Assessment of Lactate Production and Proteoglycans Synthesis by the Intact and Degenerated Intervertebral Disc Cells under the Influence of Activated Macrophages: an In Vitro Study.

The effects of proinflammatory cytokines on the secretion of glycosaminoglycans and lactate production by normal and degenerated intervertebral disk cells were studied on the model of their co-culturing with activated macrophage-like cells. It was found that proinflammatory cytokines produced a direct effect on intervertebral disk cells in a 3D culture reducing the rate of glycolysis and synthetic activity of both normal and degenerated cells of annulus fibrosus and nucleus pulposus, which is an important factor in progression of intervertebral disk degeneration.

Development of an In Vitro Model of Inflammatory Cytokine Influences on Intervertebral Disk Cells in 3D Cell Culture Using Activated Macrophage-Like THP-1 Cells.

We developed a new model for evaluation of the influence of proinflammatory cytokines on intervertebral disc cells in a 3D culture based on co-culturing of these cells with activated macrophage-like THP-1 cells. The levels of TNFα, IL-1ß, IL-6, IL-8, IL-10, and IL-12p70 production were assessed by flow cytofluorometry using microspheres. Considerable differences in the level of spontaneous cytokine secretion by normal and degenerated intervertebral disc cells were revealed. A significant increase in the level of IL-1ß and IL-8 was observed during co-culturing, which confirms consistency of the developed model.

[The use of apparent diffusion coefficient in diagnosis of lumbar intervertebral disk degeneration in patients with middle and old age by diffusion-weighted MRI.]

The most common cause of low back pain is the intervertebral disk (IVD) degeneration. Standard modes of MRI (T1 and T2-modes) do not allow quantifying the degree of IVD degeneration. Diffusion-weighted MRI (DW MRI) is able to analyze the state of IVD structures by the diffusion of water molecules. The degree of diffusion can be estimated using the apparent diffusion coefficient (ADC). In this paper, a quantitative assessment of the degree of IVD degeneration was made by ADC calculating. 281 IVD were studied in 57 elderly and senile patients with the definition of body mass index (BMI). ADC values and degree of C.W.Pfirmann degeneration were measured. For each of the five IVDs, reliable differences in mean ADC values were determined. Between age and mean ADC values noted inverse relationship. Between the degree of IVD degeneration, BMI and ADC values, a reliable inverse relationship noted also. Age, BMI values and the degree of IVD degeneration are the most significant factors affecting the ADC value. Thus, the DW MRI technique can be recommended, as a modern non-invasive method for diagnosing the degree of IVD degeneration in elderly and senile patients.

[Molecular biology of brain meningiomas].

Meningiomas are by far the most common tumors arising from the minges. A myriad of aberrant signaling pathways involved with meningioma tumorigenesis, have been discovered. Understanding these disrupted pathways will aid in deciphering the relationship between various genetic changes and their downstream effects on meningioma pathogenesis. An understanding of the genetic and molecular profile of meningioma would provide a valuable first step towards developing more effective treatment for this intracranial tumor. Chromosomes 1, 10, 14, 22, their associated genes, have been linked to meningioma proliferation and progression. It is presumed that through an understanding of these genetic factors, more educated meningioma treatment techniques can be implemented. Future therapies will include combinations of targeted molecular agents including gene therapy, si-RNA mediation, proton therapy, and other approaches as a result of continued progress in the understanding of genetic and biological changes associated with meningiomas.

Complex Analysis of Diffusion Transport and Microstructure of an Intervertebral Disk.

We studied the relationship between diffusion transport and morphological and microstructural organization of extracellular matrix of human intervertebral disk. Specimens of the lumbar intervertebral disks without abnormalities were studied ex vivo by diffusion-weighed magnetic resonance imaging, histological and immunohistochemical methods, and electron microscopy. Distribution of the diffusion coefficient in various compartments of the intervertebral disk was studied. Significant correlations between diffusion coefficient and cell density in the nucleus pulposus, posterior aspects of annulus fibrosus, and endplate at the level of the posterior annulus fibrosus were detected for each disk. In disks with nucleus pulposus diffusion coefficient below 15×10-4 mm2/sec, collagens X and XI were detected apart from aggrecan and collagens I and II. The results supplement the concept on the relationship between the microstructure and cell composition of various compartments of the intervertebral disk and parameters of nutrient transport.

[The possibilities for diagnostics of prescription of death coming based on the changes in the lumbar intervertebral disks (the comparison of the morphological, immunohistochemical and topographical findings)]. / Vozmozhnosti diagnostiki davnosti nastupleniia smerti po izmeneniiam v poiasnichnykh mezhpozvonkovykh diskakh (sopostavlenie morfologicheskikh, immunogistokhimicheskikh i tomograficheskikh rezul'tatov).

The objective of the present study was the comprehensive analysis of the postmortem changes in the lumbar intervertebral disks within different periods after death. A total of seven vertebromotor segments were distinguished in the lumbosacral region of the vertebral column based on the examination of 7 corpses. All these segments were divided into three groups in accordance with the prescription of death coming as follows: up to 12 hours (group 1), between 12 and 24 hours (group 2), and between 24 and 36 hours (group 3) after death. The models of the segments thus obtained were subjected to the study by means of diffusion weighted MRI. The removed intervertebral disks were used for morphological and immunohistochemical investigations. The comparison of the diffusion coefficients (DI) revealed the significant difference between the intervertebral disks assigned to groups 1 and 2 (p<0.01). The number of the cells in the pulpal core, the vertebral end plate, and the fibrous ring in all the above groups of the intervertebral disks was significantly reduced (p<0.01). The analysis of the correlation dependence between cell density and diffusion coefficients has demonstrated the well apparent relationship between these characteristics of the intervertebral disks comprising groups 1 and 2. It is concluded that diffusion weighted MRI in the combination with the calculation of diffusion coefficients for the intervertebral disks provides a tool for diagnostics of prescription of death coming as confirmed by the results of the morphometric studies and immunohistochemical analysis.

[Warfarin-associated epidural hematoma with spinal cord compression]. / Varfarinassotsiirovannaya epidural'naya gematoma s kompressiei spinnogo mozga.

Hemorrhages into the structures of the central nervous system are the most life threatening among warfarin-associated complications. There are extremely few reports about spontaneous spinal epidural hematomas (SEH) associated with warfarin, methods of their timely diagnosis, treatment approaches. The authors present the first in the domestic literature case-report of warfarin-associated spontaneous SEH and the literature review.

[New simulation technologies in neurosurgery].

The article presents a literature review on the current state of simulation technologies in neurosurgery, a brief description of the basic technology and the classification of simulation models, and examples of simulation models and skills simulators used in neurosurgery. Basic models for the development of physical skills, the spectrum of available computer virtual simulators, and their main characteristics are described. It would be instructive to include microneurosurgical training and a cadaver course of neurosurgical approaches in neurosurgery training programs and to extend the use of three-dimensional imaging. Technologies for producing three-dimensional anatomical models and patient-specific computer simulators as well as improvement of tactile feedback systems and display quality of virtual models are promising areas. Continued professional education necessitates further research for assessing the validity and practical use of simulators and physical models.

DIFFUSION-WEIGHTED MAGNETIC RESONANCE IMAGING IN THE DIAGNOSIS OF INTERVERTEBRAL DISC DEGENERATION IN THE LUMBOSACRAL SPINE.

Objective: to quantify the degree of degeneration of intervertebral discs (IVDs), by constructing functional diffusion-weighted imaging (DWI) maps, and to determine a correlation between the measured diffusion coefficient (DC) values and IVD changes on T1- and T2-weighted images. Material and methods. 545 IVDs were examined in 109 patients with no history of back pain syndrome and surgical spinal interventions. All the patients underwent magnetic resonance imaging of the lumbar spine; DWI maps were constructed and DC values estimated. Results. Statistically significant differences in the mean values of DC were determined for each of five IVDs. Multiple regression analysis showed that age and degree of degeneration were the most significant factors. The degree of IVD degeneration was negatively correlated with the values of DC at all levels (p<0.001). Also, there was a negative correlation between age and the value of DC at all levels (p<0.001). However, gender did not affect the value of DC (p>0.05), with the exception of L3-4. Conclusion. Age and the degree of degenerative changes in IVDs affect the value of DC. The value of DC is negatively correlated with the IVD degeneration graded by Pfirrmann and with the age of the examined patients. DW MRI can be used as a promising noninvasive method to diagnose the early stages of IVD degeneration.

[Simulation technologies in spinal surgery].

This review reflects the current state of simulation technologies in neurosurgery and, in particular, in spinal surgery. Currently, there are different types of simulations used in spine surgery including the biological, artificial and virtual models. Simulations help to facilitate an optimal study of the anatomy, understand the spatial relationships between organs and tissues, plan properly the surgical intervention, and gain tactile surgical skills. The implementation of simulation technologies in the educational process provides objective assessment of the initial level of training, improvement of the competence in trained professionals, as well as prevention of surgical errors in various clinical situations.

[The Use of Stem Cells in the Treatment of Intervertebral Disc Degeneration].

The paper presents a review of current data on the use of stem cells in the treatment of intervertebral disc degeneration. Acute spinal pain is often a consequence of the pathology affecting the intervertebral disc. Many applied therapeutic techniques do not provide effective results as expected because most of them address symptoms, but do not treat the underlying disease. We have outlined current findings on the molecular mechanisms of intervertebral disc degeneration, analyzed international experimental studies demonstrating the feasibility of a stem cell therapy for intervertebral disc degeneration. The conducted studies reported on the clinical application of mesenchymal stem cells or stem cells derived from adipose, synovium, and bone marrow tissue. The most pressing and undetermined issues that require further experimental and clinical studies are indicated and defined in the article.

[Facet Fixation Combined with Lumbar Interbody Fusion: Comparative Analysis of Clinical Experience and A New Method of Surgical Treatment of Patients with Lumbar Degenerative Diseases].

Background: For the treatment of patients with degenerative diseases of the lumbar spine the technique of pedicle fixation is widespread, when after open decompression channel structure locking screws are introduced into the vertebral body through the back vertebra legs. We first used a fundamentally new way of fixing the rear using the facet-boards Cage «Facet Wedge¼, when posterior fixation is done by closing the facet joints with minimally invasive, percutaneous method. We have not found data on the clinical efficacy of facet fixation in scientific literature. Aims: To compare the clinical efficacy of facet fixation combined with interbody fusion in the treatment of patients with degenerative lumbar spine disease. Materials and Methods: The study included 145 patients who were divided into 2 groups. The study group with long-term observation included patients (n=100) who underwent a new method for lumbar fixation; the method comprises unilateral or bilateral implantation of titanium Cage «facet Wedge¼ in the joint space facet joint in combination with the anterior, lateral, and transforaminal interbody fusion. Clinical comparison group (n=45) included retrospectively recruited patients who were performed titanium pedicle screw installation after open decompression and interbody fusion posterior lumbar fixation. Dynamic observation and comprehensive evaluation of the treatment clinical results was carried out for 18 months after surgery. Results: Cage facet installation technology is quite simple, universal for the stabilization of the rear of the complex after interbody fusion from the front, side, and rear access; and does not require the intraoperative application of expensive high-tech equipment. Comparative analysis of the main group showed significantly better results in terms of the duration of the operation [CG 125 (90; 140) min, the CCG 205 (160; 220) min; p=0.01], the volume of blood loss [CG 80 (70; 120) ml, CCG 350 (300; 550) ml; p=0.008], activation time [CG 2 (1; 2) days, 4 CCG (3; 5) days; p=0.02], length of hospitalization [CG 9 (10; 11) days, the CCG 13 (12; 15) days; p=0.03], the level of pain on a visual analog scale [CG 3 (2; 4) mm, CCG 15 (12; 18) mm; p=0.001], quality of life (by index Oswestry) [CG 8 (6; 8) points, the CCG 23 (20; 28) points, p=0.003], and labor rehabilitation [CG 3 (2; 6) months, CCG 9 (6; 12) months; p=0.0001]. The number of postoperative complications in group 1 was 13%, in the 2nd ­ 31,1% (p=0,0012). The new method involves fixing the back with considerably less surgical trauma of paravertebral soft tissue that results in early activation of patients, reduction of stay in hospital period, and better functional recovery of patients. Conclusions: The application of facet fixation combined with interbody fusion in the treatment of patients with degenerative diseases of the lumbar spine allows achieving the best clinical outcomes and fewer postoperative complications during the short and long-term follow-up if compared with the traditional method of transpedicular stabilization. The combination of low-impact and reliability facet fixation techniques for posterior stabilization of the operated segment creates favorable conditions for the restoration of a functional condition of patients, full social and physical rehabilitation.

High-speed extra-intracranial bypass combined with an assisting low-speed anastomosis: surgical technique and a clinical example.

Described herein is the technique of performing assisting low-speed and high-speed extra-intracranial bypass, followed by a clinical case report concerning successful application of this technique in trapping of a giant aneurysm of the cavernous portion of the internal carotid artery in a female patient after endured transitory ischaemic attack during the test with temporary balloon-mediated occlusion of the internal carotid artery.

[Optimization of segmental lumbar spine instability treatment using minimally invasive spinal fusion technique].

UNLABELLED: Open transforaminal lumbar interbody fusion (TLIF) using transpedicular rods and interbody cage, which is used to treat segmental instability, is associated with a significant paravertebral muscle and ligament injury. A new rigid fusion method was introduced to improve the outcome of patients' treatment. OBJECTIVE: To conduct a comparative analysis of the effectiveness of minimally invasive fusion technique and TLIF to improve the treatment results in patients with symptomatic lumbar spine degeneration concomitant with moderate segmental instability of the lumbar spine. MATERIAL AND METHODS: The study involved 90 patients, which were divided into 2 groups. Transforaminal interbody fusion with Pezo-T PEEK cage was performed after spinal canal reconstruction in both groups. In the first group (n=45), interbody fusion was augmented by 4-point transpedicular rod fixation (Konmet, Russia); in the second group (n=45), by Coflex-F rigid interspinous spacer. Patients were followed up and the results were assessed within 24 months after surgery. RESULTS: The intergroup comparison of pain level using the visual analogue scale, the need for analgesics, and quality of life according to Oswestry Disability Index score during the early postoperative period demonstrated significantly better outcomes in the second group of patients due to lesser operative trauma of the paravertebral soft tissue. Interbody fusion was observed within 20-36 months in 95% of group I patients and 94% of group II patients (p>0.05). Postoperative complications were observed in 17.8% of patients in group I and in 2.2% of cases in group II (p<0.001). CONCLUSION: Stabilization by rigid interspinous spacer and transforaminal interbody cage provides better clinical outcomes and fewer postoperative complications as compared to the conventional TLIF technique with similar X-ray rate of bone block formation in patients with moderate segmental instability of the lumbar spine, thus optimizing the treatment of such patients.

[CLINICAL EFFECTIVENESS OF PUNCTURE METHODS FOR THE TREATMENT OF VERTEBRAL BODY FRACTURES AND HEMANGIOMAS].

UNLABELLED: A new stenoplastic technology including implantation of expanding titanium cage is realized to improve the quality of life and relieve pain syndrome in the patients with injured vertebral bodies. The aim, of the study was to compare clinical effectiveness of puncture vertebroplasty and stenoplasty. MATERIALS AND METHODS: Vertebroplasty and stenoplasty were used in 24 and 18 cases respectively to treat 17 patients with A1 compression fractures of vertebral bodies and 25 ones with symptomatic hemangiomas in thoracic and lumbar spine. Visual-analog scale was used to estimate severity of pain syndrome, ODI scale to assess the quality of life, and Macnab scale to evaluate satisfaction of the patients with the results of surgery; in addition, duration of surgery and frequency of complications were determined. RESULTS: Results of hemangioma treatment by both procedures were similar when estimated by VAS and ODI (p < 0.05). Stentoplasty yielded better long-term results of the treatment of A1 compression fractures based on VAS and ODI (p = 0.03) and should be preferred over vertebroplasty Also, this technique can be used to treat symptomatic hemangiomas.

Nanostructure changes in the intervertebral discs after experimental laser irradiation.

Laser-induced changes in the intervertebral discs were studied by the method of atomic force microscopy. Alteration of the proximal caudal intervertebral discs was modeled in rats: puncture and exposure to diode laser (2, 3, or 5 W) in constant or pulse regimens or only puncture (control). Nanostructure of disc surface was estimated by surface skewness, root mean square and average roughness, and coefficient of kurtosis. Maximum positive effect and signs of regenerative changes in the surface microstructure of the intervertebral discs were found after exposure to laser (2-3 W) in constant or pulse regimens.

[EPIDURAL HEMATOMA WITH SPINAL CHORD COMPRESSION ASSOCIATED WITH WARFARIN INTAKE].

The most serious life-threatening warfarin-associated complications is hemorrhage in CNS structures. Reports of spontaneous spinal epidural hematomas in patients using warfarin, methods of diagnostics and treatment are but few. We describe the first case of warfarin-associated spontaneous spinal epidural hematoma in this country and a literature review of this issue.

[A model of the arterial aneurysm of the brain for microneurosurgical training].

Clipping of arterial aneurysms of the brain is one of technically complex neurosurgical interventions. In the available literature, there is no information about simulation models of aneurysm clipping that have tactile properties similar to the real ones. The study presents a technical rationale for the development of a new model for the aneurysm on human placental vessels to train skills of isolating and clipping under ruptured and unruptured aneurysm conditions.

[Factors affecting the outcome of surgical management for extramedullary spinal cord tumors: a multicenter study].

UNLABELLED: Extramedullary spinal cord tumors (ESCTs) are relatively rare neoplasms requiring surgical treatment. This paper presents a study of outcomes in patients with ESCTs treated at Irkutsk region hospitals with different facilities. AIM: To identify factors affecting the outcome of surgical treatment of ESCTs. MATERIAL AND METHODS: The disease stage before surgery was evaluated according to the I.Ya. Razdol'skiy and McCormick classifications. Features and extension of the approach, the extent of blood loss, surgery duration, and the equipment used were analyzed. Treatment outcomes were assessed according to the MacNub and McCormick neurological outcome scales. RESULTS: ESCTs were removed totally in 84 (95%) patients and subtotally in 4 (5%). Tumor recurrence was detected in 8 patients. No deaths were observed. No correlation was found between the treatment outcome, according to the McCormick scale, and factors such as gender, tumor location, histological type, tumor grade, disease duration, and type of a surgical approach and the equipment used. Factors having medium and high correlations with the disease outcome are a neurological disease phase and an initial neurological deficit: sensory deficit, r=0.32; motor deficit, r=0.33; pelvic disturbances, r=0.35; McCormick grade before surgery, r=0.74; disease phase r=0.41 (p<0.05). CONCLUSION: The disease phase is the most significant factor affecting the outcome of surgical treatment in patients with ESCTs. Despite this, important aspects of surgical treatment of ESCT include the approach that is adequate to the tumor size and localization, as well as combination of different surgical techniques.