MULTICENTER ANALYSIS OF SURGICAL TREATMENT EFFECTIVENESS FOR PATIENTS WITH SYMPTOMATIC TANDEM STENOSIS OF THE CERVICAL AND LUMBAR SPINE BASED ON DIFFERENTIATED CLINICAL-INSTRUMENTAL ALGORITHM

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Abstract

Purpose of the study — to perform a multicenter analysis of the surgical treatment effectiveness for patients with symptomatic tandem stenosis of cervical and lumbar spine based on a differentiated clinical-instrumental algorithm.

Material and methods. The study included 97 patients with symptomatic tandem stenosis of cervical and lumbar spine who were divided into two groups. The main group (perspective study) included 46 patients who underwent staged decompression and stabilizing manipulations according to the surgical treatment tactics developed by authors based on differentiated clinical-instrumental algorithm. Patients were operated in three neurosurgical departments of clinics in Irkutsk, Vladivostok and Novosibirsk (Russian Federation). Control group included 51 patients enrolled retrospectively. Depending on prevailing clinical signs the first decompressive and stabilizing surgical procedure were performed on cervical spine (29 cases) or on lumbar spine (21 cases). The authors made a comparative analysis of clinical and instrumental data prior to procedure and 24 months postoperatively. Median follow up in group I was 26 months (24; 30), in group II — 40 (34; 50).

The authors used the following scales to assess the outcomes: VAS scale for pain severity; Neck Disability Index (NDI) and Oswestry Disability Index (ODI) for life quality; Macnab scale for patients’ subjective satisfaction with treatment outcomes; Nurick scale for objective dynamics of neurological status; Bridwell scale for spondylolistesis rate of operated level; Pfirmann scale for rate of degenerative changes in adjacent intervertebral disc.

Results. Application of the surgical tactics suggested by authors for treatment of patients with symptomatic tandem stenosis of the cervical and lumbar spine allowed to start active rehabilitation at an earlier stage in prospective group of patients which fairly positively influenced late clinical and functional outcomes. Postoperative complications rate in cervical and lumbar spine in group I amounted to 15% and in group II — to 68% (p = 0.0014).

Conclusion. A differentiated and individual application of standard surgical techniques for staged procedure allowed to perform efficient decompression depending on location of pathomorphological substrate and to stabilize operated segments with lower incidence of pseudarthrosis and epidural fibrosis.

About the authors

V. A. Byvaltsev

Irkutsk State Medical University;
Railway Clinical Hospital on the station Irkutsk-Passazhirskiy of Russian Railways Ltd.;
Irkutsk Scientific Center of Surgery and Traumatology;
Irkutsk State Academy of Postgraduate Education

Author for correspondence.
Email: byval75vadim@yandex.ru

Dr. Sci. (Med.), the Head of the Center for Neurosurgery 

OJSC Russian Railways, Head of the Course of Neurosurgery

Head of Scientific and Clinical Department of Neurosurgery

Professor of Department of Traumatology, Orthopedics and Neurosurgery

1, ul. Krasnogo Vosstaniya, 664003, Irkutsk

10, ul. Botkina, 664005, Irkutsk

1, ul. Bortcov Revolutsii, 664003, Irkutsk

100, mikroraion Jubileinyi, 664049, Irkutsk

Russian Federation

A. A. Kalinin

Irkutsk State Medical University;
Railway Clinical Hospital on the station Irkutsk-Passazhirskiy of Russian Railways Ltd.;
Irkutsk Scientific Center of Surgery and Traumatology

Email: fake@neicon.ru

Cand. Sci. (Med.), Assistant Professor

Neurosurgeon of the Center For Neurosurgery 

1, ul. Krasnogo Vosstaniya, 664003, Irkutsk

10, ul. Botkina, 664005, Irkutsk

1, ul. Bortcov Revolutsii, 664003, Irkutsk

Russian Federation

V. V. Shepelev

1477 Naval Clinical Hospital

Email: fake@neicon.ru

Chief of the Neurosurgical Department 

4, Ivanovskaya ul., 690005, Vladivostok

Russian Federation

A. V. Krutko

Tsivyan Novosibirsk Research Institute of Traumatology and Orthopedics

Email: fake@neicon.ru

Dr. Sci. (Med.), Head of Neurosurgical Department N 2

17, ul. Frunze, 630091, Novosibirsk

Russian Federation

Yu. Ya. Pestryakov

Irkutsk State Medical University

Email: fake@neicon.ru

Graduate Student

1, ul. Krasnogo Vosstaniya, 664003, Irkutsk

Russian Federation

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