Vol 4, No 3 (1997)

Original study articles

Rendering of specialized medical care to patients with spine and spinal cord injuries in Belorussia

Voronovich I.R., Petrenko A.M., Makarevich S.V., Babkin A.V., Zholnerovich I.N.


In 1984 the Republic Scientific Practical Center for patients with spine and spinal cord injuries complicated by the paresis and paralysis of the lower and upper extremities as well as the pelvic function disturbances was organized on the basis of the Belorussian Institute of Traumatology and Orthopaedics. The Center has a unit for 60 beds with adequate staff and a mobile neurosurgical team. During 1984-1996 the mobile team rendered specialized medical care to 2976 victims with spine injuries. 1924 patients were hospitalized to the Center. At the Center modern diagnostic methods are used; new fixators and instruments have been elaborated in cooperation with «Medbiotech»; decompressionstabilizing operations with bone plasty and stabilization by different metallic devices are performed on the whole spine (from C1 - C2 to S1 -S2).Long standing experience of the Center shows that rendering of efficient medical care to the patients with spine injuries needs essential changes in organization, curative and rehabilitation tack- tics of patients management. Authors consider believe that the organization of regional specialized spine centers, mobile teams for urgent neuro-orthopaedic care and rehabilitation centers for medical, social, labor and psychological rehabilitation is expedient.

N.N. Priorov Journal of Traumatology and Orthopedics. 1997;4(3):3-9
pages 3-9 views

Surgical treatment of injuries and diseases of the spine using the steffee and luque systems

Vetrila S.T., Kuleshov A.A.


The experience of treatment using the Steffee transpedicular system and the Luque sublaminar system in 33 patients with spinal fractures (20), spondylolisthesis (11), spinal tuberculosis (1) and cauda equina root cavernous angioma (1) is presented. The indications for various types of operations for traumatic injuries and diseases of the spine are substantiated, depending on clinical neurological manifestations and data from special research methods (X-ray, myelography, computed and magnetic resonance imaging). Schemes of operations are given. It has been shown that the use of the Steffee and Luque systems in combination with adequate neuroorthopedic correction makes it possible to eliminate various types of spinal deformities, provides rigid fixation of it, creating an opportunity for early activation and rehabilitation treatment of patients.

N.N. Priorov Journal of Traumatology and Orthopedics. 1997;4(3):9-12
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Diagnosis and treatment of traumatic displacement of middle and lower cervical spine

Moiseenko V.A., Tsodyks V.M.


Treatment results for 142 patients with traumatic displacement of the middle and lower cervical spine are presented. Results of the experimental study of the volume and pattern of disk-ligamentous structure injuries in correlation with the degree of vertebral elements displacement detected by the profile spondylogram were used in the course of treatment. Authors distinguish 3 types of acute traumatic disk-ligamentous instability and define the adequate treatment tacktics: 1) relative posterior ligamentous instability - conservative treatment using soft external immobilization by Shanz’s collar or a similar one; 2) absolute favorable disk-ligamentous instability - conservative treatment using stiff immobilization devices such as thoracocranial plaster bandage; 3) absolute unfavorable disk-ligamentous instability - surgical treatment, predominantly anterior corporodesis.

N.N. Priorov Journal of Traumatology and Orthopedics. 1997;4(3):12-17
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Surgical treatment of uncomplicated instable injuries of lower thoracic and lumbar spine.

Azizov M.Z., Shotursunov S.S.


In 87 patients with uncomplicated instable injuries of lower thoracic and lumbar spine the examination data and results of surgical treatment were assessed. Autopsy data were analyzed in 17 patients who were lost due to severe concomitant and multiple injuries. According to clinical manifestations, anatomic and radiologic data the patients were divided into 3 groups: 1) victims with injuries of bone structures only; 2) victims with injuries of bone structures of the posterior supporting complex only; 3) victims with simultaneous injuries of the anterior and posterior supporting complexes. In every group the treatment was based on the peculiarities of the anatomic injuries and included the prevention of secondary complications. Authors consider that the posterior fusion with bone plasty is well justified in compression fractures but puncture method and posterior fixation by metallic devices are preferable in «burst» fractures. Long term good results were achieved in 67 victims (77%), satisfactory results - in 18 victims (22%) and unsatisfactory results - in 2 victims.

N.N. Priorov Journal of Traumatology and Orthopedics. 1997;4(3):17-20
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Spine fractures in population selection of persons of 50 years and older

Mikhailov E.E., Benevolenskaya L.I., Mylov N.M.


The incidence of spine fractures was studied in population selection of 50 years old persons and older. The study was conducted as a part of the European Program on Spine Osteoporosis. There were 521 patients (221 men,300 women) aged 50 years and older. The fractures were evaluated by lateral radiograms of the thoracic and lumbar spine. Morphologic analysis of the main heights of T4 -L4 with the estimation of the vertebral deformity indices were carried out. Fractures were evaluated using 25% level by Felsenberg. In 414 patients (173 men,241 women) morphometric analysis of radiograms was performed. The rate of spine fractures was 11,8% (14.5% - in men,10.0% - in women, with no statistically significant differences). Wedged fractures were the most frequent ones (13.3% in men,12.4% - in women), then pressed fractures (3.5% in men,5.8% in women) and compressed ones (4.0% in men,0.4% in women) with statistically significant prevalence in men (p < 0.05). This study is the first work in Russia related to the incidence of spine fractures in population selection of 50 years and older persons who are at risk of osteochondrosis development.

N.N. Priorov Journal of Traumatology and Orthopedics. 1997;4(3):20-26
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Discography in lumbar scheuermann’s disease

Korzh N.A., Gruntovskiy G.K., Kolesnichenko V.A.


Between 1988 and 1996 102 patients with Scheuermann’s disease were observed in Kharkov Institute of Orthopaedics and Traumatology named after M.I. Sitenko. In 40 of those patients (5 women,35 men), aged 16-30, discography was carried out including functional discography in 17 patients. Discography was performed by generally accepted method. On the base of data obtained the classification of discogram types in lumbar Scheuermann’s disease is suggested: I. Intradiscal type of contrast matter disposition: 1) intradiscal displacement of nucleus pulposus; 2) protrusion of intervertebral disc; 3)hernia of intervertebral disc; 4) protrusion of the end-plate of the vertebral body - it is one of the specific discographic signs of lumbar Scheuermann’s disease and is characterized by slight degeneration of nucleus pulposus. II. Transdiscal type of contrast matter disposition - it is specific for lumbar Scheuermann’s disease and reflects the degeneration of the intervertebral disc: 1) extralaminar type (it was observed in segments with the anterior ring apophysis separation and was characterized by the prolapse of nucleus pulposus between the anterior ring apophysis and anterior vertebral body angle. 2) translaminar type (it was observed when contrast matter penetrated into the underlying vertebral body structures through the damaged end-plate. Authors reach the conclusion that in some cases discography is the most preferable method to examine the functional and structural state of the intervertebral disc.

N.N. Priorov Journal of Traumatology and Orthopedics. 1997;4(3):26-31
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Treatment of intervertebral disc hernia in lumbar spine

Musalatov K.A., Aganesov A.G., Shulyak Y.A., Pestereva L.F., Khoreva N.E.


Four hundred fourteen cases of surgical treatment (microdiskectomy) of patients with lumbar disk herniation were analyzed. MR and CT data were studied. Authors consider that in patients with radicular syndrome prolonged conservative treatment including physiotherapy and traction causes changes in yellow and posterior longitudinal ligaments, their hypertrophy, ossification. These changes aggravate both spinal stenosis in the zone of disk herniation and radicular syndrome. When performing diskectomy these changes are to be taken into account and the main procedure should be added by the resection of the ligaments subjected to degenerative changes. Surgical treatment is indicated to all patients with severe radicular syndrome independently of the disease duration.

N.N. Priorov Journal of Traumatology and Orthopedics. 1997;4(3):31-34
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Total spondylectomy in spine tumors

Ardashev I.P.


Total spondylectomy was performed in 19 patients from 1970 to 1995. Sixteen had malignant primary or metastatic spinal tumors and 3 had benign. In 2 patients resections were done in one stage, but the remainder required a 2 stage procedure. The first stage included posterior segment resection, cord decompression and stabilizaion with metallic fixators and bone graft. The second stage completed resection of the vertebral body(ies), decompression of the anterior cord and stabilization. Benign tumor cases were stabilized with autografts. Malignant tumor cases were stabilized with porous Nickel Titanic prosthesis or Titanic prosthesis (author’s device). Three patients with benign tumors are alive. Sixteen patients with malignant tumors died. Mean survival time was 7.6 months. In malignant tumor cases neither one stage nor two stage total spondylectomy increases the survival rate but significantly improves the quality of life.

N.N. Priorov Journal of Traumatology and Orthopedics. 1997;4(3):35-40
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Surgical treatmant of scoliosis using frame design

Shevchenko S.D., Mezentsev A.A., Demchenko A.V.


Surgical treatment results of 56 patients with dysplastic scoliosis of IV degree were analysed. Follow up period ranged from 1 to 6.5 years (mean 4.3 years). In all cases the posterior approach was used. In 22 patients (1st group) two distraction rods, similar to Harrington’s ones, were placed along both sides of the curvature, fixed to the posterior vertebral elements using end hooks and tightened between each other by wires. Posterior spondylodesis was performed using cortical allografts. In 24 patients (2nd group) and 10 patients (3rd group) the distraction rods were connected to each other by stiff transverse stays. In the 2nd group the posterior spondylodesis was performed with allografts, in the 3rd group - iliac bone autografts. No principal difference in the volume of surgical correction was noted in those groups but in the 3rd group the surgical correction was slightly higher. Operative correction loss was the highest in the 1st group (main curvature - 71%, pathologic rotation - 100%) and in the 3rd group the operative correction loss was the lowest one (25% and 80%, respectively). Authors explained those results by the advantages of stiff implanted design and the more fast reconstruction of the autografts. Authors consider that the indication to use this method is scoliosis with the 50 -70° deformity and mobile main curvature arch.

N.N. Priorov Journal of Traumatology and Orthopedics. 1997;4(3):40-45
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Clinical and physiologic analysis of the efficacy of scoliotic disease treatment at the specialized rehabilitation center

Pinchuk D.Y., Sezneva T.N., Katysheva M.V., Vashchalova N.A., Yur’eva R.G.


The work is based on the analysis of treatment results of 52 scoliotic patients, aged 7-14 years. All patients were treated at the rehabilitation center for children with locomotor disorders. 14 patients had the 1st degree of scoliosis, 21 - lst-2nd degree, 13 - 2nd degree and 4 children - 2nd-3rd degree. Prior to and after treatment all patient were subjected to complex examination including the evaluation of their condition by clinical numbered scale, electromyography, apparatus evaluation of tonus, contact thermometry. In various groups of patients the main therapeutic course was supplemented with the seances of biocontrol with feedback, acupuncture, magnetic pulse stimulation, expanded physiotherapeutic course in various combinations. Authors conclude that clinical numbered scale supplemented with several indices may be used in clinical practice. Entering on the curative complex the methods which contribute to the improvement of circulation and metabolism processes with following use of biocontrol with feedback by EMG will allow to raise the efficacy of scoliotic disease treatment.

N.N. Priorov Journal of Traumatology and Orthopedics. 1997;4(3):45-51
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Treatment of vertebrogenic-dependent tachycardias and extrasystoles in children

Ulrich E.V., Krasavina D.A., Zolotukhin T.A.


Treatment results of 39 children with sinus tachycardia and extrasystolia are presented. All children simultaneously had various types of locomotor system pathology, mainly in the cervical and thoracic spine. In the majority of patients the orthopaedic correction by the author’s technique allowed to restore the cardiac rhythm without the use of antiarhythmic drugs.

N.N. Priorov Journal of Traumatology and Orthopedics. 1997;4(3):51-54
pages 51-54 views

Use of spectral analysis of tremor for the diagnosis of orthopaedic diseases

Serebryakova N.G., Ponomaryova E.A.


Spectral analysis of tremor was used for the evaluation of the functional state of loco-motor system in patients with spine osteochondrosis and scoliosis. The significance of tremor in diagnosis of that pathology was detected. The method allows to define the peculiarities of spectral features of tremor depending on the manifestations of the degenerative dystrophic changes in the spine. The coefficients of the qualitative evaluation of painful muscular-tonic response in the formation of pain syndrome are defined and some complications of osteochondrosis are detected. Spectral analysis of tremor allows to reveal minimum changes in the function of neuromuscular system which accompany the process of scoliosis formation. The coefficient obtained gives the possibility to assess integrally the myodystonic syndrome taking into account both the increase and the decrease of muscular tonicity as well as to observe the dynamics of scoliotic curvature during the course of treatment. Possibility to gain information as well as high sensitivity and non invasiveness of this method allow to use it as an additional one for the diagnosis and objectification of locomotor pathology.

N.N. Priorov Journal of Traumatology and Orthopedics. 1997;4(3):55-57
pages 55-57 views

Comparative characteristics of radiologic methods for the evaluation of thoracic kyphosis in children

Zaretskov V.V., Artem’eva I.A.


Significance of radiometric methods for the assessment of thoracic kyphosis was studied in 100 children with degenerative-dystrophic spine pathology and in 50 healthy children. It was shown that in disturbances of the vertebral body shape the routine methods of examination had significant errors. Proposed original method for the measurement of kyphotic deformity by the posterior bone structures allows to avoid such mistakes. Results of the evaluation of kyphosis degree using this method do not greatly differ from the data obtained by Ferguson’s method which is considered to be the more accurate one. The proposed method can be used side by side with the other generally accepted methods as well as for the elaboration of the pathologic kyphosis classification.

N.N. Priorov Journal of Traumatology and Orthopedics. 1997;4(3):58-59
pages 58-59 views

From Practical Experience

Experience in the treatment of scoliosis in children and adolescents in a rehabilitation center

Malakhov O.A., Cherkashov A.M., Pyzhevskaya O.P.


The rehabilitation center operates on the basis of the sanatorium boarding school No. 25 at the CITO. The sanatorium boarding school was organized in 1992 and is designed for the education and treatment of 150 children aged 6 to 16-17. A typical school building after a major overhaul was converted into an educational and medical institution. The boarding school works on a five-day week, children spend weekends at home. Unlike other similar institutions that exist in Moscow and some regions of Russia, boarding school No. 25 does not specialize in the rehabilitation treatment of patients with pathology of any one system of the musculoskeletal system (spine, large joints, etc.). The main task of the center is to provide qualified rehabilitation assistance to children suffering from a wide variety of orthopedic pathologies, as well as those who have suffered injuries of the joints, limbs, spine, etc. This report is devoted to the analysis of treatment at the center for children suffering from scoliosis. This contingent of patients here is about 60% of the total number of patients.

N.N. Priorov Journal of Traumatology and Orthopedics. 1997;4(3):60-61
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"Detenzor" method in the complex treatment of children with functional disorders and diseases of the spine on an outpatient basis

Mikhailova L.K., Smirnova T.N., Toshchakova L.V., Polyakov V.E.


Diseases of the spine (juvenile kyphosis, juvenile osteochondrosis, dysplastic scoliosis) and its functional disorders (non-fixed kyphosis, sluggish posture, flat back, postural disorder) occupy one of the first places in the structure of orthopedic pathology in childhood and adolescence [1–4]. Of 320 children examined by an orthopedist in a children's clinic for 6 months, 27 (8.4%) had dysplastic scoliosis, 48 (15%) had impaired posture, and 142 (44.4%) had flaccid posture. Out of 48 children with postural disorders, 4 had pathology of the hip joint, 3 had congenital muscular torticollis. One 9-year-old child with dysplastic scoliosis of the 1st degree suffered from congenital clubfoot.

N.N. Priorov Journal of Traumatology and Orthopedics. 1997;4(3):62-63
pages 62-63 views

Use of a universal external fixation device in the treatment of bedsores in patients with complicated spinal injury by skeletal suspension

Vorobyov A.I., Porokhin V.G.


In severe spinal injury with spinal cord injury, bedsores occur in 53-90% of patients. Being the entrance gate for infection, they contribute to the occurrence of sepsis, often leading to death.

N.N. Priorov Journal of Traumatology and Orthopedics. 1997;4(3):63-64
pages 63-64 views


Diagnosis of spinal tumors

Pashkevich L.A., Voronovich I.R.


A comparative analysis of the results was carried out at the Belarusian NIITO. Spinal tumors account for 12-18% of all skeletal neoplasms. Their diagnosis is extremely difficult, especially in the early stages. This is due to the polymorphism and vagueness of the clinical manifestations of spinal tumors in the initial period of the development of the process, with the variety of pathologies encountered. According to various authors, the frequency of diagnostic errors reaches 80%, their consequence is an increase in the number of neglected cases, inadequate treatment, which promotes tumor growth.

N.N. Priorov Journal of Traumatology and Orthopedics. 1997;4(3):65-68
pages 65-68 views

Reviews, literature review

Tuberculosis of the cervical spine

Kolesov V.V.


Infectious and inflammatory diseases of the spine remain an urgent problem in orthopedics and represent a certain difficulty for diagnosis and treatment [1,3,5,6,13,16,25,30,33]. The cervical spine is a rare localization of osteoarticular tuberculosis: according to different authors, its share in the structure of tuberculous spondylitis ranges from 2.5 to 6% [4,7,8,19,24,27]. Currently, there is an increase in atypical forms of tuberculous spondylitis of the cervical region, which is manifested by the monovertebral nature of the lesion [2,16, etc.]. The reasons for this lie in the change in the reactivity of macro- and microorganisms, the features of the age structure of the sick, the widespread use of antibacterial drugs, etc. According to Ahmadi et al. [16], out of 11 patients with spinal tuberculosis observed by them, 5 had data on the basis of which it was more likely to assume a neoplasm than an infectious process, including radiologically detected monovertebral destruction of the cervical vertebrae.

N.N. Priorov Journal of Traumatology and Orthopedics. 1997;4(3):65-68
pages 65-68 views


Society of Traumatologists-Orthopedists and Prosthetists of Moscow and the Moscow Region. 690th meeting (19.06.97)


Report by A.A. Ochkurenko, Experience in studying the peculiar course of osteomyelitis in children. Demonstration by the authors H.A. Musalatov, L.L. Silin, A.G. Aganesov, D.N. Dzukaev Transpedicular fixation in a patient with a complicated lumbar spine injury.

N.N. Priorov Journal of Traumatology and Orthopedics. 1997;4(3):72-72
pages 72-72 views

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