[Outcomes of lumbar decompression microsurgery]. / Iskhody mikrokhirurgicheskoi dekompressii koreshkov spinnogo mozga na poyasnichnom urovne.

BACKGROUND: Microsurgical decompression of the spinal root in patients with herniated intervertebral discs is the most common spinal surgery. However, most national and foreign studies devoted to assessment of postoperative outcomes contain no consensus on the timing of radicular pain syndrome relief after decompression and predictors of unfavorable outcomes. OBJECTIVE: To determine the period of radicular pain syndrome relief after microsurgical decompression and to identify clinical and neuroimaging predictors of unfavorable postoperative outcomes. MATERIAL AND METHODS: The study included 58 patients aged 26-73 years with clinical manifestations of L5 radiculopathy following compression by L4-L5 herniated disc. We assessed neurological status, functional state (Oswestry Disability Index) and fatty infiltration of paravertebral muscles. Results. Isolated radicular pain was observed in 31% of patients, combination of pain syndrome and sensory disorders - 17%, pain syndrome and motor disorders - 24%, pain syndrome, sensory and motor disorders - 28% of patients. Duration of disease until surgery was significantly longer in women (p=0.030). Complete relief of radicular pain immediately after surgery was observed in 24 (48%) patients. Sixteen (32%) patients had persistent pain syndrome for up to 1 month. Relief of radicular pain on the first postoperative day was significantly more common in patients without motor disorders (p<0.014). The outcomes of microsurgical decompression did not depend on duration of disease (p=0.551), sex (p=0.794), age (p=0.491) and degree of fatty infiltration of paravertebral muscles (p=0.686). CONCLUSION: Radicular pain regresses within 4 weeks after microsurgical decompression. The predictor of unfavorable postoperative outcomes (long-standing pain syndrome and no functional improvement) is any preoperative motor impairment.

[Electrodiagnostic evaluation in differential diagnosis and neurosurgical treatment of radiculopathies caused by spine disorders. Diagnostic value and methodology]. / Elektromiograficheskie metody v differentsial'noi diagnostike i obosnovanii neirokhirurgicheskogo lecheniya radikulopatii, vyzvannykh zabolevaniyami pozvonochnika. Informativnost' i metodologiya.

One of the most common causes of radiculopathy requiring neurosurgical treatment is a herniated disc. Magnetic resonance imaging (MRI) is still the main diagnostic approach for this lesion. However, MRI does not allow assessing the functional state of the root. Neurophysiological examination assesses the function of peripheral nervous system. These methods are used for differential diagnosis of causes of neurological symptoms and determine the level of the nerve root injury. OBJECTIVE: To assess the role of electromyography including paraspinal muscle mapping in diagnosis of radiculopathies following spine diseases. MATERIAL AND METHODS: We have analyzed literature data in the Scopus, Pubmed, and RSCI databases and selected 93 references for primary reviewing. Final analysis enrolled the manuscripts with a detailed description of neurophysiological examinations and data on sensitivity/specificity of these methods. RESULTS: Needle electromyography (EMG) is the most informative neurophysiological method for diagnosis of radicular damage. Sensitivity of EMG is up to 90% for lumbosacral radiculopathy. Electromyography of the paraspinal muscles can be used in case of of cervical, thoracic and lumbar radiculopathy in addition to EMG of limb muscles. Therefore sensitivity increases to 100%. Diagnostic value of nerve conduction study (NCS) is low, and performing NCS without EMG is not useful. CONCLUSION: In neurosurgical practice electrodiagnostic (EDX) should be performed for differential diagnosis of radiculopathy and peripheral nervous system lesions, to determine the level of radicular compression, and when physical examination does not correspond with neuroimaging or MRI is not possible to perform.

[Neurophysiological methods for predicting outcome in cases of spine and spinal cord injury]. / Neirofiziologicheskie metody prognozirovaniya iskhoda pozvonochno-spinnomozgovoi travmy.

The purpose of the review was to determine the capabilities of neurophysiological examination for predicting the outcome of spinal injury. We have analyzed the methods of neurophysiological examination of spinal cord function and the role of these data in prediction of functional recovery in patients with complicated vertebral-spinal injury. Application of functional diagnostic methods for spinal shock was also considered.

[International multicenter studies of treatment of severe traumatic brain injury].

Despite the introduction of new diagnostic and therapeutic methods, traumatic brain injury (TBI) remains one of the leading cause of death and disability worldwide. Standards and recommendations on conservative and surgical treatment of TBI patients should be based on concepts and methods with proven efficacy. The authors present a review of studies of the treatment and surgery of severe TBI: DECRA, RESCUEicp, STITCH(TRAUMA), CRASH, CRASH-2, CAPTAIN, NABIS: H ll, Eurotherm 3235. Important recommendations of the international group IMPACT are considered.

[Cerebrolysin in the treatment of brain injuries of moderate severity].

OBJECTIVE: To assess the efficacy of cerebrolysin in patients with cranial/brain injury of moderate severity. MATERIAL AND METHODS: The main group included 30 patients treated with cerebrolysin from the first day of disease, the comparison group included 32 patients matched for age, sex and disease severity. RESULTS AND CONCLUSION: Cerebrolysin promoted the early and complete reduction of common symptoms of brain injury as well as autonomic and asthenic disorders, restoration of cognitive functions, normalization of emotional condition, improvement of spontaneous bioelectrical activity. The drug was well-tolerated.