Page 1 of 7
European Journal of Business &
Social Sciences
Available at https://ejbss.org/
ISSN: 2235-767X
Volume 07 Issue 05
May 2019
Available online:https://ejbss.org/ P a g e | 1398
Transpedicular Stabilization Of The Spondylolesthesis Of The
Lumbosacral Spine
Radjabov U.U., Khayatov E.M., Akramov V.R., Saidov K.K.
Bukhara State Medical Institute, Bukhara regional multiprofile medical
center neurosurgery department
Summary:This article presents the current state of the problem of surgical
treatment of the lumbosacral spine using a transpedicular stabilizing system.
Key words: spondylolesthesis, transpedicular stabilization, lumbosacral
spine.
Relevance.
Spondylolisthesis in recent years has become a socially significant problem due
to progressive prevalence, reaching 75-80% in the population, significant
economic losses due to temporary and permanent disability, as well as costs of
compulsory medical insurance and high-tech medical care [1].
Back pain is the second most common reason for seeking medical attention after
respiratory illness and the third cause of hospitalization for patients. In most
cases, lumbodynia is observed, which occurs in almost every person throughout
life [2].
Spondylolisthesis of the lumbar spine is one of the urgent problems in
vertebrology, as evidenced by the increasing number of publications and the
number of inventions on this subject over the past 10 years [3].
Degenerative dystrophic diseases of the spine is a serious disease, manifested by
neurogenic intermittent claudication, pain in the lower extremities and lower
back. The incidence of lumbar stenosis is about 1000 cases [4]. Pain and
intermittent claudication are often accompanied by paresis or plegia of the lower
extremities, as well as severe impaired sensitivity, which leads the patient to a
disability [5].
Conservative treatment of spinal spondylolisthesis is widespread today and
gives positive results only in the early stages of the disease. However, after
several years of drug therapy, patients are often forced to seek help from an
orthopedic surgeon or a neurosurgeon [6].
Page 2 of 7
European Journal of Business &
Social Sciences
Available at https://ejbss.org/
ISSN: 2235-767X
Volume 07 Issue 05
May 2019
Available online:https://ejbss.org/ P a g e | 1399
Assessment of neurological changes from the degree of narrowing of the spinal
canal, as well as the radicular tunnel and intervertebral foramen at the level of
the lumbar spine, plays a key role in the success of surgical intervention. The
recent appearance of imaging examinations, such as computed tomography and
magnetic resonance imaging, greatly expanded the possibilities of diagnosing
the disease and led to an increase in the number of surgical interventions for
lumbar stenosis [7]. However, to date there are significant difficulties in the
diagnosis of the disease and the choice of the correct adequate indications for
surgical intervention. In many cases, there are no clear criteria and parallels
between the clinical symptoms of the disease and the pattern of pathological
changes visible on CT and MRI [8]. Quite often, signs of degenerative- dystrophic diseases of the lumbar spine are detected by chance, when the
clinical manifestations of the disease are practically absent. This is due to the
duration of the process and the formation of compensatory mechanisms. The
same reason leads to poor results of surgical treatment, since many patients are
operated on in a state of decompensation. In such cases, even a slight
deterioration in blood circulation in the area of compressed nerve trunks or the
spinal cord during surgery can lead to irreversible changes with the
corresponding neurological pattern [9]. The currently used methods of surgical
treatment of degenerative-dystrophic diseases of the lumbar spine are aimed at
decompression of the caudal nerve roots. To date, the issues of stabilization
during decompression of the spinal canal have not been resolved. Many authors
[9] suggest that all patients with lumbar stenosis will perform transpedicular
fixation. Others [10] believe that the stabilization of the vertebral segment after
surgical intervention leads to the appearance of bone growths and the emergence
of restenosis. The role of ventral decompression in the surgical treatment of
degenerative stenoses of the lumbar spine, the causes and methods of treatment
of the “unsuccessfully operated spinal syndrome” [11] has not been fully
studied.
The transpedicular stabilization of the lumbar spine is a fundamentally new
approach to solving the problem of surgical treatment of spondylolisthesis. The
purpose of dynamic fixation is the elimination of instability of the affected
vertebral segment while maintaining the physiological level of mobility in it.
From the standpoint of biomeh ¬ niki, transpedicular fixation of the vertebral
segment compared with traditional methods of stabilization by spinal fusion -
Page 3 of 7
European Journal of Business &
Social Sciences
Available at https://ejbss.org/
ISSN: 2235-767X
Volume 07 Issue 05
May 2019
Available online:https://ejbss.org/ P a g e | 1400
looks preferable because it allows you to evenly distribute the functional load on
the spine, and therefore prevent overloading of the adjacent vertebral segments
and their possible accelerated degeneration [12].
Goal of the work
Determination of indications for the installation of systems for posterior
transpedicular fixation and evaluation of the results of the surgical treatment of
lumbar spinal spondylolisthesis.
Research methodology
The study group included 102 patients operated in the period from 2012 to 2016.
in the department of neurosurgery. Among them, 58 men and 44 women, aged
16 to 58 years, with an average age of 35 years. The main indications for this
type of operation were: radio graphically confirmed stenos is from moderate to
severe, correlated with neurological symptoms, pain syndrome, intervertebral
instability associated with recurrent hernias; massive primary disc herniation
with sekvestratsii: median and paramecium in the presence of intense, resistant
to conservative therapy syndromes of horsetail root compression; stabilization of
levels above or below the segment of rigid spinal fusion to minimize the
possible degeneration of adjacent segments.
Diagnostic criteria:
1. Data of magnetic resonance tomography (MRI) of the lumbar spine: MRI
allows you to assess the degree of degenerative changes in the vertebral
segment, the state of the intervertebral disc, determine the topography of
the hernia protrusion in the axial and sagittal planes, clarify the
relationship between the hernia and spinal roots. The severity of
degenerative changes in the intervertebral disc is estimated on the basis of
MRI data according to the Pfirrmann classification. This classification
identifies five degrees of degeneration of intervertebral discs, where the
first degree corresponds to the norm, while the fifth degree indicates the
most severe degenerative lesion of the disc [13].
2. Data of survey and functional spondylograms: the lateral radiographs
taken in the neutral position assess the following radiographic parameters:
the height of the disks in the anterior and posterior regions, the average
height of the disk, the angle of the lumbar lord sis. The height of the
intervertebral disks is calculated as the ratio of the size of the
intervertebral gap to the height of the body of the overlying vertebra [14].
