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Byvaltsev VA, Kalinin AA, Polkin RA, Kuharev AV, Almatov MS, Aliyev MA, Riew KD. Simultaneous Versus Staged Surgery For Double Crush Syndrome Of Cervical Radiculopathy And Peripheral Nerve Compression At The Wrist: A Retrospective Single-Center Study. Spine (Phila Pa 1976) 2024:00007632-990000000-00577. [PMID: 38305349 DOI: 10.1097/brs.0000000000004950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 01/12/2024] [Indexed: 02/03/2024]
Abstract
STUDY DESIGN Retrospective single-center study. OBJECTIVES to evaluate the results of surgical treatment in patients with double crush syndrome associated with cervical radiculopathy and upper limb peripheral nerve compression after staged and simultaneous operations. SUMMARY OF BACKGROUND DATA Currently, choosing the optimal diagnostic and therapeutic modalities in treating patients with double crush syndrome remains unresolved. METHODS The study included 79 patients with double crush syndrome (cervical radiculopathy and syndrome of Guyon's canal or Carpal tunnel syndrome). Two independent groups were studied: In the Staged Group (n=35), we performed a cervical decompression with stabilization and peripheral nerve decompression at separate days due to ongoing clinical symptoms (average interval between interventions being 22 (18;26) days). In the Simultaneous Group (n=33), we performed both the cervical spine surgery, as well as the peripheral nerve procedures in one surgical session. Total operative time, estimate blood loss, length of hospitalization, complications and clinical data (NDI score, SF-36, VAS neck pain score, VAS arm pain score, Disabilities of Arm, Shoulder and Hand (DASH) score, Macnab scale) were compared. We used the Mann-Whitney (MW) test for intergroup comparisons, Wilcoxon criterion for dependent samples, and Fisher's exact test for binomial parameters. RESULTS There was a significantly lower operative time, duration of inpatient treatment and temporary disability in the Simultaneous Group (P=0.01, P=0.04 and P=0.006 respectively). Comparative analysis did not reveal significant intergroup differences using NDI, VAS and DASH (P>0.05), whereas, at discharge, significantly better clinical parameters were appreciated for the Simultaneous Group using SF-36 and Macnab scores (P=0.04 and P=0.03, respectively). At Last Follow-up, an intra-group analysis revealed comparable clinical effectiveness between the two approaches (P>0.05). CONCLUSION Comparison of the effectiveness of simultaneous and staged surgery revealed comparable long-term clinical outcomes. However, simultaneous surgery conveys clinically important advantages in terms of surgical time, anesthesia duration, length of hospitalization and patient disability. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Vadim A Byvaltsev
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
- Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia
- Department of Traumatology, Orthopedic and Neurosurgery, Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia
| | - Andrei A Kalinin
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
- Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia
| | - Roman A Polkin
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
- Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia
| | - Alexander V Kuharev
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
| | - Marat S Almatov
- Department of Neurosurgery, Kazakhstans School of Public Health, Almaty, Kazakhstan
| | - Marat A Aliyev
- Department of Neurosurgery, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - K Daniel Riew
- Department of Orthopedic Surgery, Columbia University, New York, USA
- Department of Neurological Surgery, Weill Cornell Medical School, New York, USA
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Byvaltsev VA, Polkin RA, Kalinin AA, Belykh E, Riew KD. Laminectomy with Laminar Reconstruction for Resection of Intradural Tumors at the Thoracolumbar Junction: A Technical Note. World Neurosurg 2023; 179:104-108. [PMID: 37611800 DOI: 10.1016/j.wneu.2023.08.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/11/2023] [Accepted: 08/12/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE To introduce a new laminar reconstruction technique to treat primary spinal cord tumors. METHODS Laminectomy and laminoplasty techniques have been used to treat intradural spinal tumors. The advantage of laminectomy is its superior exposure of the spinal cord, whereas the advantage of laminoplasty is the reconstruction of the dorsal roof of the spine. In this technical note, we present a technique that combines a full laminectomy to maximize exposure, with a reconstructive technique to repair the lamina. This technique restores the posterior ligamentous complex to preserve spinal biomechanics. RESULTS In this illustrative case, a 55-year-old woman with severe back pain radiating to the right lower extremity was found to have an intradural tumor at the T12-L1 spinal level. Given the transitional level of the spine and potentially high biomechanical stresses on the posterior support structures, we used a T12 laminectomy to resect the tumor, followed by reconstruction using miniplates. The patient tolerated the surgery well, without any complications. She was discharged home and was doing well during the 3 months follow-up visit. Appropriate patient consent was obtained. CONCLUSIONS Laminectomy and laminar reconstruction allow maximum visualization and manipulation of the tumor, followed by restoration of the dorsal roof of the spinal ring, and is an effective technique for treating spinal cord tumors.
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Affiliation(s)
- Vadim A Byvaltsev
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia; Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia; Department of Traumatology, Orthopedic and Neurosurgery, Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia.
| | - Roman A Polkin
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia; Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia
| | - Andrei A Kalinin
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia; Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia
| | - Evgenii Belykh
- Department of Neurosurgery, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
| | - K Daniel Riew
- Department of Orthopedic Surgery, Columbia University, New York, New York, USA; Department of Neurological Surgery, Weill Cornell Medical College, New York, New York, USA
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Byvaltsev VA, Polkin RA, Kalinin AA, Burnashev AA, Belykh EG. A Modified Cyst-Subarachnoid Shunt Technique for the Treatment of Intramedullary Ependymal Cyst: 2-Dimentional Operative Video. Oper Neurosurg (Hagerstown) 2023:01787389-990000000-00685. [PMID: 37083640 DOI: 10.1227/ons.0000000000000687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 01/22/2023] [Indexed: 04/22/2023] Open
Affiliation(s)
- Vadim A Byvaltsev
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
- Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia
- Department of Traumatology, Orthopedic and Neurosurgery, Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia
| | - Roman A Polkin
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
- Department of Traumatology, Orthopedic and Neurosurgery, Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia
| | - Andrei A Kalinin
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
- Department of Traumatology, Orthopedic and Neurosurgery, Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia
| | - Alean A Burnashev
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
| | - Evgenii G Belykh
- Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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Byvaltsev VA, Kalinin AA, Polkin RA, Shepelev VV, Aliyev MA, Dyussembekov YK. Minimally invasive corpectomy and percutaneous transpedicular stabilization in the treatment of patients with unstable injures of the thoracolumbar spine: Results of retrospective case series. J Craniovertebr Junction Spine 2021; 12:294-301. [PMID: 34728997 PMCID: PMC8501818 DOI: 10.4103/jcvjs.jcvjs_47_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/07/2021] [Indexed: 12/02/2022] Open
Abstract
Objective: The objective of this study was to analyze the results of surgical treatment of patients with unstable injuries of the thoracolumbar spine using simultaneous minimally invasive corpectomy and percutaneous transpedicular stabilization. Materials and Methods: The retrospective study included 34 patients with isolated single-level unstable injuries of the thoracolumbar spine (5 or more points according to the Thoracolumbar Injury Classification and Severity Score (TLICS), operated on from the moment of injury from 8 to 24 h using the technique of minimally invasive corpectomy and percutaneous transpedicular stabilization simultaneously. The technical features of surgery, clinical data (pain level according to the Visual Analog Scale, quality of life according to the SF-36 questionnaire, subjective satisfaction with the operation according to the MacNab scale, and the presence of complications), and instrumental data (angle of segmental kyphotic deformity and sagittal index to and after surgery). The assessment of clinical data was carried out before surgery, at discharge, after 6 months, and in the long-term period, on average, 30 months after surgery. Results: When evaluating the clinical data, a significant decrease in the severity of pain syndrome was found on average from 90 mm to 5.5 mm in the late follow-up (P < 0.001), as well as a significant improvement in the physical and psychological components of health according to the SF-36 questionnaire on average from 28.78 to 39.26 (P < 0.001), from 36.93 to 41.43 (P = 0.006), respectively. In the long-term period, according to the MacNab scale, the patients noted the result of the operation: excellent – 18 (52.9%), good – 13 (38.3%), and satisfactory – 3 (8.8%); no unsatisfactory results were registered. Four (11.8%) perioperative surgical complications were registered, which were successfully treated conservatively. A significant restoration of the sagittal profile with an insignificant change in blood pressure was recorded in the long-term postoperative period. An average follow-up assessment of 30 months according to the American Spinal Injury Association scale showed the presence of E and D degrees in 85.4% of patients. Conclusion: Minimally invasive corpectomy with percutaneous transpedicular stabilization in the treatment of patients with unstable injuries of the thoracolumbar spine can effectively eliminate kyphotic deformity and prevent the loss of its reduction with a low number of postoperative surgical complications. The technique has minimal surgical trauma with the possibility of early postoperative rehabilitation and provides a significant stable reduction in vertebrogenic pain syndrome, improvement of neurological deficits, and restoration of the quality of life of patients and in the follow-up.
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Affiliation(s)
- Vadim A Byvaltsev
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia.,Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia
| | - Andrei A Kalinin
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia.,Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia
| | - Roman A Polkin
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia.,Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia
| | - Valerii V Shepelev
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
| | - Marat A Aliyev
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia.,Department of Neurosurgery, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Yermek K Dyussembekov
- Department of Neurosurgery, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
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Byvaltsev VA, Bardonova LA, Onaka NR, Polkin RA, Ochkal SV, Shepelev VV, Aliyev MA, Potapov AA. Acridine Orange: A Review of Novel Applications for Surgical Cancer Imaging and Therapy. Front Oncol 2019; 9:925. [PMID: 31612102 PMCID: PMC6769070 DOI: 10.3389/fonc.2019.00925] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 09/04/2019] [Indexed: 01/10/2023] Open
Abstract
Introduction: Acridine orange (AO) was first extracted from coal tar in the late nineteenth century and was used as a fluorescent dye. In this paper, we review emergent research about novel applications of AO for fluorescence surgery and cancer therapy. Materials and methods: We performed a systematic search in the MEDLINE, PubMed, Cochrane library, Google Scholar, Embase, Web of Science, and Scopus database using combinations of the term "acridine orange" with the following: "surgical oncology," "neuropathology," "microsurgery," "intraoperative fluorescence," "confocal microscopy," "pathology," "endomicroscopy," "guidance," "fluorescence guidance," "oncology," "surgery," "neurooncology," and "photodynamic therapy." Peer-reviewed articles published in English were included in this review. We have also scanned references for relevant articles. Results: We have reviewed studies on the various application of AO in microscopy, endomicroscopy, intraoperative fluorescence guidance, photodynamic therapy, sonodynamic therapy, radiodynamic therapy. Conclusion: Although the number of studies on the clinical use of AO is limited, pilot studies have demonstrated the safety and feasibility of its application as an intraoperative fluorescent dye and as a novel photo- and radio-sensitizator. Further clinical studies are necessary to more definitively assess the clinical benefit AO-based fluorescence guidance, therapy for sarcomas, and to establish feasibility of this new approach for the treatment of other tumor types.
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Affiliation(s)
- Vadim A. Byvaltsev
- Neurosurgery and Innovative Medicine Department, Irkutsk State Medical University, Irkutsk, Russia
- Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russia
| | - Liudmila A. Bardonova
- Neurosurgery and Innovative Medicine Department, Irkutsk State Medical University, Irkutsk, Russia
| | - Naomi R. Onaka
- University of Arizona College of Medicine, Phoenix, AZ, United States
| | - Roman A. Polkin
- Neurosurgery and Innovative Medicine Department, Irkutsk State Medical University, Irkutsk, Russia
| | - Sergey V. Ochkal
- Neurosurgery and Innovative Medicine Department, Irkutsk State Medical University, Irkutsk, Russia
| | - Valerij V. Shepelev
- Neurosurgery and Innovative Medicine Department, Irkutsk State Medical University, Irkutsk, Russia
| | - Marat A. Aliyev
- Neurosurgery and Innovative Medicine Department, Irkutsk State Medical University, Irkutsk, Russia
| | - Alexander A. Potapov
- Federal State Autonomous Institution “N. N. Burdenko National Scientific and Practical Center for Neurosurgery” of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
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Byvaltsev VA, Akshulakov SK, Polkin RA, Ochkal SV, Stepanov IA, Makhambetov YT, Kerimbayev TT, Staren M, Belykh E, Preul MC. Microvascular Anastomosis Training in Neurosurgery: A Review. Minim Invasive Surg 2018; 2018:6130286. [PMID: 29796313 PMCID: PMC5896222 DOI: 10.1155/2018/6130286] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 02/20/2018] [Indexed: 11/22/2022] Open
Abstract
Cerebrovascular diseases are among the most widespread diseases in the world, which largely determine the structure of morbidity and mortality rates. Microvascular anastomosis techniques are important for revascularization surgeries on brachiocephalic and carotid arteries and complex cerebral aneurysms and even during resection of brain tumors that obstruct major cerebral arteries. Training in microvascular surgery became even more difficult with less case exposure and growth of the use of endovascular techniques. In this text we will briefly discuss the history of microvascular surgery, review current literature on simulation models with the emphasis on their merits and shortcomings, and describe the views and opinions on the future of the microvascular training in neurosurgery. In "dry" microsurgical training, various models created from artificial materials that simulate biological tissues are used. The next stage in training more experienced surgeons is to work with nonliving tissue models. Microvascular training using live models is considered to be the most relevant due to presence of the blood flow. Training on laboratory animals has high indicators of face and constructive validity. One of the future directions in the development of microsurgical techniques is the use of robotic systems. Robotic systems may play a role in teaching future generations of microsurgeons. Modern technologies allow access to highly accurate learning environments that are extremely similar to real environment. Additionally, assessment of microsurgical skills should become a fundamental part of the current evaluation of competence within a microneurosurgical training program. Such an assessment tool could be utilized to ensure a constant level of surgical competence within the recertification process. It is important that this evaluation be based on validated models.
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Affiliation(s)
- Vadim A. Byvaltsev
- Irkutsk State Medical University, Krasnogo Vosstaniya St. 1, Irkutsk, Russia
- Irkutsk Scientific Center of Surgery and Traumatology, Bortsov Revolutsii St. 1, Irkutsk, Russia
- Railway Clinical Hospital, Irkutsk-Passazhirskiy of Russian Railways Ltd., Botkina St. 10, Irkutsk, Russia
- Irkutsk State Medical Academy of Postgraduate Education, Jubileiniyi 100, Irkutsk, Russia
| | | | - Roman A. Polkin
- Irkutsk State Medical University, Krasnogo Vosstaniya St. 1, Irkutsk, Russia
| | - Sergey V. Ochkal
- Irkutsk State Medical University, Krasnogo Vosstaniya St. 1, Irkutsk, Russia
| | - Ivan A. Stepanov
- Irkutsk State Medical University, Krasnogo Vosstaniya St. 1, Irkutsk, Russia
| | | | | | - Michael Staren
- Department of Neurosurgery Research, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 West Thomas Road, Phoenix, AZ 85013, USA
| | - Evgenii Belykh
- Irkutsk State Medical University, Krasnogo Vosstaniya St. 1, Irkutsk, Russia
- Department of Neurosurgery Research, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 West Thomas Road, Phoenix, AZ 85013, USA
| | - Mark C. Preul
- Department of Neurosurgery Research, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 West Thomas Road, Phoenix, AZ 85013, USA
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