povidone-iodine solution. Results The operation for the 6 patients were completed successfully, and all patients recovered well, without any complication such as iatrogenic spinal cord injury, important blood vessel injury or infection. It was found in the 12 to 36-month follow-up visits that the efficacy was satisfying, without local neoplasm recurrence. Conclusions Proper warning and nursing interventions against intraoperative risks make significant contributions to the smooth operation of spinal tumor patients during TES and reduce the incidence of complications effectively. Key words: Intraoperative nursing; Spinal neoplasm; Total en bloc spondylectomy; Risk warning; Nursing countermeasure

THERAPY FOR COMPLICATED DEGENERATIVE STENOSIS OF THE LUMBOSACRAL SPINE SEGMENT IN ELDERLY PATIENTS

The paper present a retrospective analysis of surgical treatment of 22 elderly patients aged 60 to 80 years who had complicated degenerative stenosis of lower thoracic and lumbar spine segments associated with neurological deficits ranging from mild peripheral manifestations to severe unilateral and bilateral paresis. The severity of degenerative spine lesions and compressive stenosis of spinal channel contents correlated with patients’ age and culminated in the maximal degenerative stenotic alterations, up to 5,5±0,9 cm, at the L3 to L5 level at the age of 76,5±1,4 years. Surgery performed to decompress the spinal channel and cauda equina roots and to stabilize the spine with Stryker and Fixpain transpedicular inner fixation and correction devices resulted in the regress of neurological deficits and restoration of lower limbs motor functions up to the capability of unassisted locomotion in old age.

COMPARISON OF SURGICAL INTERVENTIONS FOR DEGENERATIVE DEFORMITIES AND INSTABILITY OF THE SPINE AMONG ELDERLY PATIENTS

ABSTRACT Objective: To evaluate the surgical results among elderly patients with degenerative deformities and instability of the spine. Methods: A retrospective study of 437 patients (337 women, 100 men) with a mean age 60. The mean follow-up time was five years. The inclusion criteria were diseases and complications following spinal trauma associated with deformities, degenerative processes, acute pain syndrome, and spinal stenosis with neurological deficit. Four study groups (A, B, C and D) were created and defined by type of surgical intervention. Group A patients (the reference group) - decompression of neural structures on both sides without fixation. Group B - decompression and transpedicular fixation performed without correction of the deformity. Group C - patients operated up to the lower-thoracic region with transpedicular screws, correction of the deformity and decompression of spinal stenosis. Group D - transpedicular fixation up to higher-thoracic region; correction of the deformity and decompression of neurological structures. The mean follow-up time was five years. Results: Group D patients achieved the best outcome. The results observed were good in 57.2% of cases (60 patients); satisfactory in 40% of cases (42 patients); and unsatisfactory in 2.8% of cases (three patients). The worst findings were observed in Group A: satisfactory in 13.4% of cases (15 patients); and, unsatisfactory in 86.6% of cases (97 patients). No good results were observed in this group. Conclusion: The results suggest that performing full deformity correction with transpedicular fixation up to the higher-thoracic region gives the best outcomes for elderly patients, and helps to prevent long-term complications. Evidence level III; Retrospective Comparative Study.

Management of postoperative Complications after posterior lumber spinal fixation

Background: For increasing safety and reducing complications that may occur with Trans-Pedicular Scre Placement, different ways have been reported including application of C-arm X-ray view, application of axial computed tomography scan (CTS), frameless stereotactically guided screw placement and different guidance devices. However, the application of all these devices and techniques are not so easy and even in many operating rooms such kinds of instruments are not available. A posterior approach to anterior and middle column reconstruction is often preferred in the lumbar spine for two reasons, the first is that the morbidity associated with an anterior approach is significant and delays recovery, the second is that pedicle screws and rods or plates can be placed before dural retraction and dissection of the intervertebral disk. Aim of the Work: The aim of this work was to evaluate the postoperative Complications. In posterior lumber transpedicular fixation and their management. Patients and Methods: Retrospective and prospective study for evaluating the history, clinical state, laboratory investigations, radiological findings and way of management in 25 cases of postoperative Complications after posterior lumber spinal fixation. Results: 25 patients operated upon for posterior lumbar fixation were included in the present work, In the current work we divided complications of posterior lumbar fixation into intraoperative complications and postoperative complications, Among the 25 patients of our work we had 5 cases of intraoperative complications (20 %) and 20 cases of postoperative complications (80%), Dural tear was the most common intraoperative complications (8%), instrument failure was the most common postoperative complications 12 cases (48%). Conclusion: According to medical history smoking was statistically significant risk factor for intraoperative complications; significant epidural bleeding and dural tear. Hypertension was statistically significant risk factor for intraoperative complications; inappropriate screw insertion and fracture pedicle. Also, smoking was Statistically significant risk factor for development of postoperative complications; infection, C.S.F leak, infection, nerve root injury and pseudoarthrosis.

Functional spine analysis at surgical treatment of burst fractures of thoracic and lumbar spine

Burst fracture — is traumatic injury under the influence of high-energy axial compression which results multifragmentary vertebrae fracture with penetration of bone fragments into spine canal and paravertebral tissues.Objective: to analyze the magnitude of kyphotic deformity and indexes of sagittal spine balance after surgical treatment of burst fractures.Methods: retrospective study was made of 99 case histories. Criteria of inclusion were: incomplete burst (type А3.1) and incomplete split burst fracture (А3.2), complete burst fracture (type А3.3), vertebrae body with destruction (АВ) and rotation (АС). All patients were divided into 4 groups: I (17 patients) — transpedicular fixation with six screws; II (55) — posterior fixation with eight screws; III (22) — anterior-posterior combined spinal 360° fusion; IV (5) — tree column reconstruction from posterior approach.Results: fixation with six screws was used mostly in patients with type A3.1 fractures, it allowed us to correct kyphotic deformity in average 8.4º ± 6.5º and provide stable osteosynthesis. In patients of II group the magnitude of kyphotic deformity after trauma was 16.4º ± 6.9º, the average magnitude of its correction was 12.6º ± 7.0º. In the III group of patients this index was 18.3º ± 9.7º, and in the IV — 18.67º ± 2.08º.Conclusions: The choice of method of fixation depends on the morphology of injury. Totally surgical treatment of burst fractures can provide preservation of sagittal vertical axis. Usage of eight screws fixation and combined anterior and posterior spine 360° fusion is the most effective for deformity correction.

Analysis of the spinal canal dimensions and neurological symptoms dynamics in surgical treatment of burst fractures of the thoracic and lumbar spine

Objective. To estimate the spinal channel dimensions and neurological symptomes dynamics in surgical treatment of burst fractures of thoracic and lumbar spine.Materials and methods. There were studied 99 patients with traumatic injuries of the thoracic and lumbar spine. A retrospective study of disease history was conducted: clinical examination data, computed tomography, before and after treatment. There was performed the analysis of the patients with uncomplicated and complicated burst fractures of the thoracic and lumbar spine. They were surgically treated using the back short transpedicular fixation, posterior long transpedicular fixation with or without laminectomy, combined anterior-posterior spondylodesis at 360°, and three-column reconstruction of the spine through posterior approach.Results. The average volume of recovering of the lumen of the vertebral canal in the group of patients with short six-screw fixation is 8.8% and reaches its maximum after a year or more after complete rebuilding of bone tissue.In the group with eight-screw fixation, the overall average degree of narrowing (stenosis) of the spinal canal after the injury was 44.9%. After surgery, restoration of the lumen of the vertebral channel was 7.5%. Restoration of the lumen of the vertebral canal during the year and more amounted to 21.55%. The average degree of stenosis of the spinal canal in the group with anterior-posterior spondylodesis used before the operation was 63.5% of the norm, and in the group of patients, in which the method of three-column spine reconstruction through posterior approach was used the degree of the spinal canal narrowing reached 96%.Conclusion. In patients with complicated injuries as the complete violation of the conduction of the spinal cord or roots of the cauda equina of A type – the lower paraplegia immediately after injury, their neurological symptoms were the most severe and in the early postoperative period did not change. The patients with partial neurological symptoms of type B, C, D by the ASIA scale may have a favorable outcome in the case of surgical treatment. The patients with more severe neurological symptoms such as B, C have the most effective recovery within a year or more. Patients with type D neurological symptoms are the most effectively recovered in the first two weeks after surgery, and further gradual recovery occurs during the year.

Особенности хирургической тактики при лечении больных с поясничным дегенеративным спондилолистезом

Purpose Carry out a comparative study of the effectiveness of surgical treatment of patients with grade I degenerative spondylolisthesis treated with rigid transpedicular and dynamic interlaminar fixation. Material and methods Surgical treatment of patients with grade I degenerative spondylolisthesis at L4 vertebra was reviewed. The inclusion criteria were as follows, L4 spondylolisthesis measuring up to 5 mm; translation of ≤ 3 mm; L4-L5 segmental kyphosis of ≤ 17 degrees, local scoliosis of ≤ 10 degrees, absence of severe osteoporosis (T-score of > – 2.5). Decompression and dynamic stabilization of the spine was produced in group I (n = 24) with Coflex and Interfix implants. Group II included 20 patients who underwent transpedicular fixation and posterolateral spondylodesis. Standard and functional spondylography, MRI were performed for all the cases. Modified Pfirrmann grading system was used to assess intervertebral disk degeneration. L4 vertebral slippage and lumbar lordosis, intervertebral disc height, L4-L5 angle, translation at lumbar flexion/extension were measured. Results Oswestry Disability Index (ODI) score was insignificantly lower in the group of dynamic fixation. Pain intensity in the leg and the spine was comparable at follow-up. Adjacent segment syndrome was not common in group I and graded not more than Pfirrmann V. Both groups showed slight changes in lumbar lordosis. Advantages of dynamic interlaminar fixation included decrease in surgical trauma, blood loss and surgical time, and lower risk of complications avoiding overstress to adjacent level. Conclusion The use of interlaminar fixation for selective patients with grade I degenerative spondylolisthesis showed advantages over rigid transpedicular fixation. However, further research is needed for extended indications to the fixators to be used for this cohort of patients.

Evaluation of Transpedicular Surgical Decompression withLong Segment Stabilization in Thoracic and Thoracolumbar SpinalTuberculosis

Pott’s disease is a common cause of neurological complications and kyphotic deformity.When deformity progressed that may lead to painful costo-pelvic impingement, respiratory distress, risk of paralysis of muscle of lower limb and consequent reduction in quality andlongevity oflife. The treatmentstrategy is to avoid neurological complication and achieve a near normal spine. In tuberculosis, spinal column may become unstable. Pathological fracture or dislocation of a diseased vertebral body may occur due to mechanical insult. Surgical decompression causefurther instability.The insertion of a metallic implant is to provide stability. Pedicle screw fixation in kyphotic correction in old Pott’s disease is a most suitable device.This prospective interventionalstudywas conducted in BanglabandhuSheikh Mujib Medical University (BSMMU) for aperiod of 60 monthsfrom July 2011, with at leasttwo years follow-up period. Twentycases (13 males and 7 females) of thoracolumbar spinal tuberculosis with neurological deficit were operated with a transpedicular decompression and screw fixation along with anti-tubercular drug treatment. All of these patients had varying degrees of neurological deficit and single level involvement with vertebral body destruction and mild kyphosis of 9–28 degrees. Long segment pedicle screw fixation, posterior decompression, and correction of kyphosis were performed in single stage.The mean age of patients was 50.9 and kyphosis improved from 17.85±1.37 degrees to 10.85±2.66 degrees (p=0.0206).Neurological recovery occurred in 18 patients (90%). Bony fusion was achieved in 67.5% cases. At 2-years follow-up mean visual analogue score (VAS) score improved from 5.5 to 0.75 (p=0.0031).So, posterior decompression and transpedicular stabilization with continued chemotherapy is a good treatment option for the management of the thoracic and thoracolumbar TB in patients with vertebral body destruction and <30degree kyphosis.

The results of conservative treatment and short transpedicular fixation at burst fractures of thoracic and lumbar spine

Multifragmentary (burst) fracture can happen in case of spine trauma under the influence of high-energy axial compression with penetration of bone fragments into spine canal and paravertebral tissues.Objective: to analyze the results of treatment of patients with burst thoracic and lumbar spine fractures who were treated by conservative therapy and surgery with short transpedicular fixation.Methods: we made retrospective analysis of 23 patients with incomplete burst fractures type A3.1 and burst split fractures type 3.2 of thoracic and lumbar spine without neurological deficiency. Patients were divided into two groups: group A (conservative treatment) and group B (surgical treatment with short transpedicular fixation). We made assessment of pain, value of kyphotic deformity, compression degree, spine canal stenosis and index of sagital balance.Results: conservative treatment is indicated for patients with burst fractures type A3.1 without neurological symptoms, spine canal stenosis (up to 10 %) and posterior ligaments damage. Method of posterior fusion with short transpedicular fixation can be recommended for the treatment of incomplete burst fractures type A3.1 and A3.2 without neurological symptoms, with reserved pedicles and fragmentation of vertebrae up to 50 % of its square. Short six screws fixation can provide incomplete deformity correction (to 5 %), stable fixation with minimal loss of correction.Conclusions: conservative and surgical methods of treatment can provide satisfactory clinical results. But X-rays analysis showed advantages of surgical treatment.

The use of porous tantalum cages in the treatment of unremitting spondylodiscitis: a case report

Background: Unsuccessful medical treatment of pyogenic multifocal spondylodiscitis including signs of sepsis and unremitting pain is challenging. The aim of our report was to present a case of multilevel spondylodiscitis successfully treated by posterior lumbar interbody fusion using porous tantalum cages.Case presentation: A 59-year-old male was diagnosed with spondylodiscitis at T8-T9 level. Although treated with antibiotics, the patient again presented with worsening of systemic signs of infection and back pain. Contrast-enhanced magnetic resonance imaging studies revealed spondylodiscitis at L1 to S1 level. Posterior lumbar interbody bone fusion with tantalum cages from L1 to S1 was performed. The inflammation rapidly subsided. Computer tomography studies showed a stable construct at 24 months.Conclusion: Porous tantalum cages used in combination with transpedicular fixation seem to be a sound alternative to interbody devices made from other materials when treating spondylodiscitis cases without definite osseous destruction.

Reactivity and Resistance of Spinocerebral Structures during Instrumented Correction of Spinal Deformities

The aim of the present work was to perform an electroneuromyographic assessment of the reactivity and resistance of pyramidal structures of the spinal cord in response to intraoperative exposure to factors associated with the use of instrumented correction of spinal deformities of different etiologies and severities using submersible transpedicular fixation systems. Before treatment and at 4–31 (mean 9.6 ± 0.3) days after surgery, global and stimulated (M responses) electroneuromyography investigations were performed in 135 patients aged 8–50 (mean 16.4 ± 0.6) years (42 male and 93 female) with spinal deformities of different etiologies and severities. maximum intraoperative correction angles for deformities of the spinal column ranged from 3 to 95° (mean 37.2 ± 1.5°). The reactivity of spinal cord structures located at the apex of the base of main deformation arc was assessed in terms of an integral indicator – the index of sensorimotor deficit – (ISD). The lowest ISD values and the clearest post-operative negative trends in this indicator were seen in people with spinal deformities of neuromuscular etiology.

Anatomical differences in the bony structure of L5 and L4: A possible classification according to the lateral tilt of the pedicles

The aim of this study is to underline the necessity of a better knowledge of pedicles anatomy in order to improve surgical treatment of spine disorders such us low back pain, spinal fractures and scholiosis. A classification of pedicles lateral tilt which could help surgeons before the application of screws during transpedicular fixation is reported. Anatomical differences in the orientiation of the pedicles of L5 and L4 have been found. For each patient that met the inclusion criteria underwent: Radiography of the lumbo-sacral region, CT examination, MRI acquisition. Patients were divided into three categories thanks to 3D direct volume rendering of CT scan. Subjects belonged to W-Type, V-Type and U-type depending on their morphometric features. The subdivision was further implemented with measurements of the distance between pedicles and adjacent nervous structures. Concerning L5, W-Type (WT) exhibited a lateral tilt of L5 larger than 36°, V-Type exhibited a lateral tilt of L5 from 30° to 36°, U-type exhibited a lateral tilt of L5 smaller than 30°. Concerning L4, WT exhibited a lateral tilt of 28.4°, VT exhibited a lateral tilt of of 25.1, UT exhibited a lateral tilt of 22.2°; we assume that the degree of lateralization of L4 depends on the one of L5. The way the screw is applied during surgical treatment is clinically relevant, thus our classification may be very useful in order to decrease surgical risk and improve conditions of patients after surgical treatment.

MINIMALLY INVASIVE SURGERY FOR LUMBAR SPINE DEGENERATIVE DISORDER ASSOCIATED WITH IDIOPATHIC SCOLIOSIS

A case of minimally invasive surgical treatment of a patient with degenerative lumbar scoliosis is presented. Percutaneous multilevel transpedicular fixation with the deformity correction, decompression of spinal canal structures, and transforaminal interbody fusion at clinically relevant spinal levels were performed. Surgery provided restoration of sagittal balance, stable fixation, and steady regression of pain existed prior to surgery.

Spinal Tuberculosis among Yemeni Patients Admitted to Two Major Hospitals in Sana’a: A Neurosurgey Experience

Objective: To analyze the outcomes of neurosurgical treatment of dorsal spinal tuberculosis (TB) among Yemeni patients.
 Methods: Forty-three patients with histopathology-confirmed dorsal spinal TB, who had been admitted to Kuwait University Hospital of Sana’a University and the University of Science and Technology Hospital, Sana’a, were followed up for the outcomes of neurosurgical treatment in the period from Ott. 2009 to Oct. 2005. Data about the clinical presentation, radiologic findings and the outcomes of surgical treatment were recorded and analyzed.
 Results: Of patients undergoing neurosurgical treatment of dorsal spinal TB, 28 were males and 15 were females, with a mean age of 41.3 years (range: 18–70). Nearly a half of patients (50.6%) were farmers and 80% of patients were admitted to hospitals three months after the disease onset. All patients presented with back pain, while paraplegia/paraparesis and sensory impairment were reported in 81.4% and 87.4% of patients at presentation, respectively. Four patients (9.2 %) had cold abscesses and were treated by abscess drainage, while 90.8% of patients were treated by surgical decompression, debridement and posterior transpedicular fixation by screws and rods.
 Conclusions: The posterior approach for the treatment of spinal TB, with bilateral transpedicular access to anterior decompression together with posterior transpedicular fixation, has satisfactory outcomes regarding the clinical improvement and spinal stabilization among Yemeni patients.

Spinal Tuberculosis among Yemeni Patients Admitted to Two Major Hospitals in Sana’a: A Neurosurgey Experience

Objective: To analyze the outcomes of neurosurgical treatment of dorsal spinal tuberculosis (TB) among Yemeni patients.
 Methods: Forty-three patients with histopathology-confirmed dorsal spinal TB, who had been admitted to Kuwait University Hospital of Sana’a University and the University of Science and Technology Hospital, Sana’a, were followed up for the outcomes of neurosurgical treatment in the period from Ott. 2009 to Oct. 2005. Data about the clinical presentation, radiologic findings and the outcomes of surgical treatment were recorded and analyzed.
 Results: Of patients undergoing neurosurgical treatment of dorsal spinal TB, 28 were males and 15 were females, with a mean age of 41.3 years (range: 18–70). Nearly a half of patients (50.6%) were farmers and 80% of patients were admitted to hospitals three months after the disease onset. All patients presented with back pain, while paraplegia/paraparesis and sensory impairment were reported in 81.4% and 87.4% of patients at presentation, respectively. Four patients (9.2 %) had cold abscesses and were treated by abscess drainage, while 90.8% of patients were treated by surgical decompression, debridement and posterior transpedicular fixation by screws and rods.
 Conclusions: The posterior approach for the treatment of spinal TB, with bilateral transpedicular access to anterior decompression together with posterior transpedicular fixation, has satisfactory outcomes regarding the clinical improvement and spinal stabilization among Yemeni patients.

Sohag experience in treatment of Dorsolumbar fractures according to Thoracolumbar injury classification and severity score(TLICS)

Background:.The Thoracolumbar Injury Classification and Severity Score (TLICS) was developed to improve injury classification and guide surgical decision making, yet validation remains necessary. This study evaluates the functional ,clinical and radiological outcome of patients with thoracolumbar spine trauma (TLST) treated according to the TLICS. Aim of the work:To validate the efficacy of Thoracolumbar injury classification and severity score (TLICS) in orthopaedic emergency department at sohag university hospitals. Patients and methods:The TLICS was prospectively applied to a consecutive series of patients (30 cases) treated for TLST between October 2016 and October 2017. Patients with a TLICS score more than 4 points were surgically treated, whereas patients with a TLICS score of less than 4 points were conservatively managed.Those with a score of equal 4 ,group were managed conservatively and the other were operated.The primary outcome was the American Spinal Injury Association Impairment Scale (AIS)(1). Results:The decision taken according to TLICS either conservative if the final score 4. Conservative treatment in the form of rest and dorsolumbosacral brace .Operative in form of posterior fixation with or without decompression .Transpedicular fixation and decompression was needed in 10 cases (33.33%) because they were suffering from neurological insult.The mean age was 34years.There were a marked improvement in angle of kyphosis , vertebral height loss and Oswestry disability index .No patient had neurological worsening during the follow-up. Conclusion:.Thoracolumnar injury and severity score is valid and safe for management of thoracolumbar fractures and has good reliability.

Comparative Analysis of Changes in the Desmal and Chondral Structures of Spinal Motion Segment at Various Methods for Posterior Spine Fixation in Experiment

Purpose:to elaborate the criteria for the assessment of the degree of spinal motion segment degradation at various methods for posterior spine fixation in experiment.Material and methods. The study included mongrel dogs with body mass of 12±1.5 kg aged 21±3 months. Transpedicular lumbar spine fixation was performed with either rigid titanium alloy rods (1st group, n=5) or dynamic nitinol rods (2nd group, n=5). X-ray examination and morphologic study of the structural elements of spinal motion segment (SME) were performed to all animals in 3, 6, 12, 18 and 24 months after surgery.Results. Functional examination showed that in both groups the range of motion made up 18±1.2° preoperatively. In the 1st group of animals the range of motion in the operated SME made up 0±0.03°. In the second group the range of motion was preserved throughout the experiment and averaged 15±1.3° that made up 78.9% of the preoperative range. In both groups the disc height at the fixation level was constant throughout the experiment and made up 0,3±0.003 cm pre- and postoperatively. Obtained roentgenologic and morphologic data indicated that posterior dynamic spine fixation with nitinol rods ensured more balanced distribution of loads on the supportive elements of the construction and enabled prevent the development of the adjacent segments degeneration. Based on the study results the criteria for the assessment of the degree of the facet joints and discs degradation were formulated.

Loss of temperature and pain sensation as risk marker of neurological complications in surgical correction of severe spinal deformity

Background. Treatment of severe spinal deformity remains a challenging surgical problem, with an iatrogenic injury to the spinal cord being a critical complication. There is a high risk of neurological deficit following surgical correction of a severe spinal deformity.
 Aim. To determine the relationship between the extent of disturbed thermal and pain sensations at Th1-S2 dermatomas and the intensity of the spinal cord pathways’ responses to surgical correction of the severe spinal deformity.
 Material and methods. We reviewed 58 patients with severe spinal deformities of different etiologies (mean age, 15.7±0.8 years). All patients underwent surgical deformity correction followed by thoracic/thoracolumbar spine fixation by using a variety of internal transpedicular fixations. Intraoperative neurophysiological monitoring (IONM) with transcranial motor-evoked potentials (MEPs) was used during operative interventions. Preoperative and postoperative thermal and pain sensations were assessed in Th1-S2 dermatomas to the right and left by using an electrical aesthesiometer.
 Results. The extent of disturbed preoperative and postoperative thermal and pain sensations in Th1-S2 dermatomas before and after correction of spinal deformities correlated with the response type scale (I–V) of the spinal cord pathways to the surgical correction we offered. Correlation between the response type and characteristics of thermal and pain sensations was mostly revealed by the test results for the thermal pain threshold (thermal analgesia). The incidence of postoperative thermal analgesia increased monotonically from patients with response type I (persistent MEP form and amplitude-time parameters close to the baseline) to patients with response type V (higher risk of neurological complications). The overall rate of thermal analgesia increased after surgical correction of the spinal deformity relative to the baseline and was higher (≤8%) in patients with response type V.
 Conclusions. Surgeons and neurophysiologists who perform IONM should give careful attention to patients with severe spinal deformity who exhibit marked postoperative thermal analgesia.

Surgical correction of severe spinal deformities using a staged protocol of external and internal techniques.

There is high risk of neurologic complications in one-stage management of severe rigid spinal deformities in adolescents. Therefore, gradual spine stretching variants are applied. One of them is the use of external transpedicular fixation. Our aim was to retrospectively study the outcomes of gradual correction with an apparatus for external transpedicular fixation followed by internal fixation used for high-grade kyphoscoliosis in adolescents. Twenty five patients were reviewed (mean age, 15.1 ± 0.4years). Correction was performed in two stages: 1) gradual controlled correction with the apparatus for external transpedicular fixation; and 2) internal posterior transpedicular fixation. Rigid deformities in eight patients required discapophysectomy. Clinical and radiographic study of the outcomes was conducted immediately after treatment and at a mean long-term period of 3.8 ± 0.4years. Pain was evaluated using the visual analogue scale (VAS, 10 points). The Oswestry questionnaire (ODI scale) was used for functional assessment. Deformity correction with the external apparatus was 64.2 ± 4.6% in the main curve and 60.7 ± 3.7% in the compensatory one. It was 72.8 ± 4.1% and 66.2 ± 5.3% immediately after treatment and 70.8 ± 4.6% and 64.3 ± 4.2% at long term, respectively. Pain relieved by 33.2 ± 4.2% (p < 0.05) immediately after treatment and by 55.6 ± 2.8% (p < 0.05) at long term. ODI reduced by 30.2 ± 1.7% (p < 0.05) immediately after treatment and by 37.2 ± 1.6% (p < 0.05) at long term. The apparatus for external transpedicular fixation provides gradual controlled correction for high-grade kyphoscoliosis in adolescents. Transition to internal fixation preserves the correction achieved, and correction is maintained at long term.

Surgical treatment of multilevel lumbar vertebral canal stenosis using dynamic stabilization. Multicenter study

Purpose: to compare the results of surgical treatment of patients with multilevel lumbar vertebral canal stenosis. Patients and methods. Prospective randomized multicenter study included 71 patients aged 41 - 79 years. In the 1st group of patients (n=38) a standard wide decompression of the spinal canal, transpedicular fixation of one clinically and roentgenologically significant spinal motion segment using rigid stabilization and interbody fusion was performed. In the 2nd group (n=33) microdecompression of the spinal canal, transpedicular fixation of one clinically and roentgenologically significant segment using the rods of nitinol transpedicular device. The results were assessed by the pain VAS, ODI and SF-36 questionnaires, roentgenologic, CT and MRI data. Results. Mean follow up made up 1.5 years, the maximum one - 3.0 years. Significant pain relief and im- provement in the quality of life as compared with the preoperative level was reported for both groups. No sig- nificant difference between the groups was observed. Functional roentgenograms showed within 5° (4.2 - 6.5°) preservation of motion in the stabilized segment only in patients from the 2nd group. Adjacent segment pathology in 12 months after operation was diagnosed only in 1 patient from the 1st group. Conclusion. Preliminary results allow considering the dynamic transpedicular fixation using nitinol rods as an effective surgical technique for the treatment of degenerative lumbar spine pathology.