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Lumbar spinal stenosis: changes in the fibrous structures of the posterior spinal column and the rule of the ligamentum flavum
Ježek, Jakub ; Krbec, Martin (advisor) ; Chaloupka, Richard (referee) ; Matějka, Jiří (referee)
The dissertation is focused on lumbar spinal stenosis (LSS), because it is a serious desease, that primary affects elderly patients and which often leads to disability. Because the pathophysiology or feasible prophylaxy is not yet fully understood, the first part of the thesis is devoted to the ligamentum flavum (LF), whose changes (hypertrophy and degeneration) are one of the main factors leading to LSS. We focused in this experimental part on changes in the LF properties that could cause its degeneration and hypertrophy - changes in vascularization (investigated as vascular density - Lv), the presence of inflammatory changes and the occurrence of chondroid metaplasia, and then to clarify changes in the LF mechanical properties (stiffness). Vascular density analysis of degenerated and healthy human LF combined with measurement of micromechanical properties was performed. It was found that Lv changes were not dependent on the degree of LSS but were age dependent, that is, LF vascular density declines up until 50 years of age and thereafter changes very little. A significant increased incidence of chondroid metaplasia and clear signs of inflammation in LSS patients were found out. LF samples from LSS patients showed significantly lower stiffness in comparison to samples of healthy patients. The...
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Treatment of Pelvic Ring Fracture Using Spinopelvic Fixation (Types of Fixation, Indications, Functional Results, Mechanical Characteristics)
Weisová, Drahomíra ; Pavelka, Tomáš (advisor) ; Douša, Pavel (referee) ; Chaloupka, Richard (referee)
In the case of a high-energy injury (traffic accident, fall from above), a pelvic ring injury with vertical instability and/or a sacrum injury with spinopelvic instability may occur. Such instabilities threaten the basic functions of the pelvic ring and lumbosacral junction. Adequate transmission of body and limb load is not possible through such injured segments. The solution is some form of reduction and stabilization to achieve the restoration of anatomical conditions and a gentle and firm connection. Spinopelvic dissociation in some cases accompanying pelvic ring fractures and / or damages is a complex injury with a difficult solution. The frequency of occurrence is reported in the literature 2.9-3.1 %. The number of such accidents is on the rise with higher density and aggressiveness of traffic, the great popularity of dangerous human activities and the accelerating pace of life. Most of these fractures are treated surgically, non-surgical treatment is reserved only for patients who are unable to undergo surgery for internal or local reasons. In our study group, we evaluated a group of patients with a pelvic ring fracture and / or sacral fracture with spinopelvic dissociation who were treated at our workplace in the period 2009- 2019. During this period, 222 patients with a pelvic fracture...
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Spondylodiscitis - Surgical Treatment
Včelák, Josef ; Chomiak, Jiří (advisor) ; Chaloupka, Richard (referee) ; Štulík, Jan (referee)
Introduction: (Experimental part). Hypothesis evaluates the quasi-static risk of transpedicular fixation failure in the spinal cadaver with anterior column defect due to the fixation extension and defines the risk of transpedicular fixation failure due to screw convergence in cyclic loading. (Clinical part). Hypothesis evaluates the risk of isolated dorsal approach to ventral lumbar spondylodiscitis due to clinic and radiopraphic results and the risk of anterior radical debridement due to using titanium implant in the site of bone infection. Methods: (Experimental part). Four anatomically preparated spinal cadavers with anterior spinal column defect transpediculary instrumented were quasi-statically tested on MTS 858,2 Mini-Bionix. Concept of cyclic loading part were based on ASTM standard F1717. (Clinical part). The group A consisting of 23 patients was treated only by dorsal transmuscular approach and the second group B consisting of 8 patients was treated by two-stage postero- anterior surgery in lumbar spondylodiscitis. Results: (Experimental part). There were progress in all assessed parametres with considerable asymmetry direction in extension to flexion and duction in spinal column loading with anterior defect during quasi-static loading. The rod deformation decrease with extent of...
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Radiological, Histochemical and Histological Changes M. Erector Spinae by Patients with a Fracture of Thoracolumbal Spine Treated With Open or Miniivasive Stabilisation
Matějka, Tomáš ; Matějka, Jiří (advisor) ; Džupa, Valér (referee) ; Chaloupka, Richard (referee)
Today, miniinvasive operations are part of modern medicine and in recent years have partially replaced open methods. The aim of this study was to compare radiological, histochemical and histological changes of the erector spinae muscle in patients with thoracolumbar spine fractures treated with open (OPEN) and miniinvasive (MISS) stabilization. The purpose was not to evaluate one method as better or worse, it was only a comparison and finding out the advantages and disadvantages of individual operations. During the study, we compared both the above-mentioned differences in the quality of the erector spinae muscle and laboratory changes in blood levels of muscle enzymes, we compared the duration of operations, the accuracy of insertion of transpediculars screws, blood loss, kyphotization of spine segments and exposure of radiation. It has been hypothesized that muscle damage in all factors will be lower in MISS than in OPEN. A total of 38 patients with type A and B fractures according to the Vaccar classification, 19 underwent MISS surgery and 19 at the OPEN method were included in the prospective randomized study. The average age of the whole group was 46.4 years (18 - 68), the average age for MISS procedures was 42.6 (18 - 66), for OPEN was 48.7 (19 - 68). Only monotrauma of the TL spine was...
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The Surgical Treatment Options in Thoracolumbar Spine Degeneration: The Importance of Morphological and Clinical Classifications in Preoperative Decision Making
Bludovský, David ; Přibáň, Vladimír (advisor) ; Chaloupka, Richard (referee) ; Rudinský, Bruno (referee)
The surgical treatment options in thoracolumbar spine degeneration: The importance of morphological and clinical classifications in preoperative decision making David Bludovský Abstract: Objective: The aim of our study was to investigate the relations between subjective difficulties, clinical findings and the MR imaging in patients who have been operated for symptomatic lumbar spinal stenosis (LSS), and the possibility of using these relations for surgical treatment decision. Methods: Patients operated for lumbar spinal stenosis in 2009-2010 were included in the study. Subjective difficulties were assessed using the Oswestry Disability Index (ODI), the clinical symptoms with the modified Neurological Impairment Score for Lumbar Spinal Stenosis (mNIS-LSS). We measured the spine canal area, dural sac area, and nerve root sedimentation classification on MR. By correlation analysis at significance level p <0.05, we tested the relations between these categories. 61 patients with a median age of 67 were included. Overall, we evaluated 162 spinal segments. Results: Median of ODI values were 48. Correlation coefficients for ODI, mNIS-LSS and graphical findings were less than 0.5. Correlation coefficients greater than 0.5 were between all the MR measurement methods. Conclusions: In the group of patients indicated...
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Spondylodiscitis - Surgical Treatment
Včelák, Josef ; Chomiak, Jiří (advisor) ; Chaloupka, Richard (referee) ; Štulík, Jan (referee)
Introduction: (Experimental part). Hypothesis evaluates the quasi-static risk of transpedicular fixation failure in the spinal cadaver with anterior column defect due to the fixation extension and defines the risk of transpedicular fixation failure due to screw convergence in cyclic loading. (Clinical part). Hypothesis evaluates the risk of isolated dorsal approach to ventral lumbar spondylodiscitis due to clinic and radiopraphic results and the risk of anterior radical debridement due to using titanium implant in the site of bone infection. Methods: (Experimental part). Four anatomically preparated spinal cadavers with anterior spinal column defect transpediculary instrumented were quasi-statically tested on MTS 858,2 Mini-Bionix. Concept of cyclic loading part were based on ASTM standard F1717. (Clinical part). The group A consisting of 23 patients was treated only by dorsal transmuscular approach and the second group B consisting of 8 patients was treated by two-stage postero- anterior surgery in lumbar spondylodiscitis. Results: (Experimental part). There were progress in all assessed parametres with considerable asymmetry direction in extension to flexion and duction in spinal column loading with anterior defect during quasi-static loading. The rod deformation decrease with extent of...
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Reconstructive operations in spine region with bio-ceramic materials use
Lukáš, Richard ; Karpaš, Karel (advisor) ; Štulík, Jan (referee) ; Chaloupka, Richard (referee) ; Rudinský, Bruno (referee)
1. SUMMARY Introduction: During the period of the last 25 years remarkable changes occurred in the treatment of traumas of thoracolumbar spine. The surgical treatment was extended in cases where instability and impairment of its physiological shape are expected. This development is based on the progress in imaging technologies, more detailed understanding of spine biomechanics and a pathophysiology of its impairment. The situation was also influenced by the progression in surgical instruments and implants and also in the technology of bone substitutes. Aim of the study: The aim of the study is to analyze the long term morphological and clinical results after the surgical treatment of thoracolumbar fractures, in which the bioactive glass-ceramics in the form of granules was used as a bone substitute. Material and method: A series of 140 patients treated surgically for unstable thoracolumbar fracture (LSC points 4 - 6) during the period from 1997 to 2003 was studied. The average age of patients was 44 years (14 - 78). The patient collection consists of 83 males in the average age of 43,7 years (14-73) and 57 females in the average age of 44.9 years (15-78). The minimum follow-up was 24 months, the average follow-up period was 29 months. Patient series includes a group of 91 cases, in which the implant was...
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