Cíl: Retrospektivní observační analýza přesnosti zavedení pedikulárních šroubů, komplikací, chirurgického času a technických zákonitostí 100 pacientů operovaných pomocí robotického systému ExcelsiusGPS. Metodika: Sto dospělých pacientů podstupující stabilizační výkony lumbosakrální páteře v průběhu období 2021–2024. Pacienti podstoupili jednu z tří možných operací – otevřená meziobratlová fúze, minimálně invazivní meziobratlová fúze nebo kombinace otevřené meziobratlové fúze s neinstrumentovanou mikrodekompresí. Všechny operační výkony byly provedeny za asistence robotického systému ExcelsiusGPS s následnou intraoperační kontrolní CT. Pacienti byli sledováni v intervalech 6 týdnů, 3 měsíců a 6 měsíců. Výsledky: Celkem bylo zavedeno 418 pedikulárních šroubů, z nichž 413 (99 %) mělo optimální zavedení (Gerzbein- -Robbins A) a zbylých pět vykazovalo drobné asymptomatické narušení kortikalis stěny pediklu (Gerzbein-Robbins B). Jednou byla narušena horní hrana pediklu a ve čtyřech případech došlo k narušení spodní plochy pediklu. V sedmi případech bylo nutné opakovat navigační CT sken v důsledku chyb přenosu mezi CT a robotickou platformou, ve dvou případech bylo nutné přeplánovat trajektorie pedikulárních šroubů v důsledku pohybu dynamické reference v průběhu zavádění šroubů. Průměrný chirurgický čas byl 154 min pro jednoprostorový stabilizační výkon a 202 min pro vícepatrový stabilizační výkon. Naše práce neprokázala významný pokles chirurgického času v obrazu učební křivky. V časném pooperačním období byla nutná revize dvou pacientů pro přítomnost seromu operační rány. Závěr: Druhá generace robotických systémů vykazuje vysokou přesnost zavádění pedikulárních šroubů, čímž snižuje výskyt komplikací souvisejících s malpozicí. Hlavní nevýhodou je prodloužení chirurgického času v důsledku nastavení robotické a navigační platformy.
Aim: Retrospective observation analysis of pedicle screw accuracy, complications, surgical time, and technical nuances of 100 patients operated via the ExcelsiusGPS robotic system. Methods: One-hundred adult patients undergoing lumbosacral interbody fusion between 2021 and 2024. Patients underwent either open interbody fusion, minimally invasive interbody fusion, or open interbody fusion combined with a non-instrumented decompression. All surgeries were assisted by the ExcelsiusGPS robot, and an intraoperative control CT scan was performed in all cases. Patients were followed at 6-week, 3-month, and 6-month intervals. Results: A total of 418 pedicle screws were implanted and 413 (99%) had optimal placement (Gerzbein-Robbins A) with the remaining five having minor asymptomatic cortical breaches of the pedicle wall violation (Gerzbein-Robbins B). The superior pedicle wall was breached once, and the inferior pedicle wall was breached four times. In seven cases, the CT scan had to be repeated due to transferring errors between the CT and robotic platform, and in two cases, screw trajectories had to be replanned due to dynamic reference base shift during screw implantation. The mean surgical time was 154 min for single-level procedures and 202 min for multiple-level procedures; our study did not show a significant decrease in surgical time throughout the learning curve. During early follow-up, two patients underwent surgical revisions due to the presence of seromas. Conclusion: Second generation robotic platforms have a high percentage of optimally implanted pedicle screws decreasing malposition-related complications. The main drawback is an increase in surgical time due to set-up of the robotic and navigation platforms.
- MeSH
- délka operace MeSH
- dospělí MeSH
- fúze páteře * metody přístrojové vybavení škodlivé účinky MeSH
- lidé středního věku MeSH
- lidé MeSH
- lumbosakrální krajina chirurgie MeSH
- pedikulární šrouby MeSH
- roboticky asistované výkony * metody přístrojové vybavení škodlivé účinky MeSH
- senioři MeSH
- statistika jako téma MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- klinická studie MeSH
- pozorovací studie MeSH
- práce podpořená grantem MeSH
BACKGROUND: A comparison of fusion rates and clinical outcomes of instrumented transforaminal interbody fusion (TLIF) between polyetheretherketone (PEEK) and titanium-coated PEEK (Ti-PEEK) cages is not well documented. METHODS: A single-centre, prospective, randomised study included patients who underwent one-level TLIF between L3-S1 segments. Patients were randomised into one of two groups: TLIF surgery with the PEEK cage and TLIF surgery with the Ti-PEEK cage. Clinical results were measured. All patients were assessed by repeated X-rays and 3D CT scans. Cage integration was assessed using a modified Bridwell classification. The impact of obesity and smoking on fusion quality was also analysed. Patients in both groups were followed up for 2 years. RESULTS: Altogether 87 patients were included in the study: of these 87 patients, 81 (93.1%) completed the 2-year follow-up. A significant improvement in clinical outcome was found in the two measurements scales in both groups (RM: p = 0.257, VAS: p = 0.229). There was an increase in CobbS and CobbL angle in both groups (p = 0.172 for CobbS and p = 0.403for CobbL). Bony fusion was achieved in 37 of 40 (92.5%) patients in the TiPEEK group and 35 of 41 (85.4%) in the PEEK group (p = 0.157). Cage subsided in 2 of 40 patients (5%) in the TiPEEK group and 11 of 41 (26.8%) in the PEEK group (p = 0.007). Body mass index > 30 and smoking were not predictive factors of bony fusion achievement. CONCLUSION: There is no significant advantage of TiPEEK cages over PEEK cages in clinical outcome and fusion rate 2 years after surgery.
- MeSH
- bederní obratle chirurgie MeSH
- benzofenony * MeSH
- fúze páteře * metody MeSH
- ketony MeSH
- lidé MeSH
- polyethylenglykoly MeSH
- polymery * MeSH
- prospektivní studie MeSH
- titan * MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
INTRODUCTION: Pathological destruction of the axis vertebra leads to a highly unstable condition in an upper cervical spine. As surgical resection and anatomical reconstruction of the second cervical vertebrae represents a life threatening procedure, less radical approaches are preferred and only few cases of C2 prosthesis are described in literature. CASE DESCRIPTION: The focus of this case report is a 21-year-old man with a pathological fracture of C2 managed primarily surgically with the C1-C3 dorsal fusion. Due to the progression of giant cell tumor and destruction of the axis vertebra, C2 prosthesis through anterior approach and dorsal occipito-cervical fusion C0-C4 were performed. Postoperative infection was managed surgically with a 2-staged dorsal debridement, ostheosynthesis material change and autologous bone graft. After a 4 week-intravenous therapy with the ceftriaxone in combination with the amoxicillin/clavulanate, followed by 12 week per oral therapy with amoxicillin/clavulanate in combination with ciprofloxacin, the complete recovery of the infection was achieved. Radiotherapy was initiated 2 months after the last revision surgery and the patient showed a good clinical outcome with stable construct at a 1 year follow-up. A review of literature of all reported C2 prosthesis cases was performed CONCLUSION: C2 prosthesis allows a more radical resection in pathological processes involving the axis vertebra. Combined with the posterior fusion, immediate stability is achieved. Anterior surgical approach is through a highly unsterile oral environment which presents a high-risk of postoperative infection.
- MeSH
- axis chirurgie zranění MeSH
- fraktury páteře * chirurgie MeSH
- fraktury spontánní chirurgie etiologie MeSH
- fúze páteře * metody MeSH
- implantace protézy metody MeSH
- krční obratle chirurgie zranění MeSH
- lidé MeSH
- mladý dospělý MeSH
- nádory páteře chirurgie MeSH
- Check Tag
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- přehledy MeSH
PURPOSE OF THE STUDY: The annual number of spinal fusion procedures has been increasing and is well documented worldwide. The O-arm is slowly becoming the standard for transpedicular screw insertion. The accuracy and safety of this method have been confirmed by many studies. Therefore, the learning curve of this method and its use by younger surgeons is the focus of our investigation. Longer operative time and radiation exposure to the patient are its only disadvantages. Our aim was to evaluate the learning curve of neurosurgical residents receiving specialist training and to demonstrate the safety and accuracy compared to the conventional C-arm-guided screw insertion used in the surgical management of spondylolisthesis. MATERIAL AND METHODS: Two groups of patients were evaluated - a retrospective cohort composed of patients with degenerative lumbar spinal instability indicated for C-arm-guided posterior transpedicular screw fixation and a prospective group of patients with the same diagnosis and surgical indication for O-arm-navigated screw insertion. In the retrospective group, the surgeons were largely experienced certified spine surgeons and neurosurgeons, whereas in the prospective group there were mainly neurosurgical residents receiving specialist training under the supervision of a certified physician. Both groups underwent a postoperative CT scan to evaluate the pedicle screw malposition using the Grade system and the anatomical plane of malposition. The operative times for both groups were recorded and for the O-arm navigated group a learning curve from the introduction of the method was generated. The values obtained were statistically analysed. RESULTS: A relatively favourable learning curve of the O-arm-navigation was obtained, with operative times approximating the Carm-guided group at two years after the introduction of the method. Safety of the O-arm navigation applied by less experienced surgeons was confirmed through statistically significantly higher accuracy achieved in the O-arm group at the expense of longer operative times. Also, a significantly lower number of significant Grade 2 and 3 malposition was reported in the O-arm group. DISCUSSION: The higher accuracy of transpedicular screw insertion in the navigation method has been confirmed multiple times. In our study, even in the group of less experienced surgeons. The favourable learning curve of neurological residents receiving specialist training is less documented. Time efficiency of the method and its safety when applied by younger surgeons could help make O-arm navigation the new gold standard in spine surgery. The longer operative time, the purchase price of the device, and a relatively higher radiation exposure to the patient continue to be its disadvantages. CONCLUSIONS: Based on the data obtained, a conclusion can be drawn that the O-arm navigation in spine surgery represents a safer and more accurate method for transpedicular fixation compared to the conventional C-arm technique, even when used by less experienced surgeons. In future, we should focus on increasing its time-efficiency. We are convinced that the navigationassisted spinal instrumentation will soon become a necessity for spine surgery centres. KEY WORDS: O-arm, transpedicular fixation, spondylolisthesis, fusion, navigation, learning curve.
- MeSH
- bederní obratle * chirurgie MeSH
- chirurgie s pomocí počítače metody přístrojové vybavení MeSH
- délka operace MeSH
- fúze páteře přístrojové vybavení metody výchova MeSH
- kostní šrouby MeSH
- křivka učení * MeSH
- kurzy a stáže v nemocnici MeSH
- lidé středního věku MeSH
- lidé MeSH
- prospektivní studie MeSH
- retrospektivní studie MeSH
- spondylolistéza * chirurgie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- srovnávací studie MeSH
INTRODUCTION AND PURPOSE: With current imaging modalities and diagnostic tests, identifying pain generators in patients with non-specific chronic low back pain (CLBP) is difficult. There is growing evidence of the effectiveness of SPECT/CT examination in diagnosing the source of pain in the spine. The study aims to investigate the effect of posterior interbody fusion on a single-level SPECT/CT positive lumbar degenerative disc disease (DDD). MATERIAL AND METHODS: This is a prospective study of patients with chronic low back pain (CLBP) operated on for a single-level SPECT/CT positive DDD. Primary outcomes were changes in visual analogue scale (VAS) scores and the Oswestry Disability Index (ODI). Secondary outcomes were complications, return to work, satisfaction and willingness to re-undergo surgery. RESULTS: During a 3-year period, 38 patients underwent single-level fusion surgery. The mean preoperative VAS score of 8.4 (± 1.1) decreased to 3.2 (± 2.5, p < 0.001) and the mean preoperative ODI of 51.5 (± 7.3) improved to 20.7 (± 14.68, p < 0.001) at a 2-year follow-up. A minimum clinically important difference (30% reduction in VAS and ODI) was achieved in 84.2% of patients. Some 71% of patients were satisfied with the surgery results and 89.4% would undergo surgery again. There were four complications, and two patients underwent revision surgery. Some 82.9% of patients returned to work. CONCLUSION: Fusion for one-level SPECT/CT positive lumbar DDD resulted in substantial clinical improvement and satisfaction with surgical treatment. Therefore, SPECT/CT imaging could be useful in assessing patients with CLBP, especially those with unclear MRI findings. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04876586.
- MeSH
- bederní obratle diagnostické zobrazování chirurgie MeSH
- degenerace meziobratlové ploténky * diagnostické zobrazování chirurgie MeSH
- fúze páteře * metody MeSH
- jednofotonová emisní výpočetní tomografie MeSH
- lidé MeSH
- lumbalgie * diagnostické zobrazování etiologie chirurgie MeSH
- počítačová rentgenová tomografie MeSH
- prospektivní studie MeSH
- retrospektivní studie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- práce podpořená grantem MeSH
BACKGROUND CONTEXT: Several minimally invasive lumbar interbody fusion techniques may be used as a treatment for spondylolisthesis to alleviate back and leg pain, improve function and provide stability to the spine. Surgeons may choose an anterolateral or posterior approach for the surgery however, there remains a lack of real-world evidence from comparative, prospective studies on effectiveness and safety with relatively large, geographically diverse samples and involving multiple surgical approaches. PURPOSE: To test the hypothesis that anterolateral and posterior minimally invasive approaches are equally effective in treating patients with spondylolisthesis affecting one or two segments at 3-months follow-up and to report and compare patient reported outcomes and safety profiles between patients at 12-months post-surgery. DESIGN: Prospective, multicenter, international, observational cohort study. PATIENT SAMPLE: Patients with degenerative or isthmic spondylolisthesis who underwent 1- or 2-level minimally invasive lumbar interbody fusion. OUTCOME MEASURES: Patient reported outcomes assessing disability (ODI), back pain (VAS), leg pain (VAS) and quality of life (EuroQol 5D-3L) at 4-weeks, 3-months and 12-months follow-up; adverse events up to 12-months; and fusion status at 12-months post-surgery using X-ray and/or CT-scan. The primary study outcome is improvement in ODI score at 3-months. METHODS: Eligible patients from 26 sites across Europe, Latin America and Asia were consecutively enrolled. Surgeons with experience in minimally invasive lumbar interbody fusion procedures used, according to clinical judgement, either an anterolateral (ie, ALIF, DLIF, OLIF) or posterior (MIDLF, PLIF, TLIF) approach. Mean improvement in disability (ODI) was compared between groups using ANCOVA with baseline ODI score used as a covariate. Paired t-tests were used to examine change from baseline in PRO for both surgical approaches at each timepoint after surgery. A secondary ANCOVA using a propensity score as a covariate was used to test the robustness of conclusions drawn from the between group comparison. RESULTS: Participants receiving an anterolateral approach (n=114) compared to those receiving a posterior approach (n=112) were younger (56.9 vs 62.0 years, p <.001), more likely to be employed (49.1% vs 25.0%, p<.001), have isthmic spondylolisthesis (38.6% vs 16.1%, p<.001) and less likely to only have central or lateral recess stenosis (44.9% vs 68.4%, p=.004). There were no statistically significant differences between the groups for gender, BMI, tobacco use, duration of conservative care, grade of spondylolisthesis, or the presence of stenosis. At 3-months follow-up there was no difference in the amount of improvement in ODI between the anterolateral and posterior groups (23.2 ± 21.3 vs 25.8 ± 19.5, p=.521). There were no clinically meaningful differences between the groups on mean improvement for back- and leg-pain, disability, or quality of life until the 12-months follow-up. Fusion rates of those assessed (n=158; 70% of the sample), were equivalent between groups (anterolateral, 72/88 [81.8%] fused vs posterior, 61/70 [87.1%] fused; p=.390). CONCLUSIONS: Patients with degenerative lumbar disease and spondylolisthesis who underwent minimally invasive lumbar interbody fusion presented statistically significant and clinically meaningful improvements from baseline up to 12-months follow-up. There were no clinically relevant differences between patients operated on using an anterolateral or posterior approach.
- MeSH
- bederní obratle chirurgie MeSH
- bolesti zad etiologie MeSH
- fúze páteře * škodlivé účinky metody MeSH
- kvalita života MeSH
- lidé MeSH
- miniinvazivní chirurgické výkony škodlivé účinky metody MeSH
- následné studie MeSH
- prospektivní studie MeSH
- retrospektivní studie MeSH
- spondylolistéza * chirurgie etiologie MeSH
- stenóza MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pozorovací studie MeSH
- práce podpořená grantem MeSH
OBJECTIVE: To determine the efficacy of adding instrumented spinal fusion to decompression to treat degenerative spondylolisthesis (DS). DESIGN: Systematic review with meta-analysis. DATA SOURCES: MEDLINE, Embase, Emcare, Cochrane Library, CINAHL, Scopus, ProQuest Dissertations & Theses Global, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform from inception to May 2022. ELIGIBILITY CRITERIA FOR STUDY SELECTION: Randomised controlled trials (RCTs) comparing decompression with instrumented fusion to decompression alone in patients with DS. Two reviewers independently screened the studies, assessed the risk of bias and extracted data. We provide the Grading of Recommendations, Assessment, Development and Evaluation assessment of the certainty of evidence (COE). RESULTS: We identified 4514 records and included four trials with 523 participants. At a 2-year follow-up, adding fusion to decompression likely results in trivial difference in the Oswestry Disability Index (range 0-100, with higher values indicating greater impairment) with mean difference (MD) 0.86 (95% CI -4.53 to 6.26; moderate COE). Similar results were observed for back and leg pain measured on a scale of 0 to 100, with higher values indicating more severe pain. There was a slightly increased improvement in back pain (2-year follow-up) in the group without fusion shown by MD -5·92 points (95% CI -11.00 to -0.84; moderate COE). There was a trivial difference in leg pain between the groups, slightly favouring the one without fusion, with MD -1.25 points (95% CI -6.71 to 4.21; moderate COE). Our findings at 2-year follow-up suggest that omitting fusion may increase the reoperation rate slightly (OR 1.23; 0.70 to 2.17; low COE). CONCLUSIONS: Evidence suggests no benefits of adding instrumented fusion to decompression for treating DS. Isolated decompression seems sufficient for most patients. Further RCTs assessing spondylolisthesis stability are needed to determine which patients would benefit from fusion. PROSPERO REGISTRATION NUMBER: CRD42022308267.
- MeSH
- bederní obratle chirurgie MeSH
- bolest MeSH
- chirurgická dekomprese metody MeSH
- fúze páteře * metody MeSH
- lidé MeSH
- randomizované kontrolované studie jako téma MeSH
- spinální stenóza * MeSH
- spondylolistéza * komplikace chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- metaanalýza MeSH
- práce podpořená grantem MeSH
- systematický přehled MeSH
PURPOSE: Low back pain is a significant socio-economic problem which is expected to deepen. Degenerative disc disease is considered to be one of its main causes. Unsuccessful conservative treatments usually lead to surgical treatments, including methods providing pain relief by vertebral fusion in the affected segment. However, this leads to changes in biomechanics, which is why approximately 30 years ago total disc replacements appeared. This work aims at determining the current state of treatments with this kind of replacement, comparing the results with those of fusion methods and assessing why fusion continues to dominate. Current treatments of degenerative disc disease by advanced procedures (regenerative and gene therapy, 3D printing) is also examined and evaluated, and future developments are considered. METHODS: A critical review based on available scientific articles from online databases. The main keywords used were "lumbar", "total", "disc" and "replacement", supplemented according to the individual, monitored areas ("follow-up", "fusion", "future" etc.). For the articles found through database search (n = 895), narrower selection was made and the result was 33 articles included in review. REVIEW: Total disc replacements have not yet satisfactorily demonstrated that they are superior to fusion methods in long term follow-up. Advanced methods are in their infancy. CONCLUSIONS: Additional research and development of total disc replacements is still necessary. For implants, the 3D scan - 3D model - 3D printing chain and its related technologies are increasingly important. The development of regenerative procedures using induced pluripotent stem cells and gene therapies is important, but conservative treatments and primary prevention should also be developed because regenerative procedures and gene therapies apparently will not be used routinely until the future.
- MeSH
- artroplastika meziobratlové ploténky * škodlivé účinky metody MeSH
- bederní obratle chirurgie MeSH
- degenerace meziobratlové ploténky * chirurgie komplikace MeSH
- fúze páteře * škodlivé účinky metody MeSH
- lidé MeSH
- lumbalgie * chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Závěrečná zpráva o řešení grantu Agentury pro zdravotnický výzkum MZ ČR
Nestr.
Newly designed hybrid biodegradable nanocomposite porous implant (HBNPI) modified with biogenic polyphosphate (bio-polyP) represents a very good opportunity to create bone fusion. Particularly effective utilization seems to be in spinal problems ,where the method of intervertebral fusion is mainly applied in injuries or degenerative spinal diseases. Our designed resorbable HBNPI composed of a hard ceramic outer ring and the inner soft collagen/nanohydroxyapatit foam modified with bio-polyP copy osteoconductive and osteoinductive properties of currently used autologous bone grafts. Synthetic HBNPI is prepared in laboratory manner eliminating both the complications associated with autografts collection and possibly the risk of infection transmission in the case of allografts. This project is focused on in-vivo testing of HBNPI ability to create intervertebral fusion in animal model and compare histology and ex-vivo bimechanics with standard autograft method. Results will create base of new and safer method of intervertebral fusion allowing subsequent clinical testing.
Nově navržený hybridní biodegradabilní nanokompozitní porézní implantát (HBNPI) modifikovaný biogenním polyfosfátem (bio-polyP) představuje velmi dobrou možnost jak vytvořit kostní fúzi. Zvláště efektivní využití se nabízí v páteřní problematice, kde při jejím poranění či degenerativním postižení je často využívána metoda tzv. intervertebrální dézy. Námi navržený resorbovatelný HBNPI složený z vnějšího tvrdého keramického prstence a vnitřní měkké kolagen/nanohydroxyapatitové pěny v kombinaci s bio-polyP kopíruje osteokonduktivní a osteoinduktivní vlastnosti dosud užívaných autologních kostních štěpů. Syntetický HBNPI je připravován laboratorně a tím odpadají komplikace spojené s odběrem autoštěpů, eventuálně i riziko přenosu infektu v případě užití aloštěpu. Tento projekt se zaměřuje na in-vivo testování schopnosti HBNPI vytvořit intevertebrální dézu na zvířecím modelu a provést histologické a ex-vivo biomechanické porovnání s dosud užívanými autoštěpy. Výsledky budou tvořit podklad k vytvoření nové a bezpečnější metodiky intervertebrální dézy a umožní následné klinické testování.
- MeSH
- fúze páteře metody MeSH
- implantace protézy MeSH
- lidé MeSH
- modely u zvířat MeSH
- nanokompozity terapeutické užití MeSH
- páteř chirurgie MeSH
- polyfosfáty terapeutické užití MeSH
- prasata MeSH
- testování materiálů MeSH
- vstřebatelné implantáty MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- zvířata MeSH
- Publikační typ
- hodnotící studie MeSH
- Konspekt
- Ortopedie. Chirurgie. Oftalmologie
- NLK Obory
- ortopedie
- technika lékařská, zdravotnický materiál a protetika
- NLK Publikační typ
- závěrečné zprávy o řešení grantu AZV MZ ČR
Cí l: Dysfunkce sakroiliakálního skloubení (sacroiliac joint; SIJ) je chronické onemocnění zodpovídající za významné množství případů bolestí zad. Následující práce prezentuje systematickou analýzu odborných článků založených na důkazech týkajících se chirurgického managementu dysfunkce SIJ publikovaných v průběhu posledních 10 let. Jejím hlavním cílem je prezentovat výsledky stran klinické efektivity chirurgické artrodézy SIJ srovnáním předoperačního a pooperačního hodnocení bolesti, a také incidencí chirurgických komplikací. Metodika: Stratifikace datového souboru byla provedena pomocí algoritmu PRISMA, jehož výsledkem byla skupina 27 studií. Sledovanými parametry byly design studií, počet zařazených pacientů, výskyt chirurgických komplikací, předoperační a pooperační hodnocení. Visuální analogové škály bolesti (VAS) a hodnoty Oswestry Disability Index (ODI). Metaanalýza byla provedena na základě modelu s náhodnými efekty, statistická heterogenita byla analyzována pomocí I2 indexu, publikační bias byl analyzován pomocí Eggerova testu a funnel plotu. Výsledky: Průměrné (95% CI) předoperační hodnoty VAS a ODI dosahovaly 7,86 (7,65–8,07) a 55,1 (49,8–60,5). Pooperačně došlo k poklesu VAS na průměrnou hodnotu 3,23 (2,89–3,58) a poklesu ODI na průměrnou hodnotu 30,7 (25,9–35,5). Celková incidence chirurgických komplikací byla 7,04 %, přičemž průměrná incidence ranných komplikací byla 3,87 % (2,44–6,09) a průměrný výskyt dislokace či malpozice šroubů byl 4,32 % (3,18–5,81). Celkem 5,19 % (3,93–6,83) pacientů vyžadovalo reoperaci. Závěr: Naše práce demonstrovala významné zlepšení předoperačních hodnot VAS (o 4,6 bodů ) a ODI (o 25 bodů ) u pacientů, kteří podstoupili chirurgickou stabilizaci SIJ. Tyto výsledky naznačují, že stabilizace SIJ může být u těchto pacientů využitelná a efektivní metoda. Navíc celková morbidita tohoto výkonu se jeví jako nižší, nežli popisovaly předchozí práce. Můžeme očekávat, že v důsledku zlepšujících se chirurgických technik a navigačních metod se bude chirurgická morbidita tohoto výkonu nadále snižovat.
Aim: Sacroiliac joint (SIJ) dysfunction is a chronic disorder, representing a significant cause of lower back pain. This study aims to present an evidence-based systematic analysis of published literature concerning the surgical management of SIJ dysfunction within the last 10 years. Its main goal is to demonstrate the clinical efficacy of SIJ arthrodesis via preoperative and postoperative analysis of patient pain and disability scores, as well as presenting the incidence of surgery-related complications. Methods: The PRISMA algorithm was used to stratify online search results into 27 studies, which made up our dataset. The parameters collected included study design, number of follow-up patients, surgical complications and preoperative and postoperative Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores. A random eff ects meta-analysis model was used to analyze the selected data, statistical heterogeneity was assessed using the inconsistency I test, publication bias was analyzed using the funnel plot and Egger’s test. Results: The mean (95% CI) values of the preoperative VAS and ODI scores were 7.86 (7.65–8.07) and 55.1 (49.8–60.5), resp. These values improved postoperatively to a mean (95% CI) score of 3.23 (2.89–3.58) for VAS and 30.7 (25.9–35.5) for ODI. The total number of recorded surgical complications was 7.04%. The mean (95% CI) incidence of wound complications was 3.87% (2.44–6.09) and the mean (95% CI) proportion of screw dislocation or malposition was 4.32% (3.18–5.81). The proportion (95% CI) of patients requiring a second operation was 5.19% (3.93–6.83). Conclusion: This study demonstrated that patients indicated for sacroiliac stabilization showed significant improvement in VAS (by 4.6 points) and ODI (by 25 points) scores. These findings suggest that SIJ stabilization is a feasible and effective treatment option for this group of patients. Furthermore, overall morbidity of the procedure was lower than in previously reported studies and is expected to decrease with improvement in surgical technique and navigational imaging.
