ВЗАИМОСВЯЗЬ СПОНДИЛОМЕТРИЧЕСКИХ ПАРАМЕТРОВ С ИСХОДОМ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ПАЦИЕНТОВ С ДЕГЕНЕРАТИВНЫМИ ЗАБОЛЕВАНИЯМИ ПОЯСНИЧНО-КРЕСТЦОВОГО ПЕРЕХОДА

Abstract

Objective . To evaluate the relationship between the radiological and neuroimaging parameters of the spinal motion segment and the clinical outcome of surgical treatment of patients with degenerative diseases of the lumbosacral junction to clarify the indications for dynamic and rigid stabilization. Material and Methods . The study included 267 patients with degenerative diseases of the lumbosacral spine. Depending on the stabilization method, patients were divided into two groups: Group I (n = 83) with dynamic intervertebral disc (IVD) prosthesis; and Group II (n = 184) with interbody fusion and transpedicular fixation. Long-term clinical parameters and biomechanical characteristics before and after surgery were analyzed. Results . A significant nonparametric correlation of the long-term result of surgical treatment assessed by VAS and Oswestry Disability Index with radiological parameters and results of neuroimaging was revealed. It was determined that the use of artificial IVD allows achieving a minimum level of pain syndrome and good functional recovery with effective preservation of the volume of physiological movements in the operated segment and restoration of the total angle of lumbar lordosis. Conclusion . Objective neuroimaging data (grade II-IV of degeneration according to the measured diffusion coefficient) and radiological parameters (linear displacement of vertebrae not more than 4 mm, sagittal volume of movements in the spinal motion segment less than 6°, decrease in the height of intervertebral disc space no more than 2/3 of the superjacent one) make possible using total arthroplasty. It is advisable to perform interbody fusion and rigid stabilization in grade IV-V of degeneration, linear displacement of vertebrae more than 4 mm, sagittal volume of movements of at least 6°, and decrease in the interbody space height over 2/3 of the superjacent one.