The study objective is to study the causes of repeated surgical treatment in patients of an older age group with degenerative pathology of the lumbar spine.Materials and methods. A retrospective analysis of the treatment of 962 patients who underwent surgical treatment of degenerative pathology on the basis of the FCN of Novosibirsk from 2013 to 2017. A total of 360 men, 602 women; average age 66 years. 624 (64.9 %) patients underwent decompression, 338 patients (35.1 %) underwent stabilizing intervention in combination with decompression. The study group consisted of 98 (10.2 %) patients who underwent repeated operations taking into account the inclusion and exclusion criteria. On average, the period after the previous intervention is 17 months (from 1 day to 6 year). 68 patients (69.4 %) previously underwent decompression interventions, 30 (30.6 %) rigid stabilization. The indication for revision treatment was the presence of pain and (or) neurological deficiency, resistant to treatment for at least 6 weeks. Evaluation criteria are described, and the structure of complications is analyzed. The minimum follow-up period after repeated surgery was 1 year, the maximum 6 years.Results. Iatrogenic factors were detected in 39 patients (39.8 %). Progression of degenerative pathology in 59 (60.2 %) patients. More often, repeated intervention was performed at the level of L4–L5 (36.1 %), the cranial adjacent segment was 76.5 %, and the caudal segment was 23.5 %. The minimum period of manifestation of continued degeneration is 3 months. The development of the disease of the adjacent segment after fixation is higher in the period of 3–4 years (p = 0.015). Patients with repeated surgical treatment after decompression for continued degeneration had a higher BMI of 32.3 (p = 0.12), as well as patients with damage to the adjacent segment 32.5 (p = 0.10), compared with the group of primary patients (BMI 30.6 on average). The similar dependance is registered for patients after stabilization: BMI of patients with repeated interventions is 34.5 that is higher than BMI of primary interventions group (on average 33.2, р = 0.13).Conclusions. The main reason for repeated interventions in patients of an older age group is the progression of degenerative pathology on the segments on the segment operated as as well as the adjacent segments (60.2 % repeated interventions, 46.9 % at the adjacent level including).Repeated surgical treatment of patients of an older age group in the early period (for up to 1 year) is most often due to insufficiently effective primary surgical intervention with prevailing early recurrence of disk herniation (1.6 % patients of total number of primarily operated). In the long term (more than 3 years), the reason for repeated surgical treatment is due to the development of an adjacent segment disease where the number of operations of patients with primarily made rigid fixation is increasing progressively in the course of time.High BMI is a predictor of the development of instability of the vertebral motor segment and continued degeneration of the operated one as well as the adjacent level in the long follow-up time.

Objective. To evaluate the outcomes of the differentiated surgical treatment in patients with aggressive vertebral hemangiomas. Material and Methods. The study included 127 patients with aggressive vertebral hemangiomas operated on in 2013-2016. The tumor localization was cervical in 9.5% of cases, thoracic in 59.8 % and lumbar in 30.7 %. Patients were divided into two groups: Group I (n = 110) with type IIIA aggressive hemangiomas, and Group II (n = 17) with type IIIB aggressive hemangiomas. Preoperative assessment included clinical and neurological examination, VAS, ODI, JOA, Weinstein-Boriani-Biagini classification, and radiography; MSCT and MRI studies of the spine were performed before treatment and in 12 months after surgery. Results. Patients in Group I underwent puncture vertebroplasty. Back pain was 6 VAS, after 12 months-2 VAS. The average preoperative ODI score was 32 and decreased to 9 in 12 months after surgery. In Group II, patients underwent decompression and stabilization with intraoperative open vertebroplasty of the affected vertebra. Preoperative embolization of tumor vessels was performed in two of 17 patients to reduce intraoperative blood loss. Preoperative back pain was 6 VAS, in 12 months after surgery-2 VAS. The ODI score showed the improvement in all patients as compared to preoperative values. Conclusion. Puncture vertebroplasty ensures the achievement of good functional result in 95.4 % of cases of type IIIA aggressive hemangioma. Decompression and stabilization surgery with intraoperative open vertebroplasty provides good functional result in 93.4 % of cases of type IIIB aggressive hemangioma. The use of vertebroplasty in type IIIB aggressive hemangiomas allows for vertebral segment stabilization with a low risk of the tumor recurrence.

Comparative analysis of treatment results in patients with disс herniation of different age groups

Objective. To analyze the influence of somatic comorbidity on the results of surgical treatment of elderly and senile patients with degenerative lumbar spinal stenosis.Material and Methods. The study design corresponds to a single-center non-randomized retrospective cohort study with level 3 evidence (OCEBM Levels of Evidence Working Group. The Oxford 2011 Levels of Evidence). The influence of somatic comorbidity on quality of life after surgery for degenerative lumbar spinal stenosis was analyzed in 962 patients 60–85 years old. Analysis and evaluation of the results of the study was carried out in two groups of patients with radicular compression syndrome: Group 1 (less than 5 points according to White – Panjabi criteria) included 625 (65%) patients, and Group 2 (5 or more points according to White – Panjabi criteria) – 337 (35%) patients.Results. Body mass index of patients in Group 1 was statistically significantly lower than in Group 2. Repeated surgical interventions performed during the first year after the primary operation were statistically significantly more frequent in Group 1, and those performed after 3–4 years were more frequent in Group 2 (BMI ≥ 30) due to the development of adjacent level disease. In obese patients, the duration of surgery, blood loss and postoperative hospital stay are statistically significantly increased. One year after surgery, a statistically significant negative effect of increase in BMI on the parameters of back pain, lower limb pain, functional adaptation, and quality of life was revealed in both groups of patients. No association of obesity and complication rates was noted. In Group 2, the incidence of adjacent level disease 2–5 years after the primary operation was higher in patients with BMI ≥ 30 compared with patients with BMI < 30 and with patients in Group 1. It was found that somatic comorbidity and the age of patients statistically significantly prolonged postoperative hospital stay in Group 1 and did not affect its duration in Group 2. No effect of the comorbidity index on the quality of life was noted. Osteoporosis was statistically significantly associated with an increase in the frequency of technical complications during surgery (malposition of pedicle screws, cage migration, and damage to the vertebral endplates).Conclusion. Obesity is statistically significantly associated with an increase in postoperative hospital stay, surgery duration and blood loss, and is a predictor of the development of instability of the spinal motion segment and adjacent level disease. Obese patients have higher levels of back and lower limb pain and worse quality of life parameters after surgical interventions than patients with normal body weight. When using minimally invasive technologies in the surgical treatment of degenerative lumbar spine pathology, the number of complications in obese patients is not higher than in patients with normal body weight. The effect of comorbidity on the results of minimally invasive surgery for degenerative lumbar pathology was not detected. Osteoporosis affects the frequency of technical complications during surgery.