[Comparison of the long-term outcomes of total arthroplasty and anterior spinal fusion in the treatment of cervical degenerative disc disease: a metaanalysis]. / Sravnenie otdalennykh rezul'tatov primeneniia total'noi artroplastiki i perednego spondilodeza v lechenii degenerativnogo zabolevaniia sheinykh mezhpozvonkovykh diskov: metaanaliz.

AIM: The study aim was to perform a meta-analysis based on the results of randomized clinical trials comparing long-term outcomes of total intervertebral disc arthroplasty (TA) and anterior cervical spinal fusion (ACSF) in the surgical treatment of cervical degenerative disc disease. MATERIAL AND METHODS: We searched Pubmed, EMBASE, ELibrary, and Cochrane Library databases for randomized clinical trials reported between 2008 and August 2018. The relative risk and 95% confidence interval were calculated for dichotomous variables; for continuous variables, we used the standardized mean difference and their 95% CI with application of a random effects model. RESULTS: The metaanalysis involved 9 randomized controlled clinical trials including the long-term outcomes of surgical treatment in 2,439 patients. A pooled analysis of the data showed that regression of neurological symptoms (p<0.00001), improvement in the quality of life of patients (Neck Disability Index), and lower pain severity (visual analogue scale for upper extremities) were significantly more often observed (p=0.02) in the group of TA patients. In addition, the TA technique was characterized by a statistically significantly lower rate of re-surgery (p<0.0005) and degeneration of the superjacent segment (p<0.0001), with the rate of adverse events being slightly increased (p=0.04). CONCLUSION: Compared to anterior cervical spinal fusion, TA of cervical intervertebral discs is characterized by significantly better clinical efficacy in patients with cervical degenerative disc disease in the long-term postoperative follow-up.

[Minimally invasive dorsal decompression-stabilization surgery in patients with overweight and obesity]. / Vozmozhnosti primeneniia minimal'no invazivnykh dorsal'nykh dekompressivno-stabiliziruiushchikh vmeshatel'stv u patsientov s izbytochnoi massoi tela i ozhireniem.

Spinal surgery in patients with overweight and obesity is associated with an increased risk of perioperative complications. Minimally invasive (MIS-TLIF) and traditional (O-TLIF) techniques of rigid stabilization are extensively used, but the advantages and disadvantages of MIS-TLIF in patients with an elevated body mass index (BMI) remain controversial. AIM: The study aim was to assess the efficacy of a new low-invasive rigid fixation technique and traditional open spinal fusion in surgical treatment of degenerative lumbar spine diseases in patients with overweight and obesity. MATERIAL AND METHODS: The study included 73 patients (49 males and 24 females, aged 53 (42; 65) years) with a BMI of more than 25 kg/m2. Two study groups were allocated: group I (MIS-TLIF, n=32) included patients operated on using an original technique of spinal canal reconstruction, interbody spinal fusion, and combined transpedicular stabilization; group II (O-TLIF, n=41) included patients who underwent single-level rigid stabilization through the median approach. The mean follow-up period was 34 months in group I and 40 months in group II. Comparative analysis assessed clinical parameters, intraoperative indicators, postoperative period specificity, instrumental data, and complications. RESULTS: Compared to the O-TLIF group, the MIS-TLIF group was characterized by a shorter time of surgery, X-ray exposure, activation, and hospital stay as well as by a smaller amount of blood loss. A comparative analysis of the pain severity (visual analogue scale) and performance status (ODI) in the follow-up period revealed significantly better results in group I, which was associated with smaller intraoperative injury to soft tissues. The total rate of postoperative complications was 9% in group I and 17% in group II (p=0.01). In this case, the interbody bone block formed in the long-term postoperative period in 88% of group I patients and in 83% of group II patients (p=0.15). According to the instrumental data, there was statistically significant greater muscular atrophy in the group after O-TLIF (p<0.001). CONCLUSION: The original technique of minimally invasive rigid stabilization is safe and highly effective in surgical treatment of degenerative lumbar spine diseases in patients with overweight and obesity. MIS-TLIF has a number of significant advantages over O-TLIF in the dynamics of clinical parameters and a low number of perioperative complications, which is confirmed by smaller injury to paravertebral tissues and a better performance status in the long-term postoperative period.

[Analysis of the results of total cervical disc arthroplasty using a M6-C prosthesis: a multicenter study]. / Analiz rezul'tatov primeneniia total'noi artroplastiki mezhpozvonkovogo diska sheinogo otdela pozvonochnika protezom M6-S: mul'titsentrovoe issledovanie.

Cervical spondylosis and intervertebral disc (IVD) degeneration are the most common cause for compression of the spinal cord and/or its roots. Total IVD arthroplasty, as a modern alternative to surgical treatment of IVD degeneration, is gaining popularity in many neurosurgical clinics around the world. Aim - the study aim was to conduct a multicenter analysis of cervical spine arthroplasty with an IVD prosthesis M6-C ('Spinal Kinetics', USA). MATERIAL AND METHODS: The study included 112 patients (77 males and 35 females). All patients underwent single-level discectomy with implantation of the artificial IVD prosthesis M6-C. The follow-up period was up to 36 months. Dynamic assessment of the prosthesis was based on clinical parameters (pain intensity in the cervical spine and upper extremities (visual analog scale - VAS); quality of life (Neck Disability Index - NDI)); and subjective satisfaction with the results of surgical treatment (Macnab scale) and instrumental data (range of motion in the operated spinal motion segment, degree of heterotopic ossification (McAfee-Suchomel classification), and time course of degenerative changes in the adjacent segments).

[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.

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.

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.

[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.

[Nanostructural analysis of the lumbar intervertebral disc on the various stages of degenerative process].

Intraoperative specimens of lumbar intervertebral disc (IVD) on the various stages of degeneration was studied by the method of atomic-force microscopy using hardware complex (probe nanolaboratory with video microscope Ntegra Prima). New nanostructural data, characterizing the staging of degenerative changes of IVD were revealed.

[Analysis of anterior cervical spondylodesis using plate cage PCB Evolution for a 2 year period].

The aim of this study was to analyze treatment results of patients who underwent cervical fusion using plate cage PCB Evolution during 2 year period. 37 hybrid cages (titanium plate and PEEK cage) were implanted to 34 patients with degenerative disease of cervical spine. Assessment of results was performed by neurologic examination, neurovisualization data, visual analogue pain scale and Neck Disability Index. Mean duration of surgery was 92 min., blood loss - 42 ml, length of hospital stay - 8 days. Substantial decrease of frequency and intensity of neck and arm pain was observed after surgery in 91% of patients. Single asymptomatic complication occurred due to improper implant position owing to loosening of the upper screw. When properly performed, anterior cervical interbody fusion applying PCB Evolution plate cage is a simple and effective method with low complication rate.

[The use of scales and questionnaires in vertebrology].

Assessment of treatment results using standardized questionnaires became a routine for clinical studies in all European spinal centers and in a number of Russian clinics. Questionnaires and scales that are commonly used in spine surgery are systemized in the present paper as follows: SF-6, SF-12, ODI, RDQ, QBPDQ, BPFS, VAS, NRS, CPGQ, MPQ, WLQ, Macnab, Prolo, LBOS. Recommendations on the analysis of data obtained with the help of these scale are presented.

[A rare case of intraventricular recurrence of melanoma metastasis treated by endoscope-assisted surgery].

In the paper we describe a rare case of intraventricular recurrence of melanoma metastasis treated by endoscope-assisted surgery. Total resection was performed using microsurgical approach with endoscopic assistance. Full regression of neurological deficit, physical rehabilitation and recurrence-free 6-month follow-up was achieved in this case.

[Comparative analysis of effectiveness of endoscopic, microsurgical and endoscopic-assisted diskectomy in treatment of patients with lumbar intervertebral disk herniations].

Application of endoscopy in spinal neurosurgery is one of modern trends of minimally invasive neurosurgery. The aim of this study was to perform comparative analysis of effectiveness in 3 surgical groups with different approaches to lumbar diskectomy applied: microsurgical, endoscopic and endoscopic-assisted. Patients' quality of life concerning ODI, severity of postoperative pain, length of incision, duration of surgery and hospital stay were assessed. We observed no significant differences in three groups according to postoperative ODI index and Macnub and Nurick outcome scales. Endoscopic diskectomy allowed to decrease postoperative pain by discharge, to minimize approach and improve cosmetic effect of surgery. Advantages and disadvantages of different methods are discussed in the paper.

[Arthroplasty of the cervical disks using artificial prodisc C(tm) in 54 patients with 2-year follow-up].

Aim of the study was to analyze results of arthroplasty using artificial discs Prodisc C(tm) ("Synthes, Inc., Paoli, PA) during a 2-year period. 54 patients with degenerative cervical disk disease were included in the study. 65 artificial disks Prodisc C(tm) were implanted. Results were assessed by neurological examination, neuroradiological techniques and Neck Disability Index (NDI). Significance of differences in parameters was evaluated using Student and Fischer tests (p < 0.05). Results of treatment were the following parameters: timing of surgery--82 minutes, blood loss--81 ml, hospital stay--4 days. Significant decrease of frequency and intensity of pain in cervical spine and upper extremities was observed after surgery (according to Visual Analog Scale (VAS) data). VAS assessment revealed discovered reduction of cervical pain severity from 4.5 to 2.8 points and its frequency from 6.1 to 3.2 points, and intensity of pain in arms decreased from 5.6 to 2.5 points while frequency changed from 7.0 to 2.7 points. 2-year of postoperative follow-up discovered decrease of NDI from 32 to 22. Full preservation of movement range in operated segments after 2 years was observed in 76.9% patients, stage 0, I and II limitation of movements--in 15.4%, absence of movements (stage IV)--in 7.7% (p < 0.05). Spontaneous heterotopy of bone tissue after implantation of artificial disks was encountered in 61.5% cases (stages I-IV) (p < 0.05). 2 intraoperative complications (splitting of vertebral body during insertion of implant) occurred. Arthroplasty using artificial disks Prodisc C(tm) is a perspective innovation of modem spinal surgery. Analysis of results of treatment during 2-year follow-up demonstrates necessity of further investigations in this area of neurosurgery.

[Amplification of therapeutic effect after inclusion of hyperbaric oxygenation into complex conservative management of patients with recurrent pain syndrome following microdiskectomy].

Comparative analysis of results of conservative treatment of pain syndrome after diskectomy was performed. Analyzed patients were divide into 2 groups (main and control). In the first group barotherapy was used along with the standard conservative treatment. Preliminary results of comparative analysis of 2 groups demonstrated significant advantages of this method. Excellent and good results dominated in the main group over control group with difference 8.9% (p = 0.046). Oxidative status of organism was studied to verify our results. We relied on changes in parameters of peroxide oxidation lipids--antioxidation system to indicate effectiveness of hyperbaric oxygenation. Calculation of quantitative index of inflammatory activity was suggested to predict results of surgical treatment. Finally, the authors made a conclusion that barotherapy combined with standard conservative treatment is effective and pathogenetically reasonable method for treating patients with recurrent radicular pain after microdiskectomy.