РАЗРАБОТКА ДИФФЕРЕНЦИРОВАННОЙ ХИРУРГИЧЕСКОЙ ТАКТИКИ ПРИ  ЛЕЧЕНИИ ДЕГЕНЕРАТИВНОГО ЗАБОЛЕВАНИЯ ПОЯСНИЧНОГО ОТДЕЛА  ПОЗВОНОЧНИКА У ПРОФЕССИОНАЛЬНЫХ СПОРТСМЕНОВ

V.A. Byvaltsev; A.A. Kalinin; Y.Y. Pestryakov; M.A. Aliyev

doi:10.54890/1694-8882-2024-3-42

V.A. Byvaltsev A.A. Kalinin Y.Y. Pestryakov M.A. Aliyev

DOI:

https://doi.org/10.54890/1694-8882-2024-3-42

Abstract

The lack of an objectively based treatment strategy to guide spinal surgeons when treating professional athletes prompted us to study the experience of treating such patients. Purpose. To analyze the results of neurosurgical treatment of professional athletes and those with degenerative disease of the lumbar spine, to develop a clinical and instrumental algorithm for differentiated surgical tactics.
Material and methods. An analysis was made of the results of neurosurgical treatment of 114 professional athletes and those with degenerative disease of the lumbar spine, who underwent: (1) microsurgical/endoscopic discectomy (n=35); (2) PRP therapy of the facet joints (FJ) (n=41); total arthroplasty of intervertebral discs (IVD) (n=11); rigid decompressive and stabilizing interventions (n=27). Postoperative clinical outcomes and preoperative instrumental results were assessed.
Results. A correlation was established between the method of surgical treatment and preoperative clinical symptoms, the severity of degenerative changes in the IVD and DS, the timing of return to sports, the long-term level of pain, quality of life according to SF-36 and the degree of tolerance to physical activity. To optimize the results of surgical treatment of the analyzed patients, an algorithm for planning neurosurgical treatment tactics was developed, based on individual preoperative neurological manifestations and morphological changes in the lumbar segments.
Conclusion. The use of a personalized method of neurosurgical treatment in a group of patients who are professionally involved in sports can ensure: rapid restoration of preoperative sports activity, reduce the risk of perioperative complications, and reduce financial costs for non-core treatment.

Keywords:

professional athletes; lumbar spine; degenerative diseases; preoperative planning; algorithm of neurosurgical tactics.

References

1. Reid PC, Morr S, Kaiser MG. State of the union: a review of lumbar fusion indications and techniques for degenerative spine disease. J Neurosurg Spine. 2019;31(1):1-14. https://doi.org/10.3171/2019.4.SPINE18915

2. Davison MA, Lilly DT, Moreno J, Bagley C, Adogwa O. A comparison of successful versus failed nonoperative treatment approaches in patients with degenerative conditions of the lumbar spine. J Clin Neurosci. 2021;86:71-78. https://doi.org/10.1016/j.jocn.2020.12.033

3. Бывальцев В.А., Калинин А.А., Шепелев В.В., Пестряков Ю.Я, Сатардинова Э.Е., Бирючков М.Ю. Результаты проведения минимально-инвазивного поясничного спондилодеза у профессиональных спортсменов. Журнал неврологии и психиатрии им. С.С. Корсакова. 2021;121(11):49-54. https://doi.org/ 10.17116/jnevro202112111149

4. Gause P.R., Godinsky R.J., Burns K.S., Dohring E.J. Lumbar Disk Herniations and Radiculopathy in Athletes. Clin Sports Med. 2021;40(3):501-511.https://doi.org/ 10.1016/j.csm.2021.04.001

5. Shah K, Bharuka A, Gadiya A, Nene A. Assessment of Outcomes of Spine Surgery in Indian Athletes Involved in High-End Contact Sports. Asian Spine Journal. 2021;15(2):192-199. https://doi.org/10.31616/asj.2019.0376

6. Cook RW, Hsu WK. Return to Play after Lumbar Spine Surgery. Clinics in Sports Medicine. 2016;35(4):609-619. https://doi.org/10.1016/j.csm.2016.05.006

7. Бывальцев В.А., Калинин А.А., Оконешникова А.К., Бирючков М.Ю. Результаты применения методики PRP-терапии для лечения изолированного поясничного фасет-синдрома у профессиональных атлетов, занимающихся спортивными играми. Человек. Спорт. Медицина. 2022422(1):169-178. https://doi.org/10.14529/hsm220123

8. Byvaltsev VA, Kalinin AA, Aliyev MA, Shepelev VV, Pestryakov YY, Ivanov M. Clinical-Instrumental Results and Analysis of Functional Activity Restoration in Professional Athletes After Lumbar Total Disk Replacement. World Neurosurg. 2021;151:e1069-e1077. https://doi.org/10.1016/j.wneu.2021.05.066

9. Бывальцев В.А., Калинин А.А., Шепелев В.В., Пестряков Ю.Я., Алиев М.А., Коновалов Н.А. Результаты минимально инвазивного поясничного спондилодеза у профессиональных спортсменов: одноцентровое ретроспективное исследование. Вопросы нейрохирургии имени Н.Н. Бурденко. 2021;85(4):12-19. https://doi.org/10.17116/neiro 20218504112

10. Takatalo J, Karppinen J, Näyhä S, Taimela S, Niinimäki J, Blanco Sequeiros R, et al. Association between adolescent sport activities and lumbar disk degeneration among young adults Scand J Med Sci Sports. 2017;27(12):1993-2001. https://doi.org/10.1111/sms.12840

11. Deng H, Yue JK, Ordaz A, Suen CG, Sing DC. Elective lumbar fusion in the United States: national trends in inpatient complications and cost from 2002-2014. J Neurosurg Sci. 2021;65(5):503-512. https://doi.org/10.23736/S0390-5616.19.04647-2

12. Davis GA, Makdissi M, Bloomfield P, Clifton P, Cowie C, Echemendia R, et al. Concussion Guidelines in National and International Professional and Elite Sports. Neurosurgery. 2020;87(2):418-425. https://doi.org/10.1093/neuros/nyaa057

13. Choi JH, Ochoa JK, Lubinus A, Timon S, Lee YP, Bhatia NN. Management of lumbar spondylolysis in the adolescent athlete: a review of over 200 cases. Spine J. 2022;10:1628-1633. https://doi.org/10.1016/j.spinee.2022.04.011

14. Ziegler DS, Jensen RK, Storm L, Carreon L, Andersen MO. The Association Between Early Postoperative Leg Pain Intensity and Disability at 1-Year and 2-Year Follow-Up After First-Time Lumbar Discectomy. Global Spine J. 2021;11(1):81-88. https://doi.org/10.1177/2192568219893296

15. Kantrowitz DE, Padaki AS, Ahmad CS, Lynch TS. Defining platelet-rich plasma usage by team physicians in elite athletes. The Orthopaedic Journal of Sports Medicine. 2018;6(4):1-10. https://doi.org/10.1177/2325967118767077

16. Van de Kelft E, Verguts L. Clinical outcome of monosegmental total disc replacement for lumbar disc disease with ball-and-socket prosthesis (Maverick): prospective study with four-year follow-up. World Neurosurg. 2012;78(3-4):355-363. https://doi.org/10.1016/j.wneu.2011.10.043

17. Jain NS, Lin CC, Halim A, Knight B, Byrne CT, Alluri R, et al. Return to Recreational Sport Following Lumbar Fusion. Clin Spine Surg. 2020;33(4):E174-E177. https://doi.org/10.1097/BSD.0000000000000980