Papers by Sergey Mlyavykh
Lumbar fusion through the anterolateral mini-approach: comparison of anterior interbody (OLIF-AF) and percutaneous pedicle (OLIF-PF) fixations in the surgical treatment of single-level stenosis
Хирургия позвоночника, Oct 3, 2023
Degenerative changes in the intervertebral joints of the cervical spine after anterior interbody fusion and intervertebral disc arthroplasty
Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika)
Objective. To study the effect of arthroplasty and anterior interbody fusion in the cervical spin... more Objective. To study the effect of arthroplasty and anterior interbody fusion in the cervical spine on degenerative changes in the adjacent intervertebral joints.Material and Methods. A retrospective cohort study included 46 patients (22 with cervical total disc arthroplasy – CTDA, and 24 with anterior cervical discectomy and fusion – ACDF) with symptoms of cervical spondylogenic compression myelopathy and/or radiculopathy. The degree of degeneration of facet joints adjacent to the operated segments was evaluated 12 months after surgical treatment. Degenerative changes in the cervical spine were assessed using CT according to the Okamoto classification. Vidar Dicom Viewer 3.2 software was used to view images and evaluate intervertebral joints. Statistical processing was performed using IBM SPSS Statistics 23. Data were presented as median and 25th and 75th percentiles – Me [Q1; Q3].Results. The mean age of patients in both groups was 47 [39; 52] years (Mann – Whitney U-test, p = 0.04...
Journal of neurosurgery, Sep 1, 2018
L umbar spinal stenosis (LSS) is defined as a reduction in the diameter of the spinal canal and/o... more L umbar spinal stenosis (LSS) is defined as a reduction in the diameter of the spinal canal and/or neural foramina. The most frequent cause of LSS is degenerative changes, including narrowing and bulging of the intervertebral disc, hypertrophy of the facet joints, thickening and buckling of the ligamentum flavum, and/ or degenerative spondylolisthesis. Lumbar spinal stenosis most commonly affects the L4-5 segment, but can affect any lumbar level. 1 Affected patients often suffer from symptoms of back and/or leg pain, which limits their ability to stand and ambulate. Unfortunately, nonsurgical therapies for LSS may be
Clinical and Radiographic Correlation (According to CT) in Patients with Degenerative Lumbar Spinal Stenosis
Medicinskaâ vizualizaciâ, Oct 28, 2017
Сomputed tomography (CT) is widely used in the diagnosis of degenerative pathology of the lumbar... more Сomputed tomography (CT) is widely used in the diagnosis of degenerative pathology of the lumbar spine, but the relationship between clinical manifestations of lumbar stenosis and its anatomical prerequisites has not been sufficiently studied to date.The objective: to determine the significance of the morphometric parameters of lumbar stenosis according to CT scans and to establish their relationship with the prevailing symptoms of the disease.Material and methods. Seventy-five consecutive patients with clinically significant lumbar stenosis who underwent CT scan before surgery were enrolled in this study. The average values of thirteen different morphometric parameters were calculated at LIII–SI levels of the intervertebral discs and of the pedicels in the axial and sagittal views. The possibility of classification of clinical observations and the correlation of morphometric parameters with the clinical forms of lumbar stenosis were investigated using discriminant and logistic regression analysis. Results. CT scan with high probability allocates patients with predominant symptoms of neurogenic claudication or bilateral radiculopathy. The most significant morphometric predictors of this clinical group are the depth of the lateral recesses and the cross-sectional area of the spinal canal.Conclusion. CT scan significantly expands the informative value of magnetic resonance imaging and can be used in planning the decompressive stage of the surgery intervention in patients with lumbar spinal canal stenosis.
Pain Physician, Dec 14, 2011
Background: Despite the evident progress in treating vertebral column degenerative diseases, the ... more Background: Despite the evident progress in treating vertebral column degenerative diseases, the rate of a so-called "failed back surgery syndrome" associated with pain and disability remains relatively high. However, this term has an imprecise definition and includes several different morbid conditions following spinal surgery, not all of which directly illustrate the efficacy of the applied technology; furthermore, some of them could even be irrelevant. Objective: To evaluate and systematize the reasons for persistent pain syndromes following surgical nerve root decompression. Study Design: Prospective, nonrandomized, cohort study of 138 consecutive patients with radicular pain syndromes, associated with nerve root compression caused by lumbar disc herniation, and resistant to conservative therapy for at least one month. The minimal period of follow-up was 18 months. Methods: Pre-operatively, patients were examined clinically, applying the visual analog scale (VAS), Oswestry Disability Index (ODI), magnetic resonance imaging (MRI), discography and computed tomography (CT). According to the disc herniation morphology and applied type of surgery, all participants were divided into the following groups: for those with disc extrusion or sequester, microdiscectomy was applied (n = 65); for those with disc protrusion, nucleoplasty was applied (n = 46); for those with disc extrusion, nucleoplasty was applied (n = 27). After surgery, participants were examined clinically and the VAS and ODI were applied. All those with permanent or temporary pain syndromes were examined applying MRI imaging, functional roentgenograms, and, to validate the cause of pain syndromes, different types of blocks were applied (facet joint blocks, paravertebral muscular blocks, transforaminal and caudal epidural blocks). Results: Group 1 showed a considerable rate of pain syndromes related to tissue damage during the intervention; the rates of radicular pain caused by epidural scar and myofascial pain were 12.3% and 26.1% respectively. Facet joint pain was found in 23.1% of the cases. Group 2 showed a significant rate of facet joint pain (16.9%) despite the minimally invasive intervention. The specificity of Group 3 was the very high rate of unresolved or recurred nerve root compression (63.0%); in other words, in the majority of cases, the aim of the intervention was not achieved. The results of the applied intervention were considered clinically significant if 50% pain relief on the VAS and a 40% decrease in the ODI were achieved. Limitations: This study is limited because of the loss of participants to follow-up and because it is nonrandomized; also it could be criticized because the dynamics of numeric scores were not provided. The results of our study show that an analysis of the reasons for failures and partial effects of applied interventions for nerve root decompression may help to understand better the efficacy of the interventions and could be helpful in improving surgical strategies, otherwise the validity of the conclusion could be limited because not all sources of residual pain illustrate the applied technology efficacy. In the majority of cases, the cause of the residual or recurrent pain can be identified, and this may open new possibilities to improve the condition of patients presenting with failed back surgery syndrome.
Australasian Medical Journal, 2018
It is reported that expandable pedicle screws are effective and a safer alternative to pedicle sc... more It is reported that expandable pedicle screws are effective and a safer alternative to pedicle screws with cement augmentation application in patients with poor bone quality. To study implant related complications associated with expandable pedicle screws application and to propose revision options in case of implant failure. A retrospective analysis of a heterogeneous cohort of patients operated on because of traumatic injuries and degenerative diseases of the lumbar spine and thoracolumbar junction was performed. 42 patients with osteopeny or osteoporosis were enrolled, the duration of the follow-up accounted for 18 months. Cases with implant failure (loosening and screw breakage) were registered and revision pedicle screws fixation was performed.
Global Spine Journal, May 1, 2015
Relative Contribution of Various Structures in Chronic Noncompressive Pain Syndromes Associated with Degenerative Diseases of Lumbar Spine
Global Spine Journal, Jun 1, 2012
ABSTRACT Introduction The problem of diagnostics and treatment of pain syndromes caused by degene... more ABSTRACT Introduction The problem of diagnostics and treatment of pain syndromes caused by degenerative processes of lumbar spine remains actual because of a high prevalence of these diseases and diagnostic difficulties in determining the source of pain especially in case of noncompressive pain syndromes. It was reported that in the majority of the cases, pain syndromes associated with degeneration of lumbar spine are noncompressive forming approximately 80% whereas those with nerve root compression account for only up to 20%. Different studies support the statement that in the majority of cases, the approach from the position of reductionism is applicable in case of pain syndromes associated with lumbar spine degeneration, however, a precise diagnostic of the main source of pain is required to apply highly specific minimal invasive modalities. It is a well-known fact that diagnostic methods have a limited accuracy regarding the ability to determine the source of pain in case of noncompressive pain syndromes, and in terms of this issue the evaluation of relative contribution of different structures in low back pain (LBP) could be helpful to develop a rational diagnostic algorithm. The objective of this study is to evaluate a relative contribution of various structures in LBP in case of degenerative diseases of lumbar spine. Materials and Methods This is a prospective nonrandomized study of 83 consecutive patients presenting LBP with or without sciatica at least during 6 months. In all cases, there was no evidence of nerve root compression according to the results of clinical examination and neurovisualization. All patients were resistant to the repeated courses of conservative therapy including various types of blocks. All patients were given neurological examination, examination applying visual analogue scale (the result is VAS score) and Oswestry disability questionnaire (the result is Oswestry disability index—ODI). MRI imaging was applied in all cases. To confirm the discogenic origin of pain, a provocative discography was applied under the control of the fluoroscopy, the diagnostic criterion was the reproduction of concordant pain. To confirm the contribution if facet joints or sacroiliac joints in LBP, a repeated diagnostic blocks with various anesthetics, were applied under the guidance of the fluoroscopy, the diagnostic criterion was at least 50% pain intensity relief (VAS score) during the anesthetic action. Patients were treated with nucleoplasty when discogenic origin of pain was confirmed by the results of discography. Using ablation and coagulation mode six channels were created within the disk. Radiofrequency denervation was applied in cases of facet joints blocks positive results. Chemical denervation with ethyl alcohol was applied in cases, when evidence of sacroiliac joint pain was provided by the results of diagnostic blocks. The criterion of clinically significant treatment results was at least 50% VAS score decrease and 40% decrease in ODI score after intervention was applied.1 Patients with significant biomechanical impairments who showed unsatisfactory results after interventional pain management underwent transpedicular fixation and interbody fusion. The conclusion concerning the prevalence of different pain sources was based on the estimated rate of clinically significant results after the applied interventions. Results According to the results of different interventions application, the rate of facet joint pain was accounted up to 51.2% with 95% CI (39.4 to 61.8%), the rate of discogenic pain formed 16.9% with 95% CI (9.5–26.7%), sacroiliac joint pain came to 7.2% with 95% CI (2.7–15.1%). In 8.4% cases, the source of pain was not determined. In the minority of cases the approach from the position of reductionism was ineffective because of the agglomeration of different factors including biomechanical impairments, those cases formed 16.3% with 95% CI (9.8–27.0%); further stabilization of segment with pedicle screws and interbody fusion resulted in a clinically significant pain relief. Conclusion The results of our study show that approach from the position of reductionism is effective in the majority of cases of chronic noncompressive pain syndromes presentation, associated with lumbar spine degenerative processes. In other words, main source of pain can be identified, justifying the application of the specific interventional pain management as the first stage of surgical treatment. The results of our study shows the domination of facet joints in structure of LBP causes, and according to the results of 95% CI estimation, the difference in rate of two most frequent types of pain—facet joint pain and discogenic pain is considerable. Diagnostic algorithm should be adjusted to the probability of different pain sources detection to diminish a number of the applied invasive diagnostic manipulations. The reason to focus on the facet joints pathology evaluation in case of chronic…
Journal of Pain Research, Apr 1, 2013
To study the possible effects of various diagnostic strategies and the relative contribution of v... more To study the possible effects of various diagnostic strategies and the relative contribution of various structures in order to determine the optimal diagnostic strategy in treating patients with noncompressive pain syndromes. Study design: Prospective, nonrandomized cohort study of 83 consecutive patients with noncompressive pain syndromes resistant to repeated courses of conservative treatment. The follow-up period was 18 months. Results: Nucleoplasty was effective in cases of discogenic pain; the consequences related to false positive results of the discography were significant. The most specific criterion was 80% pain relief after facet joint blocks, whereas 50% pain relief and any subjective pain relief were not associated with a significant increase in the success rate. A considerable rate of false negative results was associated with 80% pain relief, whereas 50% pain relief after facet joint blocks showed the optimal ratio of sensitivity and specificity. Facet joint pain was detected in 50.6% of cases (95% confidence interval 44.1%-66.3%), discogenic pain in 16.9% cases (95% confidence interval 9.5%-26.7%), and sacroiliac joint pain in 7.2% cases (95% confidence interval 2.7%-15%). It was impossible to differentiate the main source of pain in 25.3% of cases. It is rational to adjust the diagnostic algorithm to the probability of detecting a particular pain source and, in doing so, reduce the number of invasive diagnostic measures to evaluate a pain source. False positive results of diagnostic measures can negatively affect the overall efficacy of a particular technology; therefore, all reasons for the failure should be studied in order to reach an unbiased conclusion. In choosing diagnostic criteria, not only should the success rate of a particular technology be taken into consideration but also the rate of false negative results. Acceptable diagnostic criteria should be based on a rational balance of sensitivity and specificity.
Хирургия позвоночника, Sep 15, 2017
An analysis of key publications devoted to transpedicular fixation of the cervical spine has been... more An analysis of key publications devoted to transpedicular fixation of the cervical spine has been carried out. The installation of transpedicular screws in the cervical spine is a technically challenging procedure, the frequency of screw deviation from the optimal trajectory remains high even with the use of modern intraoperative technologies, and there is a risk of serious lifethreatening complications. The use of this technique allows achieving reliable three-column stabilization of the cervical spine through only posterior approach, which is the preferred or only possible option for a limited group of patients. According to literature data, screw displacement beyond the pedicle borders occurs, on average, in 15–20 % of cases, while clinically significant complications occur in 4–5 % of cases. Among 32 operated patients, one severe neurologic complication caused by vertebral artery compression by the screw was noted. Of the 79 installed screws, 18 (22.79 %) cases of lateral pedicl...
Sovremennye tehnologii v medicine, Oct 1, 2021
The aim of the study was to develop a new method of vertebral augmentation based on autologous an... more The aim of the study was to develop a new method of vertebral augmentation based on autologous and allogeneic bone chips to be used in pedicle screw fixation and to compare this method with the technique based on polymethyl methacrylate (PMMA). Materials and Methods. This prospective non-randomized study included 164 patients with degenerative pathologies or traumatic injuries of the lumbar spine and transitional thoracolumbar segments; 153 of the operated patients were followed up for 18 months. In these patients, radiodensity of the cancellous bone tissue was below 110 HU by the Hounsfield scale. Patients with degenerative spinal disorders underwent pedicle screw fixation using transforaminal interbody fusion; patients with traumatic spinal injuries underwent intermediate pedicle screw fixation, and those with a loss of vertebral body height by >50% underwent anterior fusion. The patients were divided into three groups: in group 1 (n=39), bone tissue augmentation was performed using PMMA; in group 2 (n=21), augmentation was done with bone chips; in group 3 (n=93), no augmentation was performed (control group). The follow-up period was 12 months; cases with fixator breakage or loosening were recorded. Results. After augmentation with PMMA, 11 cases (28.2%) of fixator destabilization were detected. With bone chips, fixator instability developed in 2 patients (9.5%) only, whereas in patients operated without augmentation, the instability was observed in 43 cases (46.2%). With PMMA augmentation, the incidence rate of fixator destabilization did not significantly differ from that in the control group (p=0.0801), while the use of bone chips resulted in a statistically significant decrease of this index compared to the control group (p=0.0023). A logistic regression analysis confirmed the superiority of the developed method over the PMMA-based vertebral augmentation. Conclusion. The use of bone chips for vertebral augmentation provides a statistically significant decrease in the incidence of pedicle screw fixator destabilization in the post-operative period. By reducing the risk of proximal loosening and eliminating the risk of bone cement drainage into the spinal canal and vascular bed, the proposed method may become especially effective in patients with impaired bone density.
The relationship between Computed Tomography and DXA results: A potential bias in Bone Mineral Density assessment
Australasian Medical Journal, 2017
The Risk of Low Energy Vertebral Body Compression Fracture Can be Predicted by CT Hounsfield Units
Global Spine Journal, May 1, 2015
Introduction Vertebral compression fractures (VCF) are an increasingly common spinal pathology in... more Introduction Vertebral compression fractures (VCF) are an increasingly common spinal pathology in the older adult population. Dual emission X-ray absorptiometry (DEXA) is frequently used to assess bone mineral density. Unfortunately, the sensitivity of DEXA in predicting fracture risk has been shown to be relatively poor, leading some to suggest the need for additional diagnostic studies that more accurately predict fracture risk. The objective of this study was to define the CT parameters that could be used to predict the risk of VCF. Materials and Methods A total of 100 consecutive patients undergoing CT scans for the workup of new onset axial back pain were enrolled in this study. CT scans utilized slice thickness of 0.5 mm. Tube voltage was 120 kV, current 300 mA, auto mAs range 180 to 400, 1.0 second/3.0 mm/0.5 × 32, and helical-pitch 21.0. Patients with a history of high-energy trauma or neoplasm were excluded. Bone density measurements were obtained in Hounsfield units (HU) at the T10–L5 levels from the cancellous portion of the vertebral body in the midsagittal, midcoronal, and axial planes and the average value was calculated. The presence of a single-level or multilevel VCF was identified by CT. Multilevel degenerative changes were characterized and recorded. Logistic regression was utilized to assess the relationship between the variables of bone density in HU, single- or multilevel VCF, and the presence of degenerative changes. Results HU were found to have a strong correlation to the risk of VCF. HU of less than 101 were associated with a significant increase in the rate of VCF, the parameters of logistic regression were В0 = 2.6254, p = 0.0013; B1 = − 0.0387, p
Introduction. In recent years, Enhanced recovery after surgery (ERAS), or Fast-track, has been ac... more Introduction. In recent years, Enhanced recovery after surgery (ERAS), or Fast-track, has been actively developed and introduced into clinical practice in many industry of surgery in Europe and the USA. However, the ERAS® Society has not yet approved a unified protocol in spinal neurosurgery, and most of the publications on the topic have appeared only in the last few years. The purpose of the study is to present a systematic review of the literature to identify the key elements of the ERAS program and the effect of their use, as well as the impact on complications in the following areas of spinal neurosurgery: deformities, trauma, degenerative, infectious and oncology diseases. Materials and methods. The authors analyzed and systematically reviewed all published literature on ERAS in spine and spinal cord surgery up to October 10, 2020 using the main databases of medical literature and search resources PubMed and eLibrary according to the PICOS inclusion and exclusion criteria, as ...
Sovremennye tehnologii v medicine, Dec 1, 2018
The review addresses the currently used materials for spinal stabilization surgery by spinal fusi... more The review addresses the currently used materials for spinal stabilization surgery by spinal fusion. Among them: autografts; allo-and xenografts; materials of synthetic and biological origin; growth factors; multipotent mesenchymal stromal cells; grafts made by 3D modeling. We discuss advantages and disadvantages of these materials as reported in the literature; with this analysis, we hope to stimulate further research into the graft biocompatibility and biointegration, especially into the issue of reparative regeneration and graft transformation into the bone tissue.
Global Spine Journal, May 24, 2018
Objective: To determine risk factors that may affect the rate of pedicle screws loosening in pati... more Objective: To determine risk factors that may affect the rate of pedicle screws loosening in patients with degenerative diseases of the lumbar spine. Methods: A total of 250 patients with a low-grade spondylolisthesis and lumbar instability associated with degenerative diseases were enrolled. Preoperatively patients underwent computed tomography (CT) and cancellous bone radiodensity of a vertebral body was measured in Hounsfield units (HU). Pedicle screw fixation was used to treat patients either with a posterior fusion only or in combination with transforaminal lumbar interbody fusion (TLIF), anterior lumbar interbody fusion (ALIF), and direct lateral interbody fusion (D-LIF). Minimal follow-up period accounted for 18 months. Cases with screw loosening were registered assessing association with risk factors using logistic regression. Results: The rate of screw loosening was in positive correlation with the number fused levels and decreasing bone radiodensity. Fusion with a greater load-bearing surface cage was associated with the decrease in rate of pedicle screws loosening. Incomplete reduction in case of spondylolisthesis, bilateral facet joints removal, and laminectomy performed without anterior support favored pedicle screws loosening development. The estimated model classifies correctly 79% of cases with the specificity and sensitivity accounting for 87% and 66% respectively. Conclusions: The decreasing bone radiodensity in Hounsfield units has a considerable correlation with the rate of pedicle screws loosening. On the other hand, the length of fixation and applied surgical technique including fusion type also have a significant impact on complication rate. Spinal instrumentations should be planned by taking into account all potential risk factors and not characteristics relevant to bone quality assessment alone.
Innovacionnaâ medicina Kubani, Sep 3, 2020
Одной из причин отсутствия унифицированных подходов к лечению травматических повреждений позвоноч... more Одной из причин отсутствия унифицированных подходов к лечению травматических повреждений позвоночника на уровне поясничного отдела и переходной грудопоясничной зоны является недостаток информации о вкладе различных факторов в стабильность транспедикулярной фиксации. Цель Оценить факторы, влияющие на стабильность транспедикулярной фиксации у пациентов с нестабильными травматическими повреждениями поясничного отдела позвоночника и грудопоясничного перехода. Материал и методы Исследование является ретроспективным, изучены результаты хирургического лечения 192 пациентов с травматическими повреждениями типа А3, А4, В1, В2 и С на уровне поясничного отдела позвоночника и грудопоясничного перехода. Транспедикулярная фиксация использовалась или изолированно, или в сочетании с реконструкцией передней колонны. По показаниям выполнялась передняя или задняя декомпрессия спинного мозга или его корешков. Регистрировались случаи с нарушением стабильности транспедикулярного фиксатора. Использовался логистический регрессионный анализ для оценки прогностической значимости предполагаемых факторов риска. Результаты Частота осложнения увеличивалась при снижении радиоденсивности костной ткани, при экстенсивной резекции костных структур и связок задней опорной колонны, люмбосакральной фиксации и остаточной кифотической деформации. При реконструкции передней колонны и промежуточной фиксации частота осложнения уменьшалась, в то время как передняя декомпрессия и протяженность фиксации не влияли на частоту осложнения. Заключение Дестабилизацию транспедикулярных систем чаще всего связывают с нарушением качества костной ткани, однако хирургическая тактика также может существенно влиять на частоту осложнения, что необходимо учитывать при планировании оперативного вмешательства. Промежуточная фиксация и реконструкция передней колонны в равной степени снижают частоту осложнений. При рисках развития нестабильности фиксатора передняя декомпрессия предпочтительна, поскольку она не влияет на стабильность транспедикулярного фиксатора. Ключевые слова: транспедикулярная фиксация, реконструкция передней колонны, передняя декомпрессия, ламинэктомия, радиоденсивность, травма поясничного отдела позвоночника и грудопоясничного перехода. Цитировать: Боков А.Е., Млявых С.Г., Братцев И.С., Дыдыкин А.В. Факторы, влияющие на стабильность транспедикулярной фиксации у пациентов с нестабильными повреждениями поясничного отдела позвоночника и переходной грудопоясничной области.
Sovremennye tehnologii v medicine, Sep 1, 2018
Stenosis of the lumbar spine is a common degenerative disease; its progression leads to a signifi... more Stenosis of the lumbar spine is a common degenerative disease; its progression leads to a significant restriction in daily activities and quality of life. This pilot study presents a novel minimally invasive technology for surgical correction of lumbar stenosis; the technique involves a widening of the spinal canal and intravertebral foramen by percutaneous bilateral osteotomy of the vertebral pedicles and their subsequent lengthening. Materials and Methods. Twenty patients with symptomatic lumbar stenosis were included in this prospective study (11 of them with stable anterolisthesis grade I). The patients underwent percutaneous osteotomy with lengthening of the vertebral pedicles at one or two levels. X-ray results were obtained from either standard radiography or computed tomography of the lumbar spine. The baseline patients' condition and the clinical outcomes of the surgical treatment were assessed using a number of validated examination tests, including the Oswestry Disability Index (ODI), the Zurich Claudication Questionnaire (ZCQ), the 10-mm visual-analogue pain scale (VAS), the SF-12 nonspecific quality of life questionnaire (version 2) with the physical (PCS) and mental (MCS) component summary scores. The minimal period of postoperative follow-up was 78 months (6.5 years). Results. In all cases of surgical interventions, the percutaneous osteotomy proceeded without complications and with a minimal blood loss. As compared with the preoperative period, the patients' quality of life (according to ODI) significantly improved from 48 to 15.5 points over 12 months (p=0.0002) and 5 years (p=0.0004), and up to 20 points in 6 and more years (p=0.0001). The SF-12 test also showed a statistically significant improvement in the quality of life throughout the observation period, with the exception of the MCS score taken soon (6 weeks) after the surgery. The pain syndrome (according to VAS) significantly diminished both in the back and in the lower extremityfrom the preoperative 5.8 and 7.4 points to 2.25 and 0.05 points after 5 years (p=0.0004). However, after 6 years or more, the pain syndrome again increased to 3.2 and 2.4 points, respectively, but remained significantly better than that in the preoperative period (p=0.04 and p=0.0006, respectively). According to the ZCQ questionnaire, the patients' condition improved from 2.0 points (6 weeks after surgery) to 1.5 points at 12 months (p=0.01) and to 1.67 after 5 years (p=0.011). However, after 6 years or more, the value of ZCQ increased to 1.83 points, which did not significantly differ from the preoperative level (p=0.14). Conclusion. Percutaneous bilateral osteotomy of the vertebral pedicles followed by their lengthening in patients with symptomatic lumbar spinal stenosis (including stable spondylolisthesis grade I) is a promising innovative technology. This minimally invasive treatment is beneficial primarily for elderly patients and those suffering from comorbidity. The results of this pilot study followed up for more than 6 years indicate a good immediate and encouraging long-term outcome of this treatment.
Sovremennye tehnologii v medicine, Jun 1, 2018
The growing number of surgical interventions in patients with spinal degenerative diseases and sp... more The growing number of surgical interventions in patients with spinal degenerative diseases and spinal cord injuries necessitate the development and implementation of innovative technologies for spinal surgery. Successful pre-clinical tests assessing the safety and reliability of the proposed devices are a major step towards further routine use of the novel technologies. In this report, we describe preclinical studies on screw implants designed to length vertebral pedicles in the lumbar spine and provide indirect decompression of the nerve structures by increasing the transverse size of the spinal canal and intervertebral foramen. The results demonstrated high reliability of the developed device, its potential effectiveness in eliminating lumbar spinal stenosis, and only minor negative effects on the lumbar spine function. Altogether, our study made it possible to start a pilot clinical project on using this technology in patients with symptomatic lumbar spinal stenosis.
Frontiers in Surgery, May 16, 2022
Background Different fusion techniques were introduced in clinical practice in patients with lumb... more Background Different fusion techniques were introduced in clinical practice in patients with lumbar degenerative disc disease, however, no evidence has been provided on the advantages of one technique over another. The Objective of This Study Is to assess the potential impact of circumferential fusion employing transforaminal lumbar interbody fusion (TLIF) vs. direct lateral interbody fusion (DLIF) on pedicle screw stability. Materials and Methods This is a single-center prospective evaluation of consecutive 138 patients with degenerative instability of lumbar spinal segments. Either conventional transforaminal lumbar interbody fusion (TLIF) with posterior fusion or direct lateral interbody fusion (DLIF) using cages of standard dimensions, were applied. The conventional open technique was used to supplement TLIF with pedicle screws while percutaneous screw placement was used in patients treated with DLIF. The duration of the follow-up accounted for 24 months. Signs of pedicle screws...
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Papers by Sergey Mlyavykh