• MeSH
• dlahy MeSH
• krční obratle MeSH
• lidé MeSH
• pooperační komplikace farmakoterapie   MeSH
• poranění páteře chirurgie   MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

PURPOSE OF THE STUDY Each dynamic stabilisation should preserve motion at the operated segment as well as reduce a load on the disc and intervertebral joints. One of the methods to achieve this is the implantation of interspinous spacers between lumbar spinous processes. In this study, the patients treated with the DIAM interspinous spacer (Medtronic, USA) were prospectively followed up with the aim to evaluate clinical outcomes and post-operative complications. MATERIAL Patients with a degenerative disease of the lumbosacral spine were indicated for the operation. They suffered from axial pain with signs of nerve root involvement due to disc hernia, foraminal stenosis or disc herniation recurrence A total of 68 patients aged 23 to 75 (average age, 50.01) years, including 39 men (average age, 50.44) and 29 women (average age, 49.45), were followed up for 1 to 3 years and evaluated. METHODS All patients underwent a standard pre-operative clinical and neurological examination. Each patient assessed pain intensity using a Visual Analogue Scale (VAS) and, with an Oswestry Disability Index (ODI) questionnaire, evaluated their functional state. In the case of disc hernia or disc herniation recurrence, a sequester was removed; for foraminal stenosis, foraminotomy and partial medial facetectomy was performed. After this decompression of nerve structures, a spacer was implanted. Follow-up included clinical and neurological examination at 6 weeks, 6 months and 1 - 3 years post-operatively. At 6 months and between 1 and 3 years after surgery, pain intensity and functional outcome using VAS and ODI assessments were measured by the patients, and antero-posterior and lateral skiagrams of the lumbosacral spine were made. The X-ray examination was made to reveal a potential implant dislocation. The VAS and ODI values at 1-3 post-operative years were compared with those before surgery and the results were statistically analysed. The surgeon evaluated the outcomes at 1-3 years of follow-up according to the Odom criteria. RESULTS The average ODI of the group was 60.44 % before and 21.85 % after surgery, which showed an improvement by 63.85 %. The average VAS was 7.18 points before and 2.10 points after surgery, showing an improvement by 70.75 %. A comparison of the pre- and post-operative results showed, in the average ODI differences of 38.24 % and 39.44 % in women and men, respectively; and in the average VAS value, 5.00 in women and 5.19 in men. The results evaluated according to indication for surgery were as follows: in patients with disc hernia, the difference in ODI was 39.62 % on average, and in VAS it was 5.42 points on average. In patients with disc herniation recurrence, the differences between pre- and post-operative average values were 41.50 % for ODI and 5.00 points for VAS. In patients treated for foraminal stenosis, these differences were 39.79 % for ODI and 5.18 points for VAS. The results for the level treated showed that at L5/S1 the average difference for ODI was 46.75 % and 4.50 points for VAS ; at L4/5 it was 35.52 % for ODI and 5.12 for VAS; at L3/4 it was 48.00 % for ODI and 5.78 for VAS; and at L2/3 it was 39.00 % for ODI and 4.50 for VAS. The results related to the method of nerve root decompression included the average differences of 40.00 % in ODI and 5.17 in VAS for removal of a disc sequester; and average differences of 32.89 % in ODI and 4.78 in VAS for foraminotomy and partial medial facetectomy. The results evaluated for the duration of pre-operative complaints were as follows: surgery by 3 months, average ODI, 44, 53 % and average VAS, 5.25; surgery between 3 and 6 months, average ODI, 37.65 % and average VAS, 4.71; and surgery after 6 months, average ODI, 35.60 % and average VAS, 5.28. The Odom criteria showed results as excellent in 41 %, good in 51.5 % and fair in 7.5 % of the patients. No poor result was recorded. There were no early complications such as haematoma, wound seroma or deep subfascial infection, and no implant dislocation. One patient had to undergo repeat surgery for subcutaneous infection without affecting the implant. Until the end of the study, no signs of herniation recurrence at the segment stabilised with a Diam interspinous spacer had been found. DISCUSSION The fact that none of the patients in this study required revision surgery or had a recurrence of disc herniation provides evidence for the effectiveness of the DIAM interspinous spacer. This also suggests that the implant protects the whole operated spinal segment, i.e., both intervertebral joints and discs, from being overloaded. Lesser mechanical stress applied to intervertebral facets may slow down degenerative processes and reduce their signs. CONCLUSIONS The implantation of a DIAM interspinous spacer is a less invasive and safe method of dynamic stabilisation of the spine without intra- or post-operative complications that is well tolerated by the patient. At 3-year follow-up the patients reported improvement in their functional state, as measured with an ODI, by 64 % on the average. Their axial and nerve root pain was reduced by 71 % on the average. All patients showed improved clinical conditions and the outcomes were evaluated as excellent in 41 %, good in 51 % and fair in 7.5 % of the patients. The results of implantation were not significantly related to age, gender, operative indications, operated lumbosacral level, method of nerve root decompression or duration of pre-operative problems. No patient treated by the DIAM spacer had any recurrence of disc herniation.

• Klíčová slova
• DIAM,
• MeSH
• bederní obratle MeSH
• dospělí MeSH
• křížová kost MeSH
• lidé středního věku MeSH
• lidé MeSH
• lumbosakrální krajina chirurgie   patologie   MeSH
• následné studie MeSH
• nemoci páteře chirurgie   MeSH
• ortopedické fixační pomůcky MeSH
• prospektivní studie MeSH
• protézy a implantáty MeSH
• senioři MeSH
• spinální stenóza MeSH
• výhřez meziobratlové ploténky chirurgie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH

• MeSH
• bederní svaly MeSH
• bolest etiologie   MeSH
• bolesti zad etiologie   terapie   MeSH
• lidé MeSH
• management bolesti MeSH
• ortopedické fixační pomůcky MeSH
• páteř patofyziologie   MeSH
• terapie metody   MeSH
• Check Tag
• lidé MeSH

PURPOSE OF THE STUDY Interspinous dynamic stabilisation devices (IDSDs) are used for stabilisation and indirect decompression of the spinal motion segment in minimally invasive treatment of degenerative conditions of lumbar spine. Good methodological quality studies on biomechanical effects of IDSDs are lacking in scientific literature. The purpose of this study was to evaluate the biomechanical effect of dynamic IDSD implantation on a spinal motion segment. MATERIAL AND METHODS We conducted a parallel group randomised trial (RT) on twelve patients, comparing radiological stabilisation and indirect decompression outcome measures between groups of patients with an isolated degenerative condition of L4-L5 motion segment and unilateral L5 nerve root radiculopathy. One group of six patients was operated by decompression and dynamic IDSD implantation and the other group of six patients by decompression alone. The radiological assessment was performed 6 months postoperatively in all patients. RESULTS Dynamic IDSD implantation significantly decreased segmental intervertebral angle (IA) and significantly increased segmental foraminal height (FH) and foraminal width (FW). The implantation had no effect on segmental range of motion (ROM) and posterior disc height (PDH). CONCLUSIONS The studied dynamic IDSD improved radiological indirect decompression outcome measures while only partially improved radiological stabilisation outcome measures. Oxford Centre for Evidence-Based Medicine 2011 Level 3: randomised trial with small effect size. Key words: lumbar spine, degenerative lateral stenosis, interspinous dynamic stabilisation, DIAM, randomised trial.

• MeSH
• bederní obratle diagnostické zobrazování   chirurgie   MeSH
• chirurgická dekomprese přístrojové vybavení   MeSH
• fúze páteře přístrojové vybavení   MeSH
• lidé MeSH
• medicína založená na důkazech MeSH
• rozsah kloubních pohybů MeSH
• spinální stenóza diagnostické zobrazování   chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH

• MeSH
• fúze páteře MeSH
• karcinom MeSH
• metastázy nádorů chirurgie   MeSH
• paraplegie prevence a kontrola   MeSH
• páteř chirurgie   MeSH

Information regarding two versions of an instrument called a muscle dynamometer, which enables detailed information about muscle activity in the deep stabilisation spinal system (DSSS), presented in this article. The MD01 (muscle dynamometer ver. 01) is a simple electromechanical instrument that allows measurement of muscle activity in two areas of the lumbar spine region. Measurements on patients have confirmed the usefulness of quantifying the initial state of a patient before rehabilitation as well as monitoring rehabilitation treatment; the MD01 is a suitable device for obtaining these measurements. However, a new and improved version of the MD01, the MD02, has been developed. The MD02 allows measurements in four different body regions and now has a PC interface, which allows achieving of patient information and data export for use with statistical software.

• MeSH
• bederní obratle MeSH
• bolesti zad diagnóza   patofyziologie   rehabilitace   MeSH
• kosterní svaly patofyziologie   MeSH
• lidé MeSH
• software MeSH
• svalová síla - dynamometr MeSH
• uživatelské rozhraní počítače MeSH
• Check Tag
• lidé MeSH

Vzpřímený stoj člověka je krajně labilní, zejména v sagitální rovině. Páteř jako stožár vyvážený kokontrakcí řetězců dlouhých svalů může pro svoji členitost plnit úkol stěžně pouze tehdy, jsou-li jednotlivé obratle navzájem zajišťovány krátkými meziobratlovými svaly a mohou-li se vpředu opřít o břišní dutinu, jejíž stěny udržují intraabdominální tlak. Analogické jsou poměry u chodidla s členitou klenbou, balancující dolní končetinu nad kulatým talem. Dysfunkce chodidla má i klinicky za následek podobné řetězové reakce jako poruchy stabilizačního systému trupu, projevující se spoušťovými svalovými body (trigger points, TrPs), které jako kompenzace omezují pohyblivost. Je také významná interakce obou stabilizačních systémů.

Human upright posture is very unstable, particularly in the sagittal plane. The spinal column is held like a mast by chains of long muscles acting together like ropes. It consists, however, of 24 vertebrae which would buckle under the strain without the action of the short intervertebral muscles and the support given by the abdominal cavity and its walls. Analogically, the arch of the foot consists of 12 bones balancing the leg over the spherical talus. Disturbed function of the feet causes chain reactions throughout the entire motor system as does a dysfunction of the deep stabilisation system of the trunk manifesting itself as myofascial trigger points (TrPs) which restrict movement. There is a considerable interaction of both stabilisation systems.

• MeSH
• lidé MeSH
• noha (od hlezna dolů) patofyziologie   patologie   MeSH
• posturální rovnováha MeSH
• svalový tonus MeSH
• syndromy myofasciální bolesti MeSH
• Check Tag
• lidé MeSH

Instrumentovaná páteřní fúze u pacientů postižených osteoporózou zůstává vzhledem ke kvalitě kosti klinickou výzvou, která má svá úskalí vyjádřená tendencí k selhání vnitřního fixatéru. Tento stav může být důvodem k revizní operaci. Autoři popisují případy dvou těžce osteoporotických pacientů se selháním krční stabilizace. Víceetážová kombinovaná předozadní stabilizace doplněná polymetylmetakrylátovým zpevněním instrumentovaných obratlových těl umožnila redukovat pooperační deformitu a vedla k dosažení dlouhodobé stability celého konstruktu. Klinická zkušenost získaná u těchto pacientů potvrzuje teoretický předpoklad, podle něhož dodatečné vertebroplastické ošetření nejenže zpevňuje obratlová těla, ale současně okamžitě fixuje zavedené šrouby a snižuje rizika vboření meziobratlových klecí. V tomto aspektu se jedná o strategii použitelnou v léčbě osteoporotických pacientů, u nichž došlo k selhání dříve zavedeného instrumentaria.

The instrumented spinal fusion in patients with osteoporosis is challenging because of poor bone quality and difficult due to frequent instrument failure secondary to pullout of screws and intervertebral body fusion device subsidence, leading to revision procedures. The authors treated two severely osteoporotic patients presenting with hardware failure after an index procedure in cervical spine. Combined antero‑posterior stabilisation at multiple levels in conjunction with vertebroplasty of instrumented cervical vertebral bodies enabled reduced postoperative deformity and led to long‑term stability of the construct. Clinical experience obtained with these two patients support theoretical assumption that additional vertebroplasty not just strengthens osteoporotic vertebral bodies but also immediately anchors the screws and reduces a risk of intervertebral body device subsidence. Therefore, this seems to be a viable strategy for treatment of osteoporotic patients after cervical spine hardware failure.

• Klíčová slova
• selhání instrumentace, krční páteř, polymetylmetakrylátová vertebroplastika, vnitřní fixace, těžká osteoporóza,
• MeSH
• biomechanika MeSH
• difuzní idiopatická skeletální hyperostóza komplikace   MeSH
• fúze páteře * metody   přístrojové vybavení   MeSH
• interní fixátory MeSH
• kostní šrouby MeSH
• krční obratle chirurgie   patologie   zranění   MeSH
• kyfóza etiologie   MeSH
• lidé MeSH
• nemoci páteře chirurgie   patologie   MeSH
• ortopedické výkony metody   přístrojové vybavení   MeSH
• osteoporóza * komplikace   MeSH
• polymethylmethakrylát * aplikace a dávkování   MeSH
• poranění páteře chirurgie   MeSH
• reoperace metody   přístrojové vybavení   MeSH
• selhání zařízení MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• spondylartropatie komplikace   MeSH
• vertebroplastika MeSH
• vnitřní fixace fraktury přístrojové vybavení   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

PURPOSE OF THE STUDY: Spine stabilization surgery is nowadays one of the most common spinal surgical procedures. Spinopelvic alignment is considered to be an important factor impacting the patients' preoperative diffi culties as well as the outcome of surgery. In our study, the outcomes of stabilization surgeries in patients with lumbar spine disorders were evaluated - especially in those with stenosis and spondylolisthesis, in whom the importance of sagittal parameters were assessed with respect to the patients' clinical outcomes and diffi culties. MATERIAL AND METHODS: The study included 50 patients with lumbar spine disorders who had undergone a spine stabilization surgery for a degenerative disease - lumbar spinal stenosis, spondylolisthesis between 2015 and 2017. Spino-pelvic radiological parameters and clinical parameters were evaluated using the nonparametric Kruskal-Wallis, Mann-Whitney, and Wilcoxon tests. RESULTS: In 38 of 50 patients, who at the end of the follow-up period did not have the PI-LL (pelvic incidence-lumbar lordosis) mismatch, i.e. PI-LL was ≤10°, a statistically signifi cant difference in pelvic tilt (p=0.049) and sagittal vertical axis (p<0.001) was reported, which was not the case in the remaining patients of the study population. Claudication and OSWESTRY (ODI) showed no statistically signifi cant difference. We have also compared the differences in the number of fused vertebrae and type of stabilization. A signifi cant change was seen in the claudication parameter at 12 and 24 months after surgery (p=0.007, p=0.005), with better outcomes achieved by 360° lumbar fusion compared to posterior lumbar fusion. The improvement of VAS and ODI scores in both the groups over time (from 6.1 to 3.6 or from 6.3 to 3.5 in VAS and from 62 to 32, or from 62 to 30 in ODI) was also statistically signifi cant (p<0.001 in both groups), while when comparing the groups against each other it was statistically insignifi cant. DISCUSSION: The authors confi rmed signifi cant improvement in the studied clinical parameters in all groups of patients (VAS, ODI, claudication), which is consistent with the results of recently published papers. The authors also established the correlation between different radiological parameters in the studied groups. The results do not confi rm the importance of the length or type of instrumentation for the clinical outcomes. This is consistent with the fi ndings of other published manuscripts. The authors failed to confi rm a signifi cant change in clinical parameters in dependence on the matching relationship between the pelvic incidence and lumbar lordosis. CONCLUSIONS: Proper spinopelvic balance in patients after spinal surgery is a very important indicator of postoperative development and condition, but our cohort showed no statistically signifi cant difference in the clinical outcomes of patients whose postoperative sagittal parameters were unsatisfactory. KEY WORDS: sagittal profi le, spine stabilization, pelvic tilt, pelvic incidence, sagittal vertical axis, SVA.

• MeSH
• chůze (způsob) MeSH
• lidé MeSH
• lordóza * MeSH
• neurochirurgické výkony MeSH
• páteř MeSH
• spondylolistéza * chirurgie   MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

The aim of the study was to present the effect and advantages of surgical decompression and dynamic transpedicular stabilisation in patients with degenerative spondylolisthesis of the lumbosacral spine. MATERIAL AND METHODS: This prospective study involved patients undergoing dynamic transpedicular stabilisation using Isolock or Isobar TTL (Scient X, France) systems. Between June 2003 and June 2009, 65 patients were treated and followed-up. They were aged 35 to 75 years (average, 57.17 years), and there were 32 men and 33 women. Follow-up ranged from 1 to 6 years. Based on indications for surgery they fell into two groups. Group 1 included 52 patients with grade I or II degenerative spondylolisthesis or retrolisthesis. Group 2 (control) consisted of 13 patients with degenerative disc disease or failed back surgery syndrome. The disorder had always been manifested by combined axial and radicular symptoms. Treatment included posterior decompression of nerve structures by laminectomy in conjunction with semi-rigid stabilisation, without fusion. Followup clinical (VAS, ODI), neurological and radiographic examinations were carried out at 6 weeks, 6 months and 1 to 6 years after surgery. The VAS and ODI results of both groups were statistically analysed and compared. RESULTS: During follow-up the ODI values decreased by 54 % (from 58.4 % to 26.8 %) and VAS values by 62 % (from 7.9 to 3.0) as compared with the pre-operative values, and this was statistically significant. When both groups were compared, the VAS values decreased significantly (by 5.61) in Group 1, as compared with Group 2 (decrease by 3.54). DISCUSSION: In the treatment of pseudospondylolisthesis, the semi-rigid stabilisation with spinal decompression, as presented here, is a convenient alternative to simple decompression without fixation or to various forms of instrumented or non-instrumented arthrodesis. A disadvantage associated with arthrodesis is a higher risk of ASD development; dynamic systems do not allow for reduction of spondylolisthesis and involve a change in sagittal spinal balance, and simple decompression carries the risk of slip progression and recurrent problems. CONCLUSIONS: The authors demonstrated that decompression combined with semi-rigid stabilisation had a very good effect on the clinical state of patients with degenerative spondylolisthesis (retrolisthesis) at medium-term follow-up. The procedure was less effective in other indications. Semi-rigid stabilisation with Isobar TTL or Isolock systems prevented the progression of anterolisthesis or retrolisthesis; none of the patients experienced instrumentation failure. Neither symptomatic restenosis nor disc herniation was found in the instrumented segment. Semi-rigid stabilisation can, if necessary, be converted to fusion or disc replacement.

• MeSH
• bederní obratle chirurgie   patologie   MeSH
• biomechanika MeSH
• chirurgická dekomprese metody   přístrojové vybavení   MeSH
• dospělí MeSH
• interní fixátory MeSH
• interpretace statistických dat MeSH
• kostní šrouby MeSH
• laminektomie MeSH
• lidé středního věku MeSH
• lidé MeSH
• nestabilita kloubu chirurgie   MeSH
• pooperační komplikace MeSH
• prospektivní studie MeSH
• senioři MeSH
• spondylolistéza chirurgie   patofyziologie   MeSH
• statistika jako téma MeSH
• výsledek terapie MeSH
• výsledky a postupy - zhodnocení (zdravotní péče) MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH