Доклад клинических случаев на съезде Ассоциации Хирургов-Вертебрологов, Москва, 2016

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Впечатления о RASS 2016 в Москве и Поленовских чтениях в Петербурге

VII съезд RASS

В минувшие выходные прошел ежегодный съезд ассоциации хирургов-вертебрологов (RASS). Съезд проходил в Москве и собрал большое количество специалистов в данной области со всей страны. Сама конференция была посвящена проблемам осложнений в хирургии позвоночника. Тематический подход привел к тому, что были проведены доклады как на популярный темы: нестабильность имплантов, нарушение послеоперационного баланса, инфекции, неврологический дефицит и прочее, так и на встречающиеся реже: легочные осложнения, нарушение зрения после операции. Не смотря на то, что российские конференции по научной составляющей намного проигрывают международным, посещать их довольно интересно. Дело в том, что среди повторяющихся докладов и тем могут пробегать интересные замечания, о которых обычно не задумываешься, но которые могут сильно пригодится в дальнейшем. Я бы назвал это расширением кругозора. В дополнение общение с другими специалистами, позволяет смотреть на некоторые проблемы с другого ракурса.

Preoperative Embolization vs. Local Hemostatic Agents in Spinal Surgery of Hypervascular Metastases

Abstract

Background: 
Currently there is no consensus about how reduce the intraoperative risk of hemorrhage in spinal decompression surgery of hypervascular metastases (HVM) such as renal cell carcinoma, multiple mieloma.
Purpose: 
Compare the effectiveness of using different methods reduce blood loss.
Material and Methods: 
A retrospective study of 58 patients (median age 57 years) operated at our institute between 2001 and 2013. There were 37 male and 21 female patients with extradural HVM (39 with renal cell carcinoma, 19 with multiple mieloma). The metastatic lesions were located in the thoracic spine (n = 45; 77.6%), the lumbar spine (n = 13; 22.4%). We decided to evaluate possible parameters in a surgically homogeneous group of patients with spinal cord compression.
In first group included 30 consecutive patients who underwent preoperative spinal angiography and tumor embolization. The second group consisted of 28 consecutive patients, which were treated surgically with intraoperative using local hemostatic agents (gelatin-thrombin matrix). Each patient underwent a palliative decompression and MISS stabilization with using a posterior approach as the primary surgery for spinal metastasis. The parameters evaluated were the blood loss volume, hemoglobin level, complications. The effectiveness of methods reduce blood loss was analyzed using nonparametric statistical tests.
Results and Discussion: 
In the first group median intraoperative blood loss was 1175 mL (range, 400-1700 mL), preoperative median hemoglobin level was 13.65 g/dL compared with postoperative (on first postoperative day) 10.78 g/dL. One patient developed irreversible neurologic deficits following embolization. Although preoperative embolization is a relatively safe procedure, there remains a risk of cord ischemia.
In the second group median intraoperative blood loss was 1557 mL (range, 600-4000 mL), preoperative median hemoglobin level was 13.32 g/dL compared with postoperative 10.04 g/dL. Between groups, there was no significant difference (P>0.05).
Conclusions: 
We did not get evidence that embolization better than using local hemostatic agents for patients with HVM who underwent palliative decompression and MISS stabilization.

Abstract #104

EFORT 2015 oral presentation by Grigoriev P.

European Federation of National Associations of Orthopaedics and Traumatology (EFORT) Congress 2015

Video - Implant Failure, Proximal Junctional Disorders And HRQOL After Short Fusion For Global Spinal Alignments Correction In Adults And Elderly

Introduction: In the adult and/or elderly patients, degenerative scoliosis has become an increasing problem.

Objectives: The purpose of our research is studying of incidence of implant instability, proximal fractures of instrumented and adjacent vertebras and evaluation of health-related quality of life (HRQOL) parameters depending on extent of the sagittal balance correction after short fusion using a posterior approach.

Methods: A study of 83 patients with Type L (SRS-Schwab) deformity, operated in our institute was held in the period between 2008 and 2011. Patients were divided into two groups. The first retrospective group included 43 patients who underwent short fusion of lumbar curve from T12 or L1 to L5. The second prospective group consisted of 40 patients, which were treated using short fusion from T9 to S1 extending to the pelvis. Groups were evaluated with HRQOL-scales including VAS, ODI, SF36 and SRS-24. Radiographical assessment included Cobb coronal angle, thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS), sagittal vertical axis (SVA). Radiographical, HRQOL-parameters and complications with a 3-year minimum follow-up were analyzed and compared between two groups. The comparisons were done by using independent sample Student t-test. A p-value of less than 0.05 was accepted as significant.

Results: In the first group the ideal sagittal balance was not achieved. The second group showed a better restoration of global spinal alignments compared with the first one (p<0.05). The HRQOL-scores (VAS, ODI, SF36, SRS-24) of the patients after 3 years are slightly higher in the second group, but we did not get significant difference between groups (p>0.05). In the first group the number of complications in the form of implant instability (n=15, 35%) consists of loosening of screws at the end of fusion (T12/L1 or L4/5). The second group was obtained by a higher number of patients with complications (n=25, 63%) including loosening of screws at pelvis (n=15, 37.5%), proximal fractures of upper instrumented vertebra (n=7, 17.5%) and upper adjacent vertebra (n=8, 20%). Incidence of implant instability and proximal fractures in the second group was statistically more frequent (p<0.05).

Conclusions: The research showed that short fusion extending to the pelvis provided good sagittal balance, global spinal alignments and likely HRQOL-parameters after 3 years follow-up. But, eventually, we obtained higher number of complications.