A.K. Dulaev, A.V. Didikin
Medicomilitary Academy, Saint Petersburg, Russia
The problem urgency is conditioned by a high rate of revision interventions in cases, who have already been operated for degenerative diseases. According to literature data, this rate is 44%.
There were 103 cases, subjected to early revision operations. Their causes were as follows: repeated or incompletely removed disc hernias, segmental instability, stenosis, pseudoarthrosis, balance disorders, degenerative spondylolisthesis, i.e. pathologic states, united into one notion – failed back surgery syndrome (60.3%).
Late revision interventions (31.1%) were caused by syndrome of an adjacent level, watched against a background of progressing degeneration. We revealed the following factors, promoting development of this syndrome: stabilization peculiarities (excessive stiffness, rigid systems, groundless use of cages, massive osteogenesis in PLIF, extensive fixation, fixation with impairment of sagittal or frontal balance, high fixation) and peculiarities, characteristic of patients (age above 50, obesity, osteoporosis). The syndrome of an adjacent segment was diagnosed on the basis of a disc height reduction (less than 3 mm), presence of a fracture due to osteoporosis, impaired sagittal or frontal balance, rentgenologic signs of instability, gas in an intervertebral disc, stenosis, Modic 1 signal in adjacent bodies according to MR-data. There were 278 cases, followed up during 3-8 years; 11.5% of them demanded revision interventions due to persistent clinical manifestations. PLF, PLIF, TLIF with transpedicular fixation or without it were performed in revealing signs of segmental instability; in case of compression of neural elements adequate decompression was used; impaired balance with marked static disorders was treated by restoration of sagittal and frontal profiles. Severity of pain syndrome reduced in 100% of cases (according to VAS), its complete arrest was watched in 84% of patients.
Thus, complex estimation of factors, which condition remote clinical manifestations after primary operations for degenerative diseases, and subsequent adequate surgical correction allow to get good results in treatment of this intricate category of cases.