Kutzenko V. Lumbar spondylolisthesis (patogenesis, diagnostic, prediction and treatment)

The object: spondylolisthesis. The goal of investigation: to work out and verify the conceptual model of spondylolisthesis, to determine the criteria and work out forecast method, to improve diagnostics and treatment of the different variants of spondylolisthesis. Methods: clinical, radiological (including contrast X-ray, roentgenometry), magnetic-resonance and computer tomography; conceptual and mathematic modeling using the final-element method, biomechanical, biochemical, histological, statistical. For the first time the morphological and metabolic peculiarities of the remodeling process in vertebral segments in patients with different variants of spondylolisthesis are studied, as well as in modeling on experimental animals (rats). The similarity of pathological and sanogenetic mechanisms of structural and metabolic changes in the tissues of vertebral segments in patients with spondylolisthesis and in modeling of spondylolisthesis on experimental animals (rats). For the first time the correlation relations between the parameters of spine-pelvis balance and the parameters of remodeling of bone elements of vertebral segments in patients with different variants of dysplastic and degenerative spondylolisthesis were determined. For the first time the major modification of stressedly-deformed condition in the elements of vertebral segments in the conditions that contribute spondylolisthesis development, as well as biomechanical characteristics of abnormalities of the regulation of vertical pose and coordination of the crossing from standing to walking. New conceptual model of the pathogenesis of different variants of spondylolisthesis was created and verified. Etiopathogenetic and structural-functional classification of spondylolisthesis are improved. Quantitative criteria for the diagnostics of the different variants of spondylolisthesis were determined. Forecasting method for the course of different variants of spondylolisthesis was worked out using the results of multiple regression analysis. The technology of conservative and surgical treatment is improved. The principles of choice of optimal strategy and tactics of treatment are worked out; those allow improving the quality of treatment of patients with spondylolisthesis substantially. The results of investigation have been being used in the clinical practice of Public Institution “Sytenko Institute of Spine and Joint Pathology AMS of Ukraine”, Public Institution “Institute of Traumatology and Orthopedics AMS of Ukraine”, Public Institution “Kharkiv Regional clinical Hospital”, they are also included in the course of lectures at the department of traumatology and orthopedics of Kharkov medical academy of postgraduate education, department of traumatology and orthopedics and department of physical rehabilitation and sports medicine of Kharkov national medical university, department of traumatology and orthopedics. Traumatology and orthopedy.