[Clinical and neurological evaluation of the efficiency of transspinal magnetic stimulation during surgical treatment of tuberculosis spondylitis].

The clinical and neurophysiological efficiency of high-intensity transpinal rhythmic magnetic stimulation was studied during surgical treatment in patients with tuberculosis spondylitis complicated by neurological disorders. Its highest efficiency was determined in patients with minor neurological disorders, radicular syndrome, and paresis. Magnetic stimulation was shown to affect the regression of neurological symptoms. The use of electric neuromyography allows quantitative assessment of the course of reparative processes in the pathways.

[Neurorehabilitation in myelopathies caused by tuberculosis-induced ostitis and other diseases of the vertebral column].

An algorithm of stepwise neurorehabilitation has been developed for patients with vertebrogenic myelopathy. The algorithm is constructed as a hierarchy of parallel and series tasks to recovery movement capacities of a paralyzed patient. Their solution requires the use of original procedures, such as initiation of locomotor activity by dermal and epidural spinal cord electrostimulation, propriospinal stimulation, dynamic vertical posture training, as well as treadmill therapy, tetrapedal walk, and therapeutic exercises. Neurorehabilitative treatment by the proposed algorithm was performed in 41 patients with vertebrogenic myelopathy, including 41 patients with clinically complete plegia. In baseline complete plegias, recovery of varying degree or compensation of locomotor capacities was achieved in 71% of the patients, in incomplete plegias, improvement of motor function was observed in all 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.

[Autohemotransfusion in the surgical treatment of tuberculous spondylitis]. / Autogemotransfuziia v khirurgicheskom lechenii tuberkulëznykh spondilitov.

The analysis of 30 cases of intraoperative autohemotransfusion performed in surgical treatment of destructive pulmonary spondylitis demonstrated that such transfusions with controlled hemodilution provide uncomplicated anesthesia, stable hemodynamics in reduced quantities of donor blood.

[Manual therapy in complex treatment of patients with secondary osteochondrosis after sustained tuberculosis spondylitis]. / Manual'naia terapiia v kompleksnom lechenii bol'nykh so vtorichnym osteokhondrozom posle perenesennogo tuberkuleznogo spondilita.

The treatment results relating to 57 patients with neurological signs of osteochondrosis secondary to sustained tuberculous spondylitis with the pain syndrome prevailing in the clinical picture were studied. The majority of the patients (50) had limited affections of 1 or 2-3 adjoining vertebrae and 7 patients had extended processes (4-6 adjoining vertebrae). The treatment procedure was based on manual therapy: hand strength applied to the vertebral column, joints and muscles for eliminating pain and other neurological signs of the disease. The treatment should be complex and differential in regard to the clinical signs, the disease process and stage, the degree of functional disorders and of the pain syndrome. The manual therapy was the most efficient in patients with osteochondrosis secondary to sustained tuberculous spondylitis or the muscular tonic syndrome and moderate deformations of the vertebral column, as well as in those operated on for the main disease at the early stages.

A five-year assessment of controlled trials of in-patient and out-patient treatment and of plaster-of-Paris jackets for tuberculosis of the spine in children on standard chemotherapy. Studies in Masan and Pusan, Korea. Fifth report of the Medical Research Council Working Party on tuberculosis of the spine.

In two centres in Korea 350 patients with a diagnosis of tuberculosis of the thoracic and/or lumbar spine were allocated at random: in Masan to in-patient rest in bed (IP) for six months followed by out-patient treatment or to ambulatory out-patient treatment (OP) from the start; in Pusan to out-patient treatment with a plaster-of-Paris jacket (J) for nine months or to ambulatory treatment without any support (No J). All patients recieved chemotherapy with PAS with isoniazid for eighteen months, either supplemented with streptomycin for the first three months (SPH) or without this supplement (PH), by random allocation. The main analysis of this report concerns 299 patients (eighty-three IP, eighty-three OP, sixty-three J, seventy No J; 143 SPH, 156 PH). Pre-treatment factors were similar in both centres except that the patients in Pusan had, on average, less extensive lesions although in a greater proportion the disease was radiographically active. One patient (J/SPH) died with active spinal disease and three (all No J/SPH) with paraplegia. A fifth patient (IP/PH) who died from cardio respiratory failure also had pulmonary tuberculosis. Twenty-three patients required operation and/or additional chemotherapy for the spinal lesion. A sinus or clinically evident abscess was either present initially or developed during treatment in 41 per cent of patients. Residual lesions persisted in ten patients (four IP, two OP, one J, three No J; six SPH, four PH) at five years. Thirty-two patients had paraparesis on admission or developing later. Complete resolution occurred in twenty on the allocated regimen and in eight after operation or additional chemotherapy or both. Of the remaining four atients, all of whom had operation and additional chemotherapy, three died and one still had paraparesis at five years. Of 295 patients assessed at five years 89 per cent had a favourable status. The proportions of the patients responding favourably were similar in the IP (91 per cent) and OP (89 per cent) series, in the J (90 per cent) and No J (84 per cent) series and in the SPH (86 per cent) and PH (92 per cent) series.