Saratov JOURNAL of Medical and Scientific Research

Arsenievich V.B.

Scientific Research Institute of Traumatology Orthopedics and Neurosurgery of Saratov State Medical University n.a. V.I. Razumovsky Head of the Third Traumatology and Orthopedics Department, Candidate of Medical Science

Optimization of transpedicular spondylosynthesis application for type A3 lesions of the thoracolumbar transition: clinical experimental study

Year: 2019, volume 15 Issue: №2 Pages: 275-283
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Likhachev S.V., Zaretskov V.V., Arsenievich V.B., Shchanitsyn I.N., Shulga A.E., Zaretskov A.V., Ivanov D.V.
Organization: Saratov National Research University n.a. N. G. Chernyshevsky
Summary:

Objective: the optimization of transpedicular systems application for type A3 lesions of the thoracolumbar transition using computer simulation based on the fnite elements method. Material and Methods. The examination data (post-traumatic kyphotic deformation, intensity of pain syndrome, length of operation and extent of blood loss) of 81 prospec-tively enrolled male patients who in 2017–2018 had been operated for Th11-L2 vertebrae simple fractures of А3N0M1 type (AOSpine classifcation). The patients were divided into 3 groups in accordance with the type of intervention performed on them: short-segment (n=42), 8-screws polysegment (n=25) and 6-screws polysegment (n=14). Biome-chanical simulation based on the computer tomography data was performed for each variant of the metal construction arrangement. Results. In the process of biomechanical simulation with all the variants of the instrumented spine 3D- models loading 8-screws construction proved to be the most consistent one, at that the stability of polysegmental constructions exceeds that of bisegmental one by an order. The results of surgical management were evaluated in terms of up to a year following the intervention. The loss was less and the correction worked better with polysegmental fxation despite more complicated initial conditions for the correction compared to those of group 1 Conclusion. Biomechanical simulation shows prerequisites for the development of bisegmental systems instability as the equivalent stresses and peak displacements are higher compared to those of polysegmental fxation. The efciency analysis of application of various transpedicular fxations for type A3 thoracolumbar transition lesions attests to the advantage of polysegmental arrangements of transpedicular systems, at that the implantation of the 6- screws polysegmental system should be considered the frst choice on the number of indices.

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Circular anchorage of the spine in the correction of scoliotic deformity.

Year: 2018, volume 14 Issue: №3 Pages: 586-591
Heading: Traumatology and Orthopedics Article type: Case report
Authors: Stepukhovich S.V., Zaretskov V.V., Arsenievich V.B., Likhachev S.V., Shul'ga A.E., Zaretskov V.V.
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Summary:

Aim: to demonstrate clinical case of surgical treatment of scoliotic deformity of the spine in a 17-year-old child. It is shown that the correction of sagittal profile achieved by 2-stage intervention and normalized global balance parameters in combination with circular spine anchorage allows providing earliest and fullest rehabilitation of a child.

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Biomechanical aspects of circular spondylosynthesis of transitional thoracolumbar spine

Year: 2018, volume 14 Issue: №3 Pages: 560-566
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Likhachev S.V., Zaretskov V.V., Arsenievich V.B., Shul'ga A.E., Shchanitsyn I.N., Skripachenko K.K.
Organization:
Summary:

Aim: to present the potential of biomechanical modeling in individual choice of optimal surgical correction method for transitional thoracolumbar spine injury. Material and Methods. We built solid-base 3-dimensional model of the investigated spine segment in Mimics13 on the basis of CT data of injured thoracolumbar spine. Cage and anchorage models were created in CAE system SolidWorks. Numeric modeling was performed in ANSYS in Workbench medium. We analyzed full movement fields, their maximum values for each model as well as equivalent stress in vertebra and anchorage systems. Results. The analysis of equivalent stress and full movement fields emerging in the models under seven basic types of load revealed the most stable spondylosynthesis model which is circular spine

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On the issue of surgical reconstruction in complicated aggressive hemangiomas of sacrolumbar transitional spine

Year: 2018, volume 14 Issue: №3 Pages: 487-492
Heading: Traumatology and Orthopedics Article type: Author's opinion
Authors: Arsenievich V.B., Zaretskov V.V., Likhachev S.V., Stepukhovich S.V., Mizyurov S.A., Sadchikov D.D.
Organization: Saratov State Medical University
Summary:

We presented surgical results of complicated aggressive hemangioma treatment in transitional sacrolumbar spine. It has been stated that individual peculiarities of decompressive stabilizing surgery depend on the volume of vertebral lesions and their results improve in the combination with presurgical X-ray therapy.

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Decompressive stabilizing operations in the treatment of complicated aggressive hemangiomas of transitional spine.

Year: 2017, volume 13 Issue: №3 Pages: 746-751
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Likhachev S.V., Arsenievich V.B., Salina E.A., Stepukhovich S.V., Norkin A.l., Mizyurov S.A., Zaretskov V.V.
Organization: Saratov State Medical University
Summary:

The aim: to study the efficiency of surgical treatment of complicated aggressive hemangiomas in transitional spine. Material and Methods. Decompressive stabilizing operations were made to 26 patients aged 35-52 years with hemangiomas of vertebral bodies. Individual surgical features varied due to the character and level of the injury. Results. In the experimental patients' group in admission there was neurological deficit of compressional origin associated with the critical values of luminal narrowing due to the epidural component of the neoformation. Stable antalgic effect and decrease in neurological deficit were seen postsurgically. Conclusion. While choosing the surgical option of decompressive stabilizing treatment a surgeon should take into account roentgenomorphometric features of the injured vertebrae. Adequately planned intervention fulfilled with the account of the injury character allows obtaining favorable outcomes as well as LQ improvement, neurological deficit decrease and the elimination of pain syndrome.

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Towards the causes of secondary post-traumatic deformations of thoracic and lumbar spine

Year: 2015, volume 11 Issue: №4 Pages: 570-575
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Shulga А.Е., Zaretskov V.V., Ostrovsky V.V., Arsenievich V.B., Smolkin A.A., Norkin I.A.
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Summary:

The purpose of the study is to analyze and systematize main causes of secondary spine deformations forming in patients who had operations due to thoracic and lumbar spine damages. Material and Methods. The analysis of poor surgical results of 155 patients previously operated due to various thoracic and lumbar spine damages has been conducted. All patients had complications associated with secondary spinal column deformations at various time after the intervention. Standard investigation included the analysis of patients' complaints, their previous history, somatic, neurological and orthopedic status. Results. The intensity of spinal column deformation was defined due to the character and level of primary trauma structurally characterized predominantly by unstable damages. However as it has been found in this research the main cause of this complicated pathology lied in the number of tactical and technical pitfalls of primary surgical treatment. Conclusion. Surgical operations due to secondary post-traumatic deformations in most cases are laborious and are accompanied by significant surgical trauma therefore systematization and analysis of the main causes of poor results of primary spine surgery may contribute to the preventive treatment of this type of pathology.

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Transpedicular fixation in comminuted fractures of bodies of thoracic and lumbar vertebrae

Year: 2014, volume 10 Issue: №3 Pages: 441-446
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Zaretskov V.V. Arsenievich V.B, Likhachev S.V., Shulga A.E., Titova Ju.l..
Organization:
Summary:

Research Objective: improvement of transpedicular fixation technique in cases with spine injuries accompanied by vertebral body splintering. Material and Methods. Transpedicular spondylosynthesis was performed in 52 patients aged 18-49 years with comminuted fractures of thoracic and lumbar vertebral bodies. Individual peculiarities of the operation depended on the character of the injury ascertained during the preoperative examination. Standard roentgenography and computer tomography were used. Results. Lasting antalgic effect was observed in 94,2% of the operated patients. In cases with type A3 fractures according to F. Magerl the rate of the surgical correction of the pathologic posttraumatic kyphotic deformity averages 87%. Injuries classified as type A2, B2 or C2 were the indication for transpedicular os-teosynthesis by advanced techniques. Conclusion. Transpedicular spondylosynthesis is one of the effective methods of treatment of patients with comminuted fractures of thoracic and lumbar vertebral bodies, and the choice of carrying out of the procedure depends on the injury character. In cases with comminuted fractures of type A2, B2, C2 it is reasonable to perform transpedicular spondylosynthesis with introduction of the transpedicular screws into the injured vertebral body, and the technique of their use depends on the injury character.

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Surgical treatment of vertebral body splintered fractures

Year: 2011, volume 7 Issue: №1 Pages: 146-147
Heading: Traumatology and Orthopedics Article type: Short message
Authors: Zaretskov V.V., Arsenievich V.B., Likhachev S.V., Artemov L.A., Titova Yu.l., Zueva D.P.
Organization: Saratov Scientific Research Institute of Traumatology and Orthopedics
Summary:

The given report concerns the method of surgical treatment of vertebral body splintered fractures. The surgery is presented by transpedicular fixation of an injured part and allows to perform reduction of body fragments of the injured vertebra. Simplicity of technical performance and efficiency of the technique explain its practical value

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Staged Surgical Correction of Coarse Rigid Scoliotic Deformations

Year: 2010, volume 6 Issue: №3 Pages: 692-694
Heading: Traumatology and Orthopedics Article type: Short message
Authors: Zaretskov V.V., Arsenievich V.B., Zueva D.P.
Organization: Saratov Scientific Research Institute of Traumatology and Orthopedics
Summary:

The article concerns with surgical treatment of patients with coarse rigid scoliotic deformations. Application of modern surgical techniques in case of given pathology allows to achieve durable positive clinical results

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Ventral interventions in thoracic and lumbar spine injures

Year: 2010, volume 6 Issue: №2 Pages: 435-438
Heading: Traumatology and Orthopedics Article type: Short message
Authors: V.B. Arsenievich, V.V. Zaretskov, S.V. Lihachev, L.A. Artemov, Yu.I. Titova
Organization: Saratov Scientific Research Institute of Traumatology and Orthopedics
Summary:

The present report concerns surgical treatment of unstable thoracic and lumbar spine injuries with the use of ventral approach to vertebral bodies. The use of up-to-date ventral correcting systems and endofixators allows to achieve lasting positive result in such kind of traumas

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