THE SYNDROME OF NEUROLOGICAL DISORDERS AS A PREDICTOR OF EARLY DIAGNOSIS AND A CRITERION FOR THE EFFECTIVENESS OF SURGICAL TREATMENT OF NONSPECIFIC PURULENT DISEASES OF THE SPINE
DOI: 10.22138/2500-0918-2020-17-2-175-186
M.Yu. Goncharov, D.D. Masyutina
Sverdlovsk Regional Clinical Hospital No. 1, Yekaterinburg, Russian Federation;
Ural State Medical University, Yekaterinburg, Russian Federation
Abstract. Nonspecific purulent diseases of the spine (NPDS) are a relatively rare pathology that is little known to a wide circle of doctors, as a result of which mistakes are often made in the tactics of patient management, the timing of diagnosis and the appointment of adequate therapy is delayed. Long-term «diagnostic trap» leads to the formation of persistent neurological deficits. Goal. The purpose is to study the structure of neurological manifestations in the diagnosis NPDS and the dynamics in assessing the quality of surgical treatment. Materials and methods. The article presents an analysis of a group of patients receiving treatment for NPDS in the neurosurgical department of State budgetary health institution in the Sverdlovsk region '‘Sverdlovsk Regional Clinical Hospital No. 1’' in Yekaterinburg for the period from 2005 to 2018 with an assessment of the dynamics of neurological disorders and vertebral pain syndrome in the early postoperative period. A significantly better result in assessing regression of neurological disorders and a decrease in the severity of pain in the postoperative period was observed in the group of patients who underwent decompression-sanitizing-stabilizing surgeries (DSS) in comparison with decompression-sanitizing (DS). Conclusions. The understanding by primary care physicians, neurologists, neurosurgeons of high-risk patient groups, the dynamics of clinical manifestations, and effective diagnostic methods contributes to the choice of the correct management tactics and timely surgical treatment, which significantly improves outcomes, reduces disability rates, and improves the quality of life of patients.
Keywords: nonspecific purulent diseases of the spine, spondylitis, spondylodiscitis, surgical treatment, vertebral pain syndrome
Received 30.10.2020
For citation:
Goncharov M.Yu., Masyutina D.D. The syndrome of neurological disorders as a predictor of early diagnosis and a criterion for the effectiveness of surgical treatment of nonspecific purulent diseases of the spine. Vestn. Ural. Med. Akad. Nauki. = Journal of Ural Medical Academic Science. 2020, Vol. 17, no. 2, pp. 175–186. DOI: 10.22138/2500-0918-2020-17-2-175-186 (In Russ)
REFERENCES
1. Ardashev I.P., Noskov V.P., Ardasheva E.I. etc. Vertebral infection. Medicina v Kuzbasse. 2005; 1: 17–21 (in Russian).
2. Dulaev A.K., Nadulich K.A., YAstrebkov N.M. Hirurgicheskie tekhnologii lecheniya infekcionnyh spondilitov. 7-j Ros. nac. kongress. SPb. 2002: 200-204. (in Russian).
3. Morozov A.K., Vetrile S.T., Kolbovskij D.A. i dr. Diagnostika nespecificheskih vospalitel'nyh zabolevanij pozvonochnika. Vestn. travmatol. i ortoped. im. N.N. Priorova. 2006; 2: 32–37. (in Russian).
4. Ruf M., Stoltze D., Merk H.R., et al. Treatment of vertebral osteomyelitis by radical debridement and stabilization using titanium mesh cages. Spine. 2007; 32: 275–280.
5. Vetrile S.T., Kolbovskij D.A. Mini-invazivnye metody lecheniya bol'nyh s nespecificheskim gematogennym osteomielitom pozvonochnika. Hirurgiya pozvonochnika – polnyj spektr. M., 2007: 107–109. (in Russian).
6. Kavalerskij G.M., Procenko A.I., Sotikov K.V. i dr. Hirurgicheskoe lechenie gnojnogo spondilita. Vestn. travmatol. i ortoped. im. N.N. Priorova. 2006; 2: 37–40. (in Russian).
7. Houten J.K., Cooper P.R. Pyogenic osteomyelitis of the spine. Contemporary neurosurgery. 2000; 22: 1–5.
8. Clinical practice guideline number 1: acute pain management: operative or medical procedures and trauma. Rockville, MD: Agency for Health Care Policy and Research, AHCPR publication no. 92-0032; 1992: 116-117.
9. Fishchenko V.YA., Fishchenko YA.V. Klassifikaciya gematogennogo osteomielita pozvonochnika. Novye tekhnologii v voenno-polevoj hirurgii i hirurgii povrezhdenij mirnogo vremeni: Tez. dokl. SPb. 2006: 322–323. (in Russian).
10. McHenry M.C., Easley K.A., Locker G.A. Vertebral osteomyelitis: long-term outcome for 253 patients from 7 Clevelang-area hospitals. Clin. Infect Dis. 2002; 34: 1342–1350.
11. Gushcha A.O., Semenov M.S., Poltorako E.A., Kashcheev A.A., Vershinin A.V. Klinicheskie rekomendacii po diagnostike i lecheniyu vospalitel'nyh zabolevanij pozvonochnika i spinnogo mozga. M., 2015. (in Russian).
12. Tay B.K., Deckey J., Hu S.S. Spine infections. J. Am. Acad. Orthop. Surg. 2002; 10; 188–197.
Authors
Maksim Yu. Goncharov
Sverdlovsk Regional Clinical Hospital No. 1, neurosurgical department
Cand. Sci. (Med.), The doctor — neurosurgeon of the highest category, doctor-vertebrologist
185, Volgogradskaya str., Yekaterinburg, Russian Federation, 620102
mgmed@list.ru
Dar'ya D. Masyutina
Ural State Medical University
The doctor-intern 2 years of study
3, Repin str., Yekaterinburg, Russian Federation, 620028