The study objective is to analyze the effectiveness of the use of minimal invasive polyetheretherketone (PEEK) rod systems in the treatment of lumbar spine degenerative diseases.Materials and methods. The minimal invasive semi-rigid stabilization using PEEK rod systems was performed in 24 patients (4 (17 %) male and 20 (83 %) female) patients (mean age 46.3 ± 8.4, ranging from 32 to 63). The average follow-up duration was 15 months. Inclusion criteria: mechanical low back pain, White–Panjabi instability: 5 points, degenerative changes of the disc by C. Pfirrmann scale: II–IV grade. Follow-up at the 6 and 12 months postoperatively.Results. In the postoperative period, the majority of patients had a complete or significant regression of pain (on average, from 6.3 to 1.8 points on the visual analog scale). The Oswestry disability index decreased from 64/66 [64; 68] to 33/34 [32; 36] in 6 months (p <0.001) and 18/17 [16; 18] in 12 months (p <0.001). Before surgery, the height of the operated disk was 0.96 cm, after 1 year decreased to 0.91 cm. Range of rotary motion in the operated segment in all cases did not exceed 6°.Conclusion. The PEEK rod fixation in patients with mechanical low back pain provides good and excellent clinical results on the I. Macnab scale in 83.4 % of cases. Within 12 months, the minimal volume of movements on the operated segment remains, without signs of continued degeneration of adjacent intervertebral discs.

Results of randomized prospective study with participation of 94 patients aged from 20 to 70 years with monosegmental lumbar spine lesions are presented. Minimum invasive surgical interventions were performed in 55 patients from the main group. Control group consisted of 39 patients in whom decompressive-stabilizing operations via conventional posteromedian approach with skeletization of posterior segments of vertebral column were performed. Average size of operative wound in open interventions more than 10 times exceeded that size in minimum invasive interventions and made up 484 ± 56 and 36 ± 12 sq.cm, respectively. Mean blood loss was 326.6 ± 278.0 ml in the main group and 855.1 ± 512.0 ml in the comparative one. In the main group no one patient required substitution hemotransfusion, while in 13 patients from the comparative group donor erythrocytic mass and/or fresh-frozen plasma were used to eliminate the deficit of blood components. Intensity of pain syndrome in the zone of surgical intervention by visual analog scale in the main group was lower than in comparative group. In the main and comparative groups the duration of hospitalization made up 6.1 ± 2.7 and 9.7 ± 3.7 bed days, respectively. In no one patient from the main group complications in the zone of operative wound were noted. Three patients from the comparative group required secondary debridement and in 1 patient early deep operative wound suppuration was observed. Application of low invasive surgical techniques for the treatment of patients with degenerative lumbar spine lesions enabled to perform radical surgical treatment with minimal iatrogenic injury. The method possessed indubitable advantages over the conventional open operations especially intraoperatively and in early postoperative period.

Сколиоз взрослых диагностирует-ся у пациентов со зрелым скелетом при деформации во фронтальной плоскости более 10° по Cobb [2,23] и встречается в популяции, по данным различных источников, в 1,4-68,0 % [21,22]. Традиционно данная патоло-гия лечилась консервативно, посколь-ку возраст пациентов, наличие сопут-ствующей соматической патологии, предполагаемая кровопотеря и трав-матичность оперативного вмешатель-ства по коррекции и стабилизации деформации накладывали значитель-ные ограничения, таких пациентов включали в группу высокого риска.При этом вызывал сомнение тот факт, что сниженная минеральная плот-ность костной ткани у пациентов этой возрастной группы может выдер-жать напряжение системы после про-ведения корригирующего маневра. Большое число осложнений у паци-ентов старше 65 лет [12] не добавля-Minimally invasive surgical treatment for adult degenerative lumbar scoliosis A.V. Krutko, P. Durny, A.I. Vasilyev, A.V. Bulatov Objective. To assess the efficacy of decompression, correction, and stabilization of the lumbar spine deformity using minimally invasive techniques in patients with degenerative lumbar scoliosis. Material and Methods. A retrospective controlled two-center study included 62 patients who underwent surgery for clinical manifestations of degenerative scoliosis of the lumbar spinal canal. Results. Average Oswestry index before surgery was 69.69 %, after surgery it decreased to 33.00 % and ranged between 14 and 50 %. Average magnitude of the lumbar lordosis after surgery was 39.2°; average rate of deformity correction -56.53 %; average magnitude of deformity reduced to 13.46° ± 6.08°. Two-fold reduction of the apical vertebra rotation was observed. Conclusion. The use of the principles of minimally invasive surgery allows to expand the indications for surgical treatment of degenerative spinal deformities and the scope of intervention, and to reduce intraoperative blood loss. Key Words: degenerative scoliosis, minimally invasive surgery.Hir. Pozvonoc. 2014; (3):49-56.Цель исследования. Оценка эффективности декомпрес-сии, коррекции и стабилизации деформации пояснично-го отдела позвоночника у пациентов с дегенеративным поясничным сколиозом с применением минимально-ин-вазивных технологий. Материал и методы. В ретроспективное контролируе-мое двуцентровое исследование включены 62 пациента, прооперированные по поводу клинических проявлений дегенеративного сколиоза поясничного отдела позво-ночного канала. Результаты. Перед операцией индекс Освестри в среднем составлял 69,69 %, после операции снизился до 33,00 % и варьировал от 14 до 50 %. Средняя величи-на поясничного лордоза у больных после операции со-ставила 39,2°; средняя величина коррекции деформации -56,53 %; средняя величина деформации уменьшилась до 13,46° ± 6,08°. Отмечено уменьшение ротации вершин-ного позвонка в два раза. Заключение. Использование принципов минимально-инвазивной хирургии позволяет расширить показания к оперативному лечению дегенеративных деформаций позвоночника, объем самого вмешательства, уменьшить интраоперационную кровопо...

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Objective To explore the effect of surgical reconstruction of the local sagittal balance on the outcomes and quality of life in elderly with degenerative low-grade spondylolisthesis. Design: a retrospective non-randomized single center cohort study. Material and methods This article reviewed 110 elderly patients (91 (82.7 %) females and 19 (17.3 %) males) with degenerative spondylolisthesis who underwent surgical treatment at the Federal State Medical Center, Novosibirsk. The mean age was 66 years (range, 60 to 83 years). Radiography, spiral computed tomography, MRI of the lumbar spine were performed for all patients who were also asked to use the visual analog scale and the Oswestry disability index (ODI). Sagittal spino-pelvic radiographic parameters including PI, SS, PT, LL, SL (Segmental Lordosis), LL4–S1 (Lordosis L4–S1) were measured and related to age. Global lumbar lordosis measurements were made using the formula: LL = 0.54 × PI + 27.6°. Comorbidity assessment was produced with the body mass index (BMI) and the Charlson Comorbidity Index (CCI). Patients were subdivided into three groups according to the severity of the sagittal imbalance as described by Barrey: (1) balanced, (2) balanced with compensatory mechanisms and (3) imbalanced, and their outcomes evaluated. Results Increased body weight was observed in 97.3 % of patients. The mean BMI was 33.7. A comorbid condition was detected in all patients (n = 110). The mean CCI was 57.4 %. The mean PI was 57.4°. Most of patients (n = 95, 86.4 %) had significant segmental imbalance due to the loss of segmental lordosis at the lower lumbar motion segments. Pelvic retroversion was identified as the compensatory mechanism in the pelvis area in 95 % of patients with measurements of PT based on the available PI. A statistically significant increase in LL4-S1 was observed in the groups due to reduction of spondylolisthesis and restoration of the segmental lordosis. A statistically significant increase in LL was observed in the imbalanced group only. No statistically significant differences in ODI scores were observed in TLIF and ALIF/LLIF patients. Complications graded in the Clavien-Dindo classification were identified in 65 (59 %) cases with greater complication rate in TLIF patients (n = 59, 69 %), as compared to ALIF/LLIF (n = 6, 24 %). From them, 5 (0.5 %) were graded IIIB. Conclusion Differentiated use of surgical technologies and MIS is the method of choice for elderly patients with comorbidities. Patients with compensated sagittal balance can benefit from direct spinal canal decompression, reduction and stabilization of degenerative spondylolisthesis using the posterior approach. Treatment of patients with impaired spino-pelvic balance should be aimed at reduction and restoration of the segmental lordosis (SL) using lordotic cages to ensure good clinical and radiological results.