inovmedИнновационная медицина КубаниInnovative Medicine of Kuban2541-9897Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 110.35401/2500-0268-2021-23-3-12-18inovmed-437Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESСравнительный анализ результатов применения прямого латерального и трансфораминального поясничного межтелового спондилодеза у пациентов с дегенеративными заболеваниями поясничного отдела позвоночникаComparative analysis of the results using direct lateral interbody spondilodesis and transforaminal lumbar interbody spondilodesis in patients with degenerative diseases of the lumbar spinehttps://orcid.org/0000-0002-5203-0717БоковА. Е.BokovA. E.

Боков Андрей Евгеньевич, кандидат медицинских наук, заведующий отделением онкологии и нейрохирургии Университетской клиники

603005, Нижний Новгород, пл. Минина и Пожарского. д. 10/1

Andrey E. Bokov, Cand. оf Sci. (Med.), Chief of Department of Oncology and Neurosurgery

Minin and Pozharskiy Square, 10/1, Nizhniy Novgorod, 603005

Andrei_Bokov@mail.ruhttps://orcid.org/0000-0003-4391-7698БулкинА. А.BulkinA. A.

Булкин Анатолий Алексеевич, кандидат медицинских наук, врач-нейрохирург отделения онкологии и нейрохирургии Университетской клиники

Нижний Новгород

Anatoliy A. Bulkin, Cand. оf Sci. (Med.), Neurosurgeon

Nizhniy Novgorod

https://orcid.org/0000-0003-1368-0888КалининаС. Я.KalininaS. Y.

Калинина Светлана Яновна, кандидат медицинских наук, врач-нейрохирург отделения онкологии и нейрохирургии Университетской клиники

Нижний Новгород

Svetlana Y. Kalinina, Cand. оf Sci. (Med.), Neurosurgeon

Nizhniy Novgorod

https://orcid.org/0000-0003-2728-1618ЛеонтьевА. В.LeontevA. V.

Леонтьев Андрей Владимирович, врач-нейрохирург отделения онкологии и нейрохирургии Университетской клиники

Нижний Новгород

Andrei V. Leontev, Neurosurgeon

Nizhniy Novgorod

https://orcid.org/0000-0002-6310-4961МлявыхС. Г.MlyavykhS. G.

Млявых Сергей Геннадьевич, кандидат медицинских наук, руководитель НИИ травматологии и ортопедии, исполняющий обязанности заведующий кафедрой травматологии, ортопедии и нейрохирургии им. М.В. Колокольцева

Нижний Новгород

Sergey G. Mlyavykh, Cand. оf Sci. (Med.), Head of Institute of Traumatology and Orthopedics Neurosurgeon

Nizhniy Novgorod

Приволжский исследовательский медицинский университетРоссияPrivolzhsky Research Medical UniversityRussian Federation202130092021031218Copyright © Боков А.Е., Булкин А.А., Калинина С.Я., Леонтьев А.В., Млявых С.Г., 20212021Боков А.Е., Булкин А.А., Калинина С.Я., Леонтьев А.В., Млявых С.Г.Bokov A.E., Bulkin A.A., Kalinina S.Y., Leontev A.V., Mlyavykh S.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.innovmedkub.ru/jour/article/view/437

Введение У пациентов с дегенеративными заболеваниями поясничного отдела позвоночника применяются различные методики спондилодеза, однако преимущества их использования не доказаны.

Цель Оценка влияния типа спондилодеза на частоту развития нестабильности имплантата и проведение ревизионных операций, связанных с ней.

Материал и методы Данное моноцентровое проспективное исследование включало 133 пациента с дегенеративным стенозом поясничного отдела позвоночника и подтвержденной нестабильностью позвоночнодвигательных сегментов. Больным выполнялся трансфораминальный поясничный межтеловой спондилодез (TLIF) с одним кейджем или прямой латеральный межтеловой спондилодез (DLIF) с установкой кейджей стандартных размеров. При выполнении TLIF использовалась стандартная открытая методика, в то время как у больных, которым делали DLIF, применялась перкутанная установка винтов. Длительность наблюдения составила 18 месяцев. Для оценки различий в частоте возникновения признаков нестабильности фиксатора, по данным МСКТ и ревизионных вмешательств, использовался точный тест Фишера. Для оценки связи между потенциальными факторами риска и количеством осложнений применялась логистическая регрессия.

Результаты Использование технологии DLIF, выявляемой по данным МСКТ (32,9 против 3,6%, р < 0,0001), приводит к значительному снижению частоты возникновения нестабильности винтов и выполнения ревизионных вмешательств, связанных с данной ситуацией (11,8 против 0%, р = 0,0122). Результаты логистической регрессии, учитывающей такие факторы, как плотность костной ткани и количество уровней, на которых выполнен спондилодез, подтверждают связь снижения частоты развития осложнения и использования технологии DLIF.

Выводы Применение технологии DLIF вместо TLIF у пациентов с дегенеративным стенозом на уровне поясничного отдела позвоночника может привести к значительному снижению частоты развития нестабильности винтов и выполнения связанных с этим последующих ревизионных операций.

Introduction Various spondylodesis techniques are used in patients with degenerative diseases of the lumbar spine, but the benefits of these techniques have not been proven.

Objective of the study was to assess the effect of the type of fusion on the incidence of implant instability and related revision surgeries.

Material and Methods This monocentric prospective study included 133 patients with degenerative stenosis of the lumbar spine and confirmed instability of spinal motion segments. Patients underwent transforaminal lumbar interbody fusion (TLIF) with a single cage or direct lateral interbody fusion (DLIF) using standard-sized cages. The conventional open technique was used to supplement TLIF with pedicle screws while percutaneous screw placement was applied in patients treated with DLIF. The duration of follow-up was 18 months. Fisher's exact test was used to assess differences in the incidence of fixator instability based on MSCT and revision interventions. Logistic regression was used to assess the association between potential risk factors and complication rates.

Results The use of DLIF detected by MSCT (32.9 vs 3.6%, p < 0.0001) resulted in a significant reduction in the incidence of screw instability and associated revision interventions (11.8 vs 0%, p = 0.0122). The results of logistic regression, taking into account factors such as bone density and the number of levels at which spondylodesis was performed, confirm the relationship between the reduced incidence of complications and the use of DLIF technology. Conclusion Using DLIF instead of TLIF in patients with degenerative stenosis at the lumbar spine level can lead to a significant reduction in the frequency of screw instability and associated revision surgeries.

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The authors declare that there are no conflicts of interest present.