[The use of minimally invasive approaches to resect intradural extramedullary spinal cord tumors].

AIM: To conduct a comparative analysis of outcomes in patients with extramedullary tumors operated on using a minimally invasive approach and traditional laminectomy. MATERIAL AND METHODS: The study included 40 patients (13 males and 27 females) who underwent surgical treatment at the Department of Spinal Neurosurgery of the Burdenko Neurosurgical Institute. The mean age of patients was 47 years (range: 41-60 years). Tumors were located in the cervical, thoracic and lumbar spine. All patients were divided into two groups. In the control group, 20 patients underwent traditional laminectomy using a yard retractor or an Egorov-Freidin retractor. In the study group, 20 patients underwent hemilaminectomy using a retractor for minimally invasive surgery (Caspar and MAST Qudrant). The outcomes were evaluated 3, 6, and 12 months after surgery. The McCormik and VAS scales were used for the evaluation. MRI data were also evaluated. RESULTS: Total tumor resection was reached in all cases. The mean surgery duration was 247 min (range: 180-320 min) for the first group and 105.25 min (range: 60-190 min) for the second one. The volume of blood loss was 297 mL (range: 100-600 mL) for the first group and 210 mL (50 to 400 mL) for the second group. The histological nature of the tumors was as follows: neurinoma, meningioma, and ependymomas of the cauda equina. The evaluation of the pain syndrome in the early postoperative period revealed that the pain syndrome intensity according to VAS was reduced in patients of the second group compared to that in patients of the first group. The evaluation using the McCormik scale revealed no obvious difference in the results between the study and control groups. MRI studies performed in the postoperative period showed no tumor recurrence. CONCLUSION: Surgical treatment of patients with intradural extramedullary tumors can be safely and effectively performed using minimally invasive approaches. A potential reduction in surgery duration, intraoperative blood loss, the amount of anesthetic drugs and reduction in the pain syndrome in the early postoperative period allow us to conclude that, when performed by an experienced surgeon, the method of minimally invasive surgery may be an alternative to the traditional removal of an extramedullary tumor.

[Intradural extramedullary myxoma at the L1 level].

Myxoma of the peripheral nerve sheath is a rare benign tumor with predominant localization in the upper extremities, head, neck, and chest. In this study, we reported a clinical case of a patient with intradural myxoma at the L1 level. Much attention was given to histological characterization of the tumor and differential diagnosis of histological types of benign extramedullary tumors. A conclusion was drawn that patients with myxoma need further thorough examination as there is a risk of generalization of tumor process.

[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.