Vol 31, No 2 (2024)

BACKGROUND: Currently, the gold standard of surgical treatment of idiopathic scoliosis is dorsal or anterior correction using rigid instrumentation. However, anterior dynamic scoliosis correction has recently become a popular method for treating idiopathic scoliosis. It is recommended for patients with a certain growth potential. We present the long-term treatment results of patients with idiopathic scoliosis and the use of a dynamic correction system during completed and ending growth.

AIM: To evaluate radiological and clinical data on the results of surgical treatment of idiopathic scoliosis in patients with completed and terminating growth and a FU period of >2 years.

MATERIALS AND METHODS: A retrospective study of demographic data, X-ray (Cobb angle before and after surgery and ≥2 years, Lenke type, Risser test), number of fixation levels, nucleotomy, blood loss, surgery time, and complications, was conducted. The functional result was evaluated using the SRS-22.

RESULTS: Eighty-seven patients (men, 4; women, 83) were included. ASC (thoracic) was performed in 30 patients; lumbar/ thoracolumbar, 32; 2 sides, 13; and hybrid system, 12. Lenke: Lenke 1 (right-sided, 18; left-sided, 7); Lenke 2, 5; Lenke 3, 19; Lenke 4, 2; Lenke 5 (left-sided, 26; right-sided, 8); and Lenke 6, 2. The average blood loss was 281.2±173 ml; operation time, 174.8±42.3 min; FU, 2.2 years; age, 23.3 years; Risser, 4.42 (3–5); number of fixed levels 7.25±1.6°; and Cobb angle in the thoracic group during the first post-op study, 27.9±5.3°, and the last at 25.2±6.9° compared with the pre-op at 62.4°±10.9° (p <0.05). No significant loss of correction was found in patients with Lenke 5,6 52.5°±8.4° before surgery, 24.2±12.4° after, and a long-term FU of 27.2°±11.6° (p <0.05).

CONCLUSION: Dynamic scoliosis correction in adults is a new direction in spine surgery and provides a satisfactory radiological and functional result that persists for 2 years.

BACKGROUND: The presence of neuropathic pain syndrome (NPS) in patients with degenerative spinal diseases can make determining the tactics of surgical treatment challenging and increases the risk of residual or recurrent pain syndrome after surgery.

AIM: To investigate the perioperative course in patients with degenerative diseases of the lumbar spine depending on NPS.

MATERIALS AND METHODS: This prospective observational study included patients with planned surgical treatment for degenerative lumbar spinal stenosis. The study design included two visits: preoperative and 3 months after surgery follow-up. NPS assessment (DN4), back and leg pain intensity (NPRS back, NPRS leg), and disability index (ODI) were collected in both visits.

RESULTS: Overall, 169 patients were included; 48.5% of patients had NPS initially and 26% had NPS after surgery. NPS remained in 7.3% of patients and developed in 13% without initial signs before surgery. Patients with NPS upon admission had a higher intensity of pain in the back (6.82±2.41 vs. 5.42±2.66; p=0.041) and legs (7.43±2.34 vs. 6.32±2.16; p=0.017) than non-NPS patients. Patients with NPS at 3-month follow-up had higher intensity of pain in the back (4.31±2.52 vs. 2.31±2.38; p=0.012) and legs (4.71±2.91 vs. 1.55±2.27; p=0.003) than non-NPS patients.

CONCLUSION: Thus, 48.5% of patients with degenerative lumbar spinal stenosis had NPS before surgical treatment, and in 13% of patients, neuropathy developed after surgery. Patients with NPS, identified before surgical treatment or after surgery, have a higher pain intensity (1.2–1.3 times higher before surgery, 1.9–3 times higher after surgery) and report less pain regression after surgery. The presence of neuropathic pain syndrome at all periods of observation (or its appearance) complicates patient recovery and postoperative observation.

INTRODUCTION: Snapping triceps syndrome is a rare condition that may be misdiagnosed with ulnar nerve instability. It commonly affects young males who complain of painful snap on the medial side of the elbow. This snap appears when the elbow is being extended with resistance, such as during push-ups. Surgical treatment includes anterior transposition of the ulnar nerve and resection of the medial portion of triceps.

AIM: To analyze the results of surgical treatment performed on wide-awake patients using local anesthetic without tourniquet.

MATERIALS AND METHODS: Twenty-one patients were operated on 26 hands by a single surgeon between 2018 and 2023. Patients were assessed at least 6 months post-surgery via telephone calls, e-mails, and messaging apps.

RESULTS: Eleven patients were reached for follow-up. Amount of revision surgeries is 8 in this series with maximum number of 5 in one patient for both hands. Two patients are still having different issues in their elbows.

CONCLUSIONS: Snapping triceps syndrome is not easy to treat despite knowledge on this rare condition. The most common reason for revision surgery is persistent snapping even in those patients who were tested for active resisted extension during surgery. However, successful surgery may lead to full return to sport activities as none of our patients complained of loss of triceps power.

BACKGROUND: Fibrodysplasia ossificans progressiva is a rare genetically determined disease of the musculoskeletal system and characterized by heterotopic ossifications in the muscles, fascia, and tendons and congenital and skeletal deformities that form during life. Owing to the lack of awareness of doctors, unresolved challenges in monitoring the disease and predicting the course and development of its complications, and the lack of generally accepted effective treatment, fibrodysplasia ossificans progressiva leads to severe disability and social disadaptation, limiting the life expectancy of patients.

CLINICAL CASE DESCRIPTION: The characteristic anamnestic data of a patient with fibrodysplasia ossificans progressiva are presented. The course of the disease from the moment of detection at age 1 year and 3 months to 29 years was determined. Notably, the care and symptomatic treatment performed during this period could not prevent the regular appearance of new heterotopic ossifications, which led to severe functional disorders and loss of the patient’s ability to self-care. In a brief review, the current possibilities of pathogenetic therapy for this disease and prevention of progression and complications were considered. The risks of unjustified surgical interventions leading to increased severity of the course and functional disorders are emphasized.

CONCLUSION: The scientific studies conducted in recent years to examine the etiopathogenesis of fibrodysplasia ossificans progressiva enabled the development of effective pharmacotherapy, which provides hope for the possibility of preventing the progression of the disease and improving the quality of life and social adaptation of patients with fibrodysplasia ossificans progressiva.

Chemotherapy combined with radical surgery is the gold standard treatment for high-grade bone sarcomas. The number of cured patients has remained unchanged over the past decades. Approximately 30% of patients with stage IIB tumors, 70% with stage IIIB tumors, and more than 80% of recurrent bone sarcomas are resistant to currently used chemotherapy regimens and ultimately die from the disease. Currently available targeted therapies, mainly multiple tyrosine kinase inhibitors, are not curative, but a significant proportion of patients with advanced sarcomas achieve disease stabilization. This opens up the possibility of combining local and systemic treatments to consolidate clinical response, reduce tumor burden, and prolong progression-free interval. The optimal combination of systemic and local treatment methods (surgery, radiation therapy, radiosurgery) makes it possible to impact metastatic lesions, transforming an advanced tumor process into a chronic disease in responding patients. Early detection of relapse may improve the effectiveness of systemic treatment due to low tumor burden and lack of established resistance mechanisms. Future directions in the field of advanced sarcoma include the development of personalized treatment approaches and further studies of tumor biology based on “omics” technologies.

Aneurysmal bone cyst is a rare, locally destructive, benign neoplasm with a predominant localization in the bones. Aneurysmal bone cyst accounts for 1%–6% of primary bone tumors, and 80% of these lesions occur in the second decade of life with a slight prevalence in the female population. Currently, the optimal aneurysmal bone cyst treatment remains unclear. There are various treatment methods, each of which has its own indications, advantages, and disadvantages. The study of the key pathogenetic foundations of the process indicates the introduction of targeted aneurysmal bone cyst therapy. This study presents the systematized classification and description of the disease pathogenesis regarded from molecular and genetic viewpoints. The mechanism of targeted therapy based on the use of monoclonal human antibodies to RANKL has been studied. Articles published in 2012–2023 (July) were considered. Consequently, conclusions concerning the most common aneurysmal bone cyst localizations, patient’s age and sex, dosage regimen, treatment result, and possible complications during the therapy have been made. Thus, denosumab has therapeutic advantages regarding clinical and radiological results in patients with aneurysmal bone cyst. Closely relevant is the issue of using denosumab in the treatment of patients with aneurysmal bone cyst of complex anatomical localization and in cases of aggressive recurrence of the pathological process.

On 23 April 2024, at age of 69, our colleague Alexander V. Novikov — Doctor of Medical Sciences, Chief Scientific Officer of the Consultative and Rehabilitation Department of the Institute of Traumatology and Orthopaedics at PRMU University Hospital — passed away. Alexander V. Novikov devoted more than 30 years of his activity to the formation and development of rehabilitation direction in the Institute of Traumatology and Orthopedics in Nizhny Novgorod. He was a responsible, highly qualified specialist, a friendly and sympathetic doctor who inspired patients with faith in recovery. The staff of the Institute of Rehabilitation and Human Health N.I. Lobachevsky State University of Nizhni Novgorod and the editorial board of the journal “N.N. Priorov Journal of Traumatology and Orthopedics” deeply grieve about the loss.