[Stage wise treatment of uterine arteriovenous malformation complicated by recurrent haemorrhage]. / Étapnoe lechenie arteriovenoznoi mal'formatsii matki, oslozhnennoi retsidiviruiushchimi krovotecheniiami.

Uterine arteriovenous malformation is a rarely encountered disease threatening with massive haemorrhage. The article describes a clinical case report regarding a 37-year-old woman presenting with this pathology and previously hospitalized twice with severe posthaemorrhagic complications at a 5-month interval due to refusal from timely hysterectomy. A vascular formation in the womb was detected at ultrasonography, however its pattern was identified only by computed tomography of small pelvis organs with intravenous contrasting. However, the complete picture of the architectonics of uterine arteriovenous malformation and extension of the pathology was obtained by selective subtraction angiography, making it possible not only to perform diagnosis but also, if necessary, to immediately perform selective embolization of the supplying vessels. Due to massive uterine bleeding on the background of womb malformation, the woman was twice subjected to roentgenoendovascular embolization of afferent vessels, with the achievement of persistent haemostasis. Hysterectomy was performed after stabilization of the state. Thus, an extensive angiomatous uterine lesion accompanied by recurrent bleedings, along with roentgenoendovascular methods of treatment there is a need of additional surgical resection with the removal of the angiodysplasia focus.

[Myopericaditis as a late manifestation of the probable COVID-19].

The article describes a clinical case of myopericarditis as a late manifestation of possible COVID-19.

[Experience of using an intraoperative cone beam computed tomography scanner and the modern navigation system in surgical treatment of spine and spinal cord disorders].

UNLABELLED: Spine disorders are a highly relevant problem in neurosurgical pathology. The development of diagnostic imaging methods makes it possible to perform intraoperative computed tomography. A special intraoperative cone beam computed tomography scanner "O-arm" has been designed; it combines a function of a C-arm machine and computer tomography scanner. The O-arm system can be used along with navigation system and robotic assistance device. Availability of these devices in an operating room allowed us to study the effectiveness and features of intraoperative CT imaging. OBJECTIVE: To evaluate the intraoperative use a cone beam computed tomography scanner "O-arm" and the navigation system in surgical treatment of spine disorders. MATERIAL AND METHODS: In August-November 2013, 43 patients with degenerative spine disorders, spine and spinal canal tumors underwent surgeries at the N.N. Burdenko Neurosurgical Institute using an intraoperative computed tomography scanner "O-arm" and the navigation system. RESULTS: It is reasonable to use intraoperative CT "O-arm" device with the navigation system when surgical treatment is performed under complex anatomical conditions (a thin root of the vertebral arch, scoliotic or post-traumatic spinal deformity) and the surgery zone cannot be visualized using 2D imaging methods. Intraoperative CT control and navigation system can be employed by neurosurgeons in clinics where the standard stabilizing surgeries and percutaneous methods either are employed rarely or have just started to be used. CONCLUSIONS: The use of an intraoperative CT device "O-arm" with the modern navigation system for surgical treatment of spine and spinal cord disorders allows one to perform surgical interventions under complex anatomical conditions, reduces the absorbed radiation dose, and is safe for patients.

[Effectiveness of one-stage microdiscectomy and radiofrequency denervation of intervertebral joints compared to microdiscectomy in patients with spinal disc herniation].

The article analyzes of the early and long-term outcomes in 113 patients who underwent surgical treatment for lumbosacral disc herniations. The first group of patients (n=32) underwent microdiscectomy in a combination with radiofrequency destruction (RFD) of the facet nerves. The control group patients (n=81) underwent microdiscectomy. This study demonstrates the advantage of combining RFD with open surgery. In this case, regression of both nerve root and back pain is achieved, which greatly accelerates rehabilitation of patients, restoration of their work ability, and therefore their return to normal life.

[Virtual clinical diagnosis support system of degenerative stenosis of the lumbar spinal canal].

UNLABELLED: The aim of the study was to develop a virtual clinical diagnostic support system of degenerative lumbar spinal stenosis on database of spine registry. MATERIALS AND METHODS: Choice of criteria's for diagnostic system was made on symptom analysis of 298 patients with lumbar spinal stenosis. Also was analysed a group of patient with disc herniation's for sensitivity and specify assessment of developed diagnostic support system. Represented clinical diagnostic support system allows identifying patients with degenerative lumbar spinal stenosis on stage of patient's primary visit. System sensitivity and specify are 90 and 71% respectively. RESULTS: "Online" mode of diagnostic system in structure of spine registry provides maximal availability for specialists, regardless of their locations. Development of tools "medicine 2.0" is the actual direction for carrying out further researches with which carrying out the centralized baea collection by means of specialized registers helps.

[Working results of the electronic "on-line" version of the Spine Registry for Degenerative Lumbar Spine Diseases and study of its synchronization capacity with the electronic case history]. / Itogi raboty portal'noi versii poiasnichnogo vertebrologicheskogo registra i izuchenie voprosa ego sinkhronizatsii s élektronnoi istoriei bolezni.

AIM: To assess the results of use of lumbar spine on-line registry in 2012 (IV quarter). MATERIAL AND METHODS: The Burdenko Neurosurgery Institute of the Russian Academy of Medical Sciences (RAMS) and the System Analysis Institute of the Russian Academy of Sciences (RAS) have developed an electronic "on-line" portal of the Spine Registry for Degenerative Lumbar Spine Diseases. The data on 1295 retrospective and 145 prospective patients who underwent treatment in Burdenko Neurosurgery Institute, the "AXIS" clinic, Medical Centre of the Bank of Russia, "Marina Spine Clinic" LA, USA and in the Neurosurgery department of Research Institute of Traumatology and Orthopedics, Nizhny Novgorod were analyzed. Since May 2012 to the present time outcomes of 1295 (retrospective group) and 145 (prospective group) patients with Degenerative Lumbar Spine Diseases, which underwent treatment from 2002 to 2012 were entered into online registry and subsequently analyzed. The current study has revealed two problems that need to be discussed. First problem is that the archived information is not sufficient for data base update. The second problem is low activity of many physicians in inputting data into the register. We believe that the solution of these problems lies in the plane of synchronization of on-line registry with electronic medical records. This synchronization between registry and online records will allow studying their joint work. If found to be successful after the development of the other sections of the register they will be added to an already running version as provided by the principles of its work - scalability and extesibility. The results of this work will be profile of vertebrological version of electronic medical records. In the future it could be used in clinics dealing with spine disorders. RESULTS: Since May 2012 the outcomes of 1295 (retrospective group) and 145 (prospective group) patients with Degenerative Lumbar Spine Diseases, who were operated on in Burdenko Neurosurgery Institute (Moscow, Russia), minimally invasive spinal surgery clinic "AXIS" (Moscow, Russia), Medical Centre of The Bank of Russia (Moscow, Russia), "Marina Spine Clinic" (LA, USA) and Neurosurgery department of Research Institute of Traumatology and Orthopedics (Nizhny Novgorod, Russia) from 2002 to 2012 were analyzed. The perspective of this work is development of other parts of spine registry (for cervical and thoracic spine) and improving the outcome assessment process in Russian spinal surgery clinics.

[Evidence-based medicine methods and critical reading of the paper devoted to degenerative lumbar and sacral spinal stenosis (comment to the article)].

The paper provides critical analysis of the article "Correlated analysis of radiologic criteria's referred to central degenerative spinal canal stenosis and intensity of clinical implications". Critical analysis was carried out by the 5-step evidence cycle. First step is supposed to formulate primary goal of the research and identify its type. This investigation belongs to prognostic studying of certain patient's characteristics and their impact on the state of disease and the treatment outcome. According to Oxford evidence based center of medicine gradation, this study is attributed to level IV (clinical series). Analysis performed allowed to state that investigation sampling might be considered as representative, but nonhomogeneous. Absence of blind evaluation of the treatment results could alter treatment outcomes when compared by two different scales. Multifactor analysis was not held in the present study. Analyzed investigation has low methodological level, however, it has no major disadvantages. Statistical significance between various factors and clinical effect can be achieved when study is based upon database analysis of many patients, which however cannot be managed by efforts of a single medical institution. Organizing investigations by registration treatment outcomes with follow up evaluation nationwide could be a problem solution. In particular, vertebrological register might be a very useful tool for development prognostic risk scales and predictive models in degenerative spine disease surgery.

[Analysis of radiological criteria correlation and clinical manifestation of central lumbosacral spinal stenosis].

OBJECTIVE: to assess the correlation analysis of radiologic criteria referred to central degenerative spinal stenosis and intensity of clinical manifestation. MATERIALS AND METHODS: a retrospective cohort data were collected from 2010 till 2011, 27 patients who underwent surgical treatment of central spinal stenosis in Burdenko Neurosurgical Institute. 16 male and 11 female patients were included in the present study. Mean age of the patients at the time of surgery was 57.9 years. All patients had spinal canal decompression and transpedicular or oblique transcorporal fusion. Stabilization included different types of pedicle screws, including transcutaneous stabilization systems. Interbody fusion was achieved by posterolateral transforaminal approach (TLIF --transforaminal lumbar interbody fusion). 13 cases included combination of interbody fusion and guided oblique lumbar interbody fusion "GO-LIF", which could not be managed without robotic assistance. All patients underwent full preoperative examination. MR image evaluation included: antero-posterior diameter of the spinal canal (mm), interfacet interval (mm), and cross-section area of the spinal canal (mm2). Patients were evaluated by outcome analysis scales: Degenerative Disease Intensity Level (DDIL) and Swiss Spinal Stenosis Score (Zurich Claudication Questionnaire, Brigham spinal stenosis questionnaire). Surgical outcomes were evaluated according to modified classes of Kawabata et al. RESULTS AND DISCUSSION: analysis of our patients group demonstrated absence of correlation between intensity level of degenerative central spinal stenosis based on neurovisualization methods and intensity of its clinical manifestation. Pearson's coefficient of correlation and Spearmen rank correlation for variable which evaluates clinical signs (DDIL in %) and neurovisualization data (antero-posterior diameter of the spinal canal (mm), interfacet interval (mm), and cross-section area of the spinal canal (mm2)) are not significant to zero (p > 0.2).

[Prediction of outcomes of surgical treatment of degenerative lumbar disk disease].

The paper focuses on algorithms of outcomes assessment of surgical treatment of the patients with degenerative lumbar disk disease. From 1997 to 2006 389 patients with discogenic lumbar pain were operated in the Medical Center of Central Bank of Russia. 185 patients underwent radiofrequency destruction of facet nerves, laser percutaneous lumbar discectomy was performed in 39 patients, microdiscectomy -- in 131, and decompression combined with lumbar spine stabilization -- in 31 cases. Clinical and radiological data of each patient were recorded in the database using 3-point scale according to intensity of the feature. Assessment of patients' condition was performed pre- and postoperatively (after discharge and after 6, 12 and 24 months interval). Postoperative outcome was recorded for the current period in compliance with modified criteria of Kawabata et al. Obtained data were mathematically and statistically processed. Developed algorithms allowed assessment of postoperative outcome in the patients with degenerative lumbar disk disease. Outcome data can be used for evaluation of feasibility of surgical treatment as well as for selection of surgical technique.

[Development of navigation technologies for ambulatory surgery]. / Proektirovanie navigatsionnykh tekhnologii dlia ambulatornoi khirurgii.

The article considers the main directions in the development of navigation surgical technologies allowing to decrease traumatic effects of certain operative interventions and to fulfill them in "one day" hospitals. The historical aspects of navigation surgery are given as well as a classification of the navigation interventions and examples of the newest of them used at the present time in the Medical Center of Bank of Russia.

[Electric stimulation of spinal muscles during walking as a method of the treatment of scoliosis]. / Elektrostimuliatsiia myshts spiny v khod'be kak metod lecheniia skolioza.

In the article is summarized the experience of treatment of 15 patients with dysplastic lumbar scoliosis of the II and III degree by the method of electrostimulation of dorsal muscles by means of walking corrector. Stimulation of the given type has been employed as rehabilitation therapy after carrying out of the closed chemonucleolysis for the purpose of muscle jacket restoration. Stimulation of trunk muscles in walking allowed to increase correction and stability of vertebral column distortion. Dynamic observations of patients demonstrated stability of achieved curative effect. Therapy of described type can be employed in complex of conservative treatment of scoliosis.

[Chemonucleolysis as a method of treatment in lumbar and thoracolumbar scoliosis: errors, complications and indications for use]. / Khemonukleoliz kak metod lecheniia poiasnichnogo i grudopoiasnichnogo skolioza: oshibki, oslozhneniia, pokazaniia k primeneniiu.

The authors summarize their experience in the treatment of 106 patients with dysplastic lumbar and thoracolumbar scoliosis. Already 24 hours after closed chemonucleolysis there was considerable correction of the curvature and an increase in the stability index. The method may be recommended for the treatment of lumbar and thoracolumbar scoliosis at stages II and III if the curvature angle does not exceed 50 degrees. In severe curvatures the efficiency of chemonucleolysis is low. Observation of the patients showed that the method causes little traumatism, is easily endured by the patients and allows for reliable discontinuation of the progress of deformation. The complications after closed chemonucleolysis may be avoided by employing the technique of discography, the application of the plaster-of-Paris jacket and by making use of adequate anaesthetic and dehydration therapy during the immediate post-manipulation period. The complications after chemonucleolysis did not deteriorate the results of the treatment.