[Clinical classification of extrapulmonary tuberculosis].

The authors propose a clinical classification of extrapulmonary tuberculosis, which is based on the standard reporting signs. They give the definitions of classification criteria established in any locations of tuberculous infection: etiology (tuberculosis, BCG infection, tuberculoallergic lesions), the extent and activity of a process with regard to clinical and morphological stages; bacterial isolation with consideration of the drug resistance of Mycobacteria; the nature of complications and sequels, etc. The characterization of local lesion includes the determination of organ-dependent clinical forms of tuberculosis; the type and form of complication; residual and sequels.

[Clinical and laboratory features in tuberculosis and osteomyelitis of the spine]. / Kliniko-laboratornye osobennosti pri tuberkuleze i osteomielite pozvonochnika.

Tuberculous spondylitis runs atypically with its acute onset, high fever, and violent pain in 20% of cases. This disease is characterized by a high specific activity of T lymphocytes, by high levels of antituberculous antibodies, by a higher activity of adenosine deaminase, by higher concentrations of IgA and IgE. The gradual onset and few-symptom course of hematogenous osteomyelitis were revealed in 15% of cases. In osteomyelitis, there was a low concentration of antituberculous antibodies, higher levels of low and medium molecular mass, and IgG.

[Use of carbon-carbonic implants in surgery of tuberculous spondylitis]. / Primenenie uglerod-uglerodnykh implantatov v khirurgii tuberkuleznogo spondilita.

For surgical treatment of spinal tuberculosis, carbon-carbonic implants were used for anterior spondylosis in 29 patients; in 14 of them bone autografts were additionally applied. Carbon-carbonic implants reliably fixed the operated part of the vertebral column, prevented an increase in kyphotic deformity, and, in combined plastic repair, created favorable conditions for consolidation of bone autografts. A bone-carbon block formed in the late postoperative period.

[Immunity in patients with active tuberculous spondylitis]. / Immunnyi status bol'nykh aktivnym tuberkuleznym spondilitom.

Immunological parameters were studied in 45 patients with active tuberculous spondylitis, admitted for surgical treatment, who were divided into 2 groups in accordance with the prevalence of exudative-necrotic, or productive components of inflammation in the vertebral bodies and paravertebral tissues. The patients with a predominantly exudative-necrotic component of inflammation exhibited a severe clinical course with frequent neurological disorders, large abscesses in the paravertebral tissues, inflammatory changes in the leukogram, enhanced specific T-lymphocytic activity in the PPD blast-transformation reaction, significant increases in the levels of tuberculosis antibodies and IgE, IL-2 and it soluble IL-2 receptor RR-alpha, an excessively high increase in the functional activity of neutrophilic granulocytes, and lower with IgG2. The degree of immunological disorders corresponds to the severity of a course of tuberculous spondylitis.

[Current reconstructive surgery for tuberculosis of the vertebral column and joints]. / Sovremennaia vosstanovitel'naia khirurgiia tuberkuleza pozvonochnika i sustavov.

There has been recently a rise in the incidence of complicated forms of bone and joint tuberculosis, one of its causes is its late diagnosis. The outcomes of surgical treatment in 390 patients with tuberculosis of the spine and large joints are presented. Vascularization of bone tissues and a graft has been found to substantially increase the efficiency of an intervention used and the use of carbon-carbonic implants and posterior clamps accelerates the time of formation of a bony trochlea and diminishes deformity of a vertebral column part undergone an operation. To improve the functional results of mobilizing surgery for tuberculous arthritis and its sequelae, low-traumatic operations using the arthroscopic devices, perichondrioplasty and endoprosthesis of large joints are being practically introduced.

[Classification of neurological disorders in tuberculous spondylitis]. / O klassifikatsii nevrologicheskikh narushenii pri tuberkuleznykh spondilitakh.

The paper summarizes surveys of over 2500 patients with tuberculous spondylitis complicated by neurological disorders of the spinal cord. The authors identified 5 grades of these disorders: from reflex disorders to limb plegia and pelvic dysfunctions. The classification proposed made it possible to clearly systematize spinal cord disorders in patients with tuberculous spondylitis, to establish a topical diagnosis and the severity of spinal cord lesions, to choose surgical accesses and method for stabilizing the spine, and to make a research processing of clinical and neurological data.

[Results of decompression operations in patients with tuberculous spondylitis]. / Iskhody dekompressivnykh operatsii u bol'nykh tuberkuleznym spondilitom.

The paper summarizes the outcomes of decompression and decompression-reparative operations in patients with tuberculous spondylitis. Good surgical results with complete elimination or alleviation of neurological disorders have been achieved in 94.8% of cases.

[Surgical treatment of patients with cervicothoracic and upper thoracic spinal abnormalities]. / Khirurgicheskii dostup pri operatsiiakh u bol'nykh s patologiei sheino-grudnogo i verkhnegrudnogo otdelov pozvonochnika.

The authors have developed an approach to cervicothoracic and upper thoracic spine for surgical treatment of patients with tuberculous spondylitis complicated by severe kyphotic deformity, which allows one to make the entire scope of reparative surgical intervention under visual guidance from the fifth cervical vertebra to the ninth thoracic one with the minimum traumaticity and preserved muscle integrity. This is performed through the periscapular triangle by diverting the scapula cranially without dissecting its fixing muscles, the musculus latissimus dorsa caudally. The third or fourth rib is resected in relation to the site of a pathological process.

[Type UUKM-4d carbonic carbon and porous titanium in plastic repair of bone defects: experimental studies]. / Uglerodistyi uglerod marki UUKM-4D i poristyi titan v plastike kostnykh defektov (éksperimental'nye issledovaniia).

The experimental laboratory of the Saint Petersburg Research Institute of Pharmacology studied the potentialities of replacing bony defects and cavities by type UUKM-4d high-porous carbonic carbon. It was found that in orthotopic implantation, the more intensively bony osseous tissue was grown into the pores of an implant made of carbonic carbon, the more prolonged a postsurgical interval was; just at month 1 after orthotopic implantation, carbonic carbon implant was tightly fixed in the bony bed. Porous titanium is also fixed in the osseous defect without producing negative reactions of a patient's osseous tissue.

[Current problems of extrapulmonary tuberculosis]. / Sovremennoe sostoianie problemy po vnelegochnomu tuberkulezu.

There is an overall poor situation due to tuberculosis generally and its extrapulmonary involvement specifically. A 2-3-fold rise in the incidence of extrapulmonary tuberculosis (EPT) is estimated in the near future. The number of patients will total 100,000-120,000. The shortcoming of patients' care is associated with poor work organization in all 3 links: detection in the general therapeutical network, notification of patients in antitubrculosis dispensaries, a reduction in the level of medical care at hospitals, ineffective use of interregional hospitals and the clinics of research institutes. Recent years have been marked by an extremely alarming situation connected with physicians trained in EPT: ageing and natural increase of personnel, no staff training at the available bases which have accumulated much experience in practice and investigations. To enhance efficiency requires restoration of the whole past experience in early detecting, notifying, and treating the patients.

[Epidural computed electroneurography and electrostimulation of the spinal cord in the reconstructive surgery of the spine in tuberculous spondylitis]. / Epiduralnaia kompíuternaia életrospinoneirografiia i élektrostimuliatsiia spinnogo mozga v rekonstruktivnoi khirurgii pozvonochnika pri tuberkulëznom spondilite.

The study deals with the development of new diagnostic and therapeutical methods for deep spinal marrow diseases in spinal tuberculosis and its sequelae. The human spinal marrow has been first electroneurophysiologically studied during compression of the spine and ofter its anterolateral decompression. A comprehensive diagnostic technique--computed electrospinoneurography has been proposed; objective criteria for prediction and evaluation of therapeutical efficiency have been defined. The proposed epidural electrostimulation following a surgery for anterolateral decompression of the spine accelerates regression of neurological symptoms and increases the extent of its regression in 89.2% of cases in the early postoperative period and enhances the efficacy of prior operations up to 83.9% in the long-term period. The high efficiency of the method is 87.1%, which allows it to be recommended for introduction into clinical practice.

[Osteoplasty in limited forms of tubercular spondylitis]. / Kostnaia plastika pri ogranichennykh formakh tuberkuleznogo spondilita.

The developed variants of free and non-free vertebral autoplasty are considered to be optimal in the surgical management of tuberculous spondylitis. Their application is associated with the damage to vertebral bodies, the degree of their destruction, the extent of intervertebral diastasis, and the process site. Proper repair of the vertebral defects, not exceeding 5 cm, is achieved by free autografts having the maximum area of supporting ends. With extensive intervertebral diastasis, it is recommended to use non-free grafts taken from a rib or the upper flaring portion of the ilium and to overlap the plasty area with the rib periosteum on a feeding pedicle. In terms of significance order, the prognostic criteria for plasty outcomes are congruence of the graft ends with the grooves formed in the vertebral bodies; the extension of a suppurative process in the adjoining transplant tissues, adequate correction of intervertebral diastasis; and the length of transplants.

[Surgical treatment of hematogenic osteomyelitis of the spine]. / Khirurgicheskoe lechenie gematogennogo osteomielita pozvonochnika.

The article presents principles of the surgical treatment of hematogenic osteomyelitis of the vertebral column and its complications developed on the basis of studying and analysis of results of operative interventions performed in 145 patients. A system of operative procedures is proposed which showed high effectiveness in treatment of both purulent infections and complications of the disease, spinal disorders in particular.

[Substantiation of the use of terrilytin in the treatment of spinal cord disorders in tuberculous spondylitis]. / Obosnovaniia primeneniia terrilitina v lechenii spinno-mozgovykh rasstroistv pri tuberkuleznom spondilite.

Experiments on mice and studies with organotype cultures of the spinal ganglion showed that terrilytin, a proteolytic enzyme had neurite stimulating activity and promoted regeneration of the spinal marrow tissue after affection (squeeze). On the basis of this property and a previously observed favourable effect of the enzyme on microcirculation, the capacity for more rapid rarefaction and elimination of caseous masses and prevention of excessive fibrosis, it was recommended for use in treatment of cerebrospinal disorders in tuberculous spondylitis. A procedure for the treatment was developed. The clinical trials with 46 patients (22 in the main group and 24 in the control group) showed high efficiency of the procedure.

[Experimental substantiation and clinical evaluation of posterior spinal fusion using acryloxide]. / Eksperimental'noe obosnovanie i klinicheskaia otsenka zadnei fiksatsii pozvonochnika akriloksidom.

The investigation was performed in 24 isolated preparations of the spine, experiments in 33 rabbits and 8 dogs and clinical observation of 43 patients who were subjected to posterior fixation of the spine with copolymer Acryloxide by the method proposed by the authors. It was established that the method is very effective and may be recommended for wide practical use.

[Validation and use of component plastic repair with transplantation of the periosteum in anterior spondylodesis]. / Obosnovanie i primenenie komponentnoi plastiki s transplantatsiei nadkostnitsy pri perednem spondilodeze.

The article is devoted to further development of an original trend in the bone-articulation surgery--component plasty. In experiments (100 rabbits) and clinical observations (62 patients) the effectiveness of methods developed by the authors for transplantation of the periosteum as a component of mono-, bi- and polycomponent bone plasty was proved, in particular in anterior spondylodesis in patients with tuberculous spondylitis.