[Decision on the immunomodulating therapy in unspecific osteomyelitis of the spine].

Immunomodulating therapy was used in treatment of 54 patients with unspecific osteomyelitis of the spine (UOS). The age of the patients was from 15 through 76 years. The authors consider that immunocorrection should be included in the complex of obligatory measures of treatment of patients with purulent infections of the spine and is dependent on the type of immunological impairments. For its success it is necessary to determine the type and degree of immunity impairment. Since in most cases of UOS there is a disorder in the T-cell link of immunity, it is preferable to use cytomedins (T-activin, thymalin, thymogen etc) or cytokines (e.g. roncoleukin). In cases of an insufficient B-cell link the medicines of choice are licopid and myelopid.

[Evaluation of the capacities of neurophysiological intraoperative monitoring in reconstructive surgery on the vertebral column]. / Otsenka vozmozhnostei neirofiziologicheskogo intraoperatsionnogo monitoringa pri rekonstruktivno-vosstanovitel'nykh operatsiiakh na pozvonochnike.

AIM: To evaluate the capacities of neurosurgical intraoperative monitoring of somatosensory evoked potentials (SSEP) in reconstructive operations on the vertebral column. MATERIALS AND METHODS: The Center of Spinal Surgery examined 30 patients treated in February to July 2001. According to the diagnosis, the distribution was as follows: degenerative diseases of the vertebral column (80%), its tumors (10%), injury (7%), and inflammatory diseases (3%). Of them, 13 (43.3%) patients underwent anterolateral decompression of the dural sac of roots, 17 (56.7%) had traditional decompression of the dural sac and roots from the posterior access. The study was carried out on an 8-channel electrophysiological Viking-IV system (Nicolet, USA). Intraoperative SSEP monitoring was made by the routine procedure. The amplitude and latent time of subcortical peaks (P31) were determined at surgery. Intraoperative SSEPs were classified as defined with the American Electroencephalographic Society. The changes in the basic parameters of SSEP were also divided into transient (under 30 minutes) and permanent (above 30 minutes). RESULTS: True positive responses (significant changes in intraoperative SSEPs and the presence of postoperative neurological disorders) were 3.3% (1 patient); false positive ones (significant changes in intraoperative SSEPs without postoperative neurological disorders) were 23.3% (7 patients). False negative responses (normal intraoperative SSEPs and the presence of postoperative neurological disorders) were absent. The findings indicate that new postoperative neurological disorders should not be expected in patients with the clinical picture of mild neurological disorders if they have transient changes in the basic parameters of SSEPs that last at least 30 minutes. At the same time a risk group includes patients with severe neurological disorders since in these patients, compensatory capacities are primarily decreased and intraoperative exposures may result in early spinal circulatory decompensation. More frequent (every 10 minutes) recording of intraoperative SSEPs is also recommended for this group of patients is complicated surgical manipulations. CONCLUSIONS: 1. Neurophysiological intraoperative monitoring yields additional information for surgeons during an operation. 2. During intraoperative monitoring of SSEPs, it is necessary to assess any changes in the latter as true and to immediately find possible causes of these changes. 3. In patients with revealed spondylogenic spinal circulatory disorders and severe neurological disorders, even short-term changes in SSEPs should be assessed with particular carefulness before surgery.

[Intravenous spondylo-infusion in the treatment of lumbar osteochondrosis]. / Venospondiloinfuziia v lechenii osteokhondroza poiasnichnogo otdela pozvonochnika.

Using the intraosseous infusion technique, 87 patients with neurological symptoms of osteochondritis of lumbosacral intervertebral disks (study group) were treated. Sixty-six patients were treated by traditional drugs (control group). The study and control groups have been matched by age (mean 45 years) and symptoms--reflex-muscular, spondilosis radicular, Charcot's syndrome. An estimation of treatment efficiency was carried out by registration of somatosensory evoked potentials and ultrasonic dopplerography of the inferior vein cava and its branches as well as by measuring of intraosseous pressure in an acantha before and after infusion of a solution. The diskogenic neurological frustrations regressed more promptly and completely in the patients, to whom the intraosseous infusion technique has been applied. The positive correlation between clinical recovery and a decrease of a latency of somatosensory evoked potentials peaks is revealed. The intraosseous pressure in an acantha after a course intraosseous infusion was reduced. The directions for applying intraosseous infusion technique are developed.

[The role of somatosensory evoked potentials in evaluating the treatment of patients with degenerative-dystrophic diseases of the lumbosacral spine]. / Rol' somatosensornykh vyzvannykh potentsialov v otsenke lecheniia bol'nykh s degenerativno-distroficheskimi zabolevaniiami poiasnichno-kresttsovogo otdela pozvonochnika.

Somatosensory evoked potentials (SSEP) were dynamically studied through bilateral stimulation of n. tibialis at the cortical and spinal level in 160 patients with degenerative and dystrophic lumbosacral diseases. The study revealed significant changes in the peaks Pf, N21 and in the intervals Pf-N21 in 38 (23.75%) patients. The patients had generally vascular disorders as ascending arterial, venous or concomitant myeloradicopathies (the syndromes of venous or arterial ischemia of the epiconus or conus). There were SSEP no significant changes in the paralyzing ischiasis syndrome. Early decompressing operations on the vertebral column (within 1 to 3 months) led to reversal of neurological disorders in most patients. Thus, SSEP in combination with needle and stimulant electromyography may quantitatively assess the time course of changes in the spinal cord conductors at and beneath the lumbar enlargement of the spinal cord in the treatment of degenerative and dystrophic lumbosacral diseases.

[The assessment of the dynamics of somatosensory evoked potentials in the surgical and conservative treatment of patients following spinal and spinal cord trauma]. / Otsenka dinamiki somatosensornykh vyzvannykh potentsialov pri khirurgicheskom i konservativnom lechenii bol'nykh posle travmy pozvonochnika i spinnogo mozga.

Somatosensory evoked potentials at the cortical and spinal levels were dynamically studied in patients with vertebral column and spinal cord injuries before and after radical reparative surgery. The study showed that quantitative determination of the time course of changes occurring was highly effective in neurological disorders. Most significant were changes in the latent periods and amplitude of the peaks N11, N13, N20, P23 in the activation of n. medianus and N21, N28, P37, N45 in the bilateral stimulation of n. tibialis posterior. There was a correlation of neurophysiological and clinical manifestations in 50-60% of cases. Thus, the neurophysiological studies quantitatively verify the efficiency of surgical treatment for vertebral column and spinal cord injuries.

[Microbial flora in spinal hematogenous osteomyelitis]. / Mikrobnaia flora pri gematogennom osteomielite pozvonochnika.

The analysis of microbic flora of the pus and granulations of 155 patients, operated on hematogenic osteomyelitis of vertebral column. The microbic agents were detected in 81.2% of the patients in subacute stage of the disease, in 48.5% of the patients with chronic stage and duration of the disease less than one year, and in 74.3% of the patients with the duration of the disease exceeding one year. In all cases monoculture was detected with the domination of Staphilococcus (69.2%-83.0%). A comparative analyses of the rate of penetration of the infective agents into the spongeous bone of a damaged vertebra. In case of resection of one third of the height of a vertebra the frequency of detection of an infective agent in subacute stage of a disease decreases 2 times, and in chronic stage-in 4 times. These data provides an opportunity of verification of indications for the surgery.

[Immunological studies and the problems of the pathogenesis of osteoarticular tuberculosis (tuberculous spondylitis, tuberculous synovitis)]. / Immunologicheskie issledovaniia i voprosy patogeneza kostno-sustavnogo tuberkuleza (tuberkuleznyi spondilit, tuberkuleznyi sinovit).

Tests of levels 1-2 were employed to study immune status of 102 patients with tuberculous lesions of the spine and knee joint. Investigations of humoral local response in these patients provided evidence for comparison with systemic response, advanced diagnosis of tuberculous spondylitis and synovitis. It was found that high level of antituberculous antibodies in the synovial fluid is typical for specific allergic synovitis where synovial membrane represents the organ of immunogenesis. The appearance of even minimal number of antituberculous antibodies in the liquor indicates disorder of immune and hematoencephalic barriers of the brain in tuberculous spondylitis complicated with spinal meningitis.

[Problems in the surgical treatment of inflammatory spinal diseases]. / Problemy khirurgicheskogo lecheniia vospalitelnykh zabolevanii pozvonochnika.

The paper considers the stages of development of surgery for inflammatory spinal diseases in the past 20 years at the Institute where the author works. It also assesses the procedures developed, outlines further prospects for development of spinal surgery.

[Pathologic changes in vertebral osteomyelitis]. / Patologicheskaia anatomiia i patomorfoz osteomielita pozvonochnika.

Osteomyelitis of the vertebral column (VC) was considered in the past as a form of sepsis. The disease developed after purulent infection provoked by staphylococcus, enterobacteria and other infectious agents, rapidly progressed and terminated not infrequently, by a patient death. Wide spread destructive process due to the purulent lysis of the bone and cartilage was observed in VC. This disease acquired some new features at present. Although its etiology remained the same, osteomyelitis of VC is now chronic inflammatory process with recurrences and formation of purulent foci in VC with the spread to the paravertebral tissues and adjacent organs. The number of grave complications is reduced and lethal cases are practically absent.

[Indicators of systemic and local immunity in patients with spinal tuberculosis]. / Pokazateli sistemnogo i mestnogo immuniteta u bol'nykh tuberkulezom pozvonochnika.

The examination of 33 patients with tuberculous spondylitis and its sequelae revealed inhibition of T-cell immunity in 40% of the examinees, antituberculous antibodies in the blood of 73% of patients. An enzyme immunoassay detected antituberculous antibodies in cerebrospinal fluid of 70% seropositive sufferers with spinal tuberculosis. Positive results of this test serve a direct indication to spinal decompression and intensive pre- and postoperative antituberculosis treatment.

[Tactics in surgical treatment of combined and complicated forms of active tuberculosis of the spine and lung]. / O taktike khirurgicheskogo lecheniia sochetannykh i oslozhnennykh form aktivnogo tuberkuleza pozvonochnika i legkikh.

Questions related to surgical treatment of combined forms of active spinal and pulmonary tuberculosis are discussed. The results of conservative and surgical treatment of 14 patients with this pathology were analysed. Tactics of treatment of such patients was established. It was shown that emergency surgery on the spine because of the developing complications can be performed together with intensive antituberculous therapy.

[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.

[Biochemical criteria of the inflammatory process in spinal osteomyelitis]. / Biokhimicheskie kriterii vospalitel'nogo protsessa pri osteomielite pozvonochnika.

Patterns of collagen metabolism were studied in 36 patients with hematogenic vertebral column osteomyelitis simultaneously with evaluation of C-reactive protein, haptoglobin and ceruloplasmin in blood and consideration of the clinico-morphological steps of the disease. Hyperhydroxyprolineuria proved to be a more informative evidence for inflammation in vertebral column as compared with the proteins of acute phase of inflammation importance of hydroxyproline measurement in biological fluids for evaluation of the osteomyelitis development was elevated as the inflammation activity decreased (which was estimated by content of the acute phase proteins).