[Decompression fusion surgery and minimally invasive microsurgical decompression in patients with single-segment lumbar spinal stenosis]. / Sravnitel'nyi analiz rezul'tatov primeneniya metodik dekompressii so stabilizatsiei i minimal'no invazivnoi mikrokhirurgicheskoi dekompressii u patsientov s monosegmentarnym poyasnichnym spinal'nym stenozom.

There are few studies comparing clinical efficacy of decompression/fusion surgery (transforaminal lumbar interbody fusion (TLIF) + transpedicular interbody fusion) and minimally invasive microsurgical decompression (MMD) in patients with single-segment lumbar spinal stenosis. OBJECTIVE: To compare the results of TLIF + transpedicular interbody fusion and MMD in patients with single-segment lumbar spinal stenosis. MATERIAL AND METHODS: A retrospective observational cohort study included medical records of 196 patients (100 (51%) men, 96 (49%) women). Age of patients ranged from 18 to 84 years. Mean postoperative follow-up period was 20.1±6.7 months. Patients were divided into 2 groups: group I (control) included 100 patients who underwent TLIF + transpedicular interbody fusion, group II (study) included 96 patients who underwent MMD. We analyzed pain syndrome and working capacity using visual analogue scale (VAS) and Oswestry Disability Index (ODI), respectively. RESULTS: Analysis of pain syndrome in both groups after 3, 6, 9, 12 and 24 months clearly demonstrated stable relief of pain syndrome (VAS score) in the lower extremities. In group II, VAS score of lower back and leg pain was significantly higher in long-term follow-up period (after 9 months or more) compared to the 1st group (p<0.05). In long-term follow-up period (after 12 months), there was significant decrease in degree of disability (ODI score) in both groups (p<0.001) without between-group differences. We assessed achievement of treatment goal in 12 and 24 months after surgery in both groups. The result was significantly better in the 2nd group. At the same time, some respondents failed to achieve the final clinical goal of treatment in both groups (group I - 8 (12.1%), group II - 2 (3%) patients). CONCLUSION: Analysis of postoperative outcomes in patients with single-segment degenerative lumbar spinal stenosis revealed similar clinical effectiveness of TLIF + transpedicular interbody fusion and MMD regarding decompression quality. However, MMD was associated with less traumatization of paravertebral tissues, blood loss, fewer unwanted phenomena and earlier recovery.

[Intramedullary cervical abscess: a case report and literature review]. / Intramedullyarnyi abstsess sheinogo otdela spinnogo mozga: klinicheskii sluchai i obzor literatury.

Intramedullary abscesses of the spinal cord are the rarest form of infectious lesions of the central nervous system. We report surgical treatment of a patient with intramedullary cervical abscess caused by L. monocytogenes. Features of this case are absence of primary purulent focus and atypical infectious agent. The patient underwent surgical treatment for intramedullary cervical abscess and subsequent antimicrobial therapy. Subtotal regression of neurological symptoms was noted in early postoperative period. The authors emphasize strict collegial decision-making regarding diagnosis of this disease and choice of optimal treatment strategy.

[Minimally invasive microsurgical decompression in patients with monosegmental lumbar spinal stenosis]. / Rezul'taty primeneniya minimal'no invazivnoi mikrokhirurgicheskoi dekompressii u patsientov s monosegmentarnym poyasnichnym stenozom.

Surgical treatment of degenerative lumbar spinal stenosis is an actual problem of modern spinal surgery and orthopedics. OBJECTIVE: To analyze the results of minimally invasive microsurgical decompression (MI-MD) in patients with monosegmental lumbar spinal stenosis. MATERIAL AND METHODS: A retrospective observational cohort study was performed. We analyzed medical records of patients who underwent MI-MD for monosegmental degenerative lumbar spinal stenosis. Clinical and objective results of MI-MD, as well as the types and prevalence of adverse clinical events were studied. RESULTS: The study included 96 medical records (50 (52%) males and 46 (48%) females aged 18-84 years). Analysis of pain in lower back and lower extremities in 3, 6, 9, 12 and 24 months after MI-MD showed a significant decrease of this indicator (p<0.001). There was significant improvement of capacity according to ODI score up to 5-12% in 72.9% of patients in early postoperative period (p=0.055). In delayed postoperative period, we also observed significant improvement of working capacity according to ODI score and gradual decrease in disability index (p<0.001). Adverse clinical events occurred in 6 (6.2%) patients. CONCLUSION: MI-MD is a highly effective surgical method for monosegmental lumbar spinal stenosis with minimal incidence of adverse clinical events.

[Effect of renin-angiotensin-aldosterone system inhibitors on functional activity of the spinal cord and nerve roots in patients with degenerative lumbar spine diseases]. / Vliyanie blokatorov renin-angiotenzin-al'dosteronovoi sistemy na funktsional'nuyu aktivnost' spinnogo mozga i ego koreshkov u patsientov s degenerativnymi zabolevaniyami poyasnichno-kresttsovogo otdela pozvonochnika.

High neuroprotective activity of renin-angiotensin-aldosterone system (RAAS) inhibitors in patients with vascular diseases of the brain and spinal cord has been confirmed. OBJECTIVE: To evaluate the effect of renin-angiotensin-aldosterone system inhibitors on functional activity of the spinal cord and nerve roots in patients with degenerative lumbar spine diseases. MATERIAL AND METHODS: A retrospective observational cohort study was performed. We evaluated clinical and radiological parameters (gender, age of patients, type of antihypertensive drug, concomitant diseases, ODI (6) and SF-36 (7) scores of patient quality of life), functional recovery, increase of signal intensity and its area in T2WIs, localization and maximum spinal canal stenosis, as well as maximum spinal cord and nerve root compression. RESULTS: The study included 117 medical records of respondents (88 men and 29 women aged 56.9±13.2 years) who underwent lumbar spine surgery for degenerative diseases. Arterial hypertension was verified in 68 (58.1%) patients, diabetes mellitus in 22 (18.8%) respondents. Age (p=0.002), diabetes mellitus (p=0.007), arterial hypertension (p=0.015) and antihypertensive therapy (p=0.023) were significantly associated with worse clinical and neurological status of patients. Binary logistic regression model demonstrated that only arterial hypertension was significantly associated with low preoperative quality of life (p=0.002). CONCLUSION: Intake of AT II-1 receptor blockers and angiotensin converting enzyme inhibitors for arterial hypertension is a significant predictor of decrease in signal intensity of the spinal cord and its roots according to T2WIs.

[Degenerative lumbar spine stenosis: minimally invasive microsurgical methods of treatment]. / Degenerativnyi stenoz poyasnichnogo otdela pozvonochnika: kharakteristika minimal'no invazivnykh mikrokhirurgicheskikh metodov lecheniya.

Degenerative lumbar spine stenosis is one of the main causes of chronic pain and radiculopathy in advanced age people. Along with increase in average life expectancy, degenerative lumbar spine stenosis becomes the most common indication for spinal surgery. There is still no consensus regarding the most optimal surgical approach due to the variety of modern surgical methods. In recent years, minimally invasive spinal surgery has become a more advisable alternative to open surgery due to its advanced technical features combined with less soft tissue damage, lower risk of complications and shorter postoperative recovery.

[Intraoperative computed tomography and modern navigation in surgical treatment of spine and spinal cord diseases]. / Opyt primeneniya intraoperatsionnogo spiral'nogo komp'yuternogo tomografa i sovremennoi sistemy navigatsii v khirurgicheskom lechenii zabolevanii pozvonochnika i spinnogo mozga.

Surgical treatment of spine and spinal cord diseases is one of important objectives in modern neurosurgery. Patient safety is a priority in spine and spinal cord surgery. Intraoperative imaging ensures efficacy and safe surgery with and without stabilization, preoperative marking, control of decompression and correct implant placement. Surgical C-arms and intraoperative cone-beam CT scanners are the most widespread in everyday practice. The latest achievement was intraoperative spiral computed tomography. C-arms and CT scanners with intraoperative navigation increase the efficiency and safety of surgical interventions.

[Smoking as a risk factor of advanced heterotopic ossification in patients after lumbar total disk arthroplasty]. / Kurenie kak faktor riska uvelicheniya skorosti formirovaniya ochagov geterotopicheskoi ossifikatsii u patsientov posle vypolneniya total'noi artroplastiki poyasnichnykh mezhpozvonkovykh diskov.

Smoking is an obvious risk factor of adverse events in early and long-term postoperative period after spine surgery including lumbar total disk arthroplasty. Objective. To study the effect of smoking on clinical and radiological outcomes after lumbar total disk arthroplasty. MATERIAL AND METHODS: A single-center retrospective observational cohort study was performed. We have analyzed medical records of patients who underwent single-level lumbar total disk arthroplasty for degenerative disease. RESULTS: The study included 57 medical records of respondents. The examined medical records were divided into two groups - smokers (n=26) and non-smokers (n=31). There were no significant between-group differences in clinical outcomes. Incidence of adverse events was similar too. Kaplan-Meier event-free survival was similar in both groups. There were no significant between-group differences in X-ray data. Development of heterotopic ossification after lumbar total disk arthroplasty was more active in smokers. CONCLUSION: Smoking has no significant effect on clinical and radiological outcomes in patients after single-level after lumbar total disk arthroplasty. On the other hand, smoking significantly increases formation of heterotopic ossification after lumbar total disk arthroplasty.

[Intraoperative video-angiography in surgery for spinal intramedullary cavernous malformations: first experience of its application at the Burdenko Neurosurgical Center]. / Intraoperatsionnaia videoangiografiia v khirurgii intramedulliarnykh kavernoznykh mal'formatsii spinnogo mozga: pervyi opyt ispol'zovaniia v FGAU 'Natsional'nyi meditsinskii issledovatel'skii tsentr neirokhirurgii im. akad. N.N. Burdenko'.

Spinal intramedullary cavernous malformations are a rare vascular pathology of the central nervous system. They account for 3-5% of spinal cord diseases. The clinical picture in patients with cavernous malformations varies from an asymptomatic course to gross neurological deficit in the case of bleeding from a malformation. Due to the lack of reliable methods for predicting the development of bleeding, the need for surgical treatment of asymptomatic patients remains a relevant and open topic for discussion. The goal of surgical treatment of cavernous malformations is to minimize the risk of repeated hemorrhages and gross neurological deficits in patients. Intraoperative indocyanine green video angiography is a promising technique for intraoperative visualization of the size and adherence area of a cavernous malformation to the spinal cord tissue. This increases the radicality of cavernous malformation resection and minimizes intraoperative risks for the patient.