[Surgical treatment of clival and axis bone cysts].

OBJECTIVE: The study objective is to present the tactics of surgical treatment of simple (solitary) bone cysts of the clival region and CII body. MATERIAL AND METHODS: Two patients were operated on for simple clival and axis cysts. RESULTS: The first patient with a simple clival cyst underwent transoral clivectomy and bone cyst evacuation. Postoperative control SCT scans revealed that the cyst cavity was lined with a hemostatic material and biological glue. Restoration of bone structures of the clivus occurred after 8 months. The second patient with a simple cyst of the second cervical vertebra (axis) underwent a two-stage surgical treatment: occipitospondylodesis was carried out first, and transoral removal of the pathological process of the CII body was performed at the second stage. Control scans a year after the surgery revealed the formation of bone tissue in the axis body region, an increased cystic cavity in the odontoid process of the axis, and posterior migration of the odontoid process, which caused compression of the brainstem structures. In connection with this, we performed transoral re-intervention with removal of the cystic separated odontoid process. Postoperative control scans revealed complete removal of the cystic odontoid process and decompression of the dural sac. The article provides a detailed analysis of the modern literature that has not reported any cases of a simple bone cyst located in the clivus or upper cervical vertebrae region and, thus, has not described the tactics for surgical treatment of these complex diseases. The article presents illustrative pre-, intra-, and postoperative images and histological specimens. CONCLUSION: The described cases present successful recurrence-free surgical treatment of simple (solitary) bone cysts located both in the clivus region (1 case) and in the body and odontoid process of the axis (1 case). A feature of the second case was that the patient had an extremely rare combination of a bone cyst of the C2 body and the cystic separated odontoid process of the axis (cystic os odontoideum).

[Operative treatment of severe spine deformities].

87 patients with scoliosis, 32 cases with kyphosis of a various etiology were operated. Patients with severe scoliotic deformations (the total angle 75-140 [Russian character: see text]) got 2 types of the treatment. The first group consisted of 18 patients who were operated in two-stage surgery during the same anesthesia. In the second group (69 patients) after anterior diskectomy within 10-20 days preliminary correction of deformation with halo-pelvic traction was carried out followed by main stage of operation the final dorsal correction of deformation with Cotrel-Dubousset instruments. A significant (more than 40%) correction of deformation was achieved in both groups. However in the 2nd group the value of main angle exceeded 90 [Russian character: see text]. There were operated 32 patients with severe kyphotic deformities. Out of them 15 patients had severe posttraumatic vertebral kyphotic deformations (dislocation fractures of III-IV type according to Denis classification), 11 cases had--postlaminectomy kyphoses, 6 patients suffered from Scheuermann-Mau's disease. The patients with dislocation-fractures underwent laminectomy, reposition of dislocation, and transpedicular fixation of the vertebral column. In 14 patients dislocation was reduced completely, in the one case partially, but in all cases stable spondylosyndesis was achieved. In 8 patients dislocation-fractures were complicated by paraplegia or rough paraparesis), the 3 cases showed practically entire regress after operation, in the 5 cases no evident improvement in the neurologic status occurred. Patients with postlaminectomy kyphoses were treated with wedge vertebrotomy at the top of a curve, dorsal correction and fixation of the vertebral column with CDI system. In the 4 cases there was noted significant improvement in the neurologic status. Patients with Scheuermann-Mau's kyphosis were treated with anterior multilevel diskectomy, followed by halo-pelvic traction, and later dorsal correction of deformation with CDI system. Treatment resulted in significant correction of deformation was achieved and physiological or close to physiological sagittal profile of spine was restored.

[Diagnosis and treatment of paretic forms of lumbar osteochondrosis]. / Diagnostika i lechenie pareticheskikh form poiasnichnogo osteokhondroza.

This study was based on the analysis of the results of examination and treatment of 85 patients with lumbar osteochondrosis with paretic disturbances. The degrees of neurological disorders were analyzed by distributing these patients into three groups including patients with monoradicular, polyradicular motor disorders and circulatory disturbances in the caudal portions of the spinal cord. The informative value of the performed techniques (X-ray study, MRI, myelography, myelography with computed tomography, electroneuromyography) and the necessity of their combination for increasing the quality of diagnosis were determined. Criteria for choosing this or that treatment were defined. Indications for surgery, the time of its performance, and its efficiency were investigated. Surgical outcomes were analyzed by the groups of patients. The paper shows it necessary to use metallic fixing devices in some cases in order to stabilize an altered segment degeneratively, which allows improve the outcome of a surgical intervention. Postoperative rehabilitative treatment is also outlined.