[Minimally invasive removal of dumbbell shaped schwannomas with transforaminal lumbar fusion: a retrospective study with a minimum 3-year follow-up]. / Minimal'no invazivnoe udalenie ganteleobraznykh shvannom s transforaminal'nym poyasnichnym spondilodezom: retrospektivnoe issledovanie s minimal'nym 3-letnim katamnezom.

Currently, there are no standards in surgical treatment of dumbbell-shaped tumors of lumbo-foraminal region. OBJECTIVE: To evaluate the effectiveness and long-term results of minimally invasive resection of dumbbell-shaped lumbar schwannomas Eden type 2 and 3 combined with transforaminal lumbar interbody fusion and transpedicular stabilization. MATERIAL AND METHODS: A retrospective study included 13 patients (8 men and 5 women) with lumbar dumbbell tumors Eden type 2 and 3 who underwent minimally invasive facetectomy through posterolateral anatomical corridor, microsurgical tumor resection and MI TLIF. We analyzed intraoperative parameters, neurological functions (ASIA scale), clinical characteristics (ODI, SF-36), and complications. Resection quality and area of the multifidus muscle were assessed according to MRI data. All patients were followed-up throughout at least 3-year. RESULTS: Surgery time was 147 min, blood loss - 118 ml, hospital-stay - 7 days. Clinical parameters significantly improved in the follow-up period: ODI score decreased from 72 to 12 (p=0.004), SF-36 PCS increased from 26.24 to 48.51 (p=0.006) and MCS score increased from 29.13 to 53.68 (p=0.002). According to MRI data, no tumor recurrences and severe muscle atrophy (>30%) were observed after 3 years in all cases. Superficial wound infection occurred in 1 (7.7%) case. There were normal neurological functions (ASIA type E) in all patients. CONCLUSION: Minimally invasive facetectomy through posterolateral approach with MI TLIF technology can be used for safe and effective resection of dumbbell-shaped schwannomas Eden type 2 and 3.

[VITOM 3D exoscopic system compared to microsurgical technique in spinal surgery]. / Rezul'taty ispol'zovaniya 3D-ekzoskopii VITOM v sravnenii s mikrokhirurgicheskoi tekhnikoi v spinal'noi khirurgii.

3D exoscopy based on Video Telescope Operating Monitor (VITOM) technology provides good visualization quality and portability. There are few data on comparison of extracorporeal telescoping with microsurgical techniques in spinal surgery. OBJECTIVE: To compare the effectiveness of VITOM 3D exoscopy and microsurgical techniques in spinal surgery. MATERIAL AND METHODS: A prospective study included 80 patients (54 men and 26 women). Two groups were distinguished: group 1 (ES, n=40) - VITOM 3D exoscopy, group 2 (SM, n=40) - Pentero 900 surgical microscope. We analyzed surgery time, postoperative rehabilitation, hospital-stay and complications. ES and microsurgical technique were compared using the questionnaire by Takahashi S. and rapid upper limb assessment (RULA). RESULTS: Conventional microsurgical technique was characterized by less surgery time (p<0.05) and morbidity (p=0.02). Postoperative rehabilitation and hospital-stay were similar (p=0.26 and p=0.39, respectively). Image quality in ES was comparable to microsurgical technique in shallow accesses and manipulations perpendicular to skin incision. Availability of neurosurgical instruments at different depths of the wound channel was comparable in both groups. The limitation of ES was length of skin incision, depth of the wound and its visualization at certain angle. These features required expansion of surgical approach or conversion of intervention. In general, surgeons rated intraoperative posture comfort as comparable in both groups that was consistent with the RULA scale. CONCLUSION: VITOM 3D exoscopy is an alternative to traditional microscopy and more ergonomically beneficial in spinal surgery in case of manipulations perpendicular to skin incision and shallow wide accesses. There are several important limitations of this device including difficult manipulations in narrow deep wounds and visualization under certain angle.

[Comparative analysis of the results of anterior decompression-stabilization techniques in the treatment of degenerative stenosis of the cervical spine in elderly patients: a retrospective study.]

The purpose of the study was to compare the clinical and radiological efficacy of 2-level anterior cervical discectomy and fusion (ACDF) and 1-level anterior cervical corpectomy and fusion (ACCF) in the treatment of two-segment degenerative stenosis of the cervical spine in elderly patients. The retrospective study included 74 elderly patients (over 60 years old), two cohorts were identified: the 1st (n=38) - patients who underwent staged 2-level ACDF; the 2nd (n=36) - patients operated on using the technique of 1-level ACCF. For comparative analysis, we used general information about patients (gender, age, body mass index, physical status according to ASA), characteristics of surgical interventions (time of surgery, volume of blood loss), features of the postoperative period, clinical data, radiological outcomes, and the presence of complications. Analysis of the results was carried out in a minimum period of 36 months. As a result, it was found that 2-level ACDF in the treatment of two-segment degenerative stenosis of the cervical spine in older patients is associated with less blood loss and the level of local pain syndrome. At the same time, better clinical outcomes and fewer revision interventions after 1-level ACCF were recorded in the long-term postoperative period.

[Analysis of preoperative risk factors of adjacent segment disease after transforaminal lumbar interbody fusion]. / Analiz predoperatsionnykh faktorov riska degenerativnogo zabolevaniya smezhnogo segmenta posle vypolneniya transforaminal'nogo poyasnichnogo spondilodeza.

Currently, there is no information on the combined effect of body mass index (BMI), age, gender, main spinal-pelvic parameters and parameters of adjacent functional spinal unit (FSU) degeneration according to magnetic resonance imaging on development of adjacent segment degenerative disease (ASDd). OBJECTIVE: To evaluate the effect of preoperative biometric and instrumental parameters of adjacent FSU on the risk of ASDd after transforaminal lumbar interbody fusion and determine personalized neurosurgical approach. MATERIAL AND METHODS: We retrospectively studied patients after single-level transforaminal lumbar interbody fusion (group I, n=54), single-level transforaminal lumbar interbody fusion and interspinous stabilization of adjacent level (group II, n=55), preventive rigid fusion of adjacent segment (group III, n=56). Preoperative parameters and long-term clinical outcomes were assessed. RESULTS: Paired correlation analysis established the main predictors of ASDd. Regression analysis determined absolute values of these predictors for each type of surgical intervention. CONCLUSION: Surgical intervention at the level of asymptomatic proximal adjacent segment is recommended as interspinous stabilization for moderate degenerative lesions, BMI <25 kg/m2, difference between pelvic index and lumbar lordosis 10.5-15°, segmental lordosis 6.5-10.5°. In case of severe degenerative lesions, BMI 25.1-31.1 kg/m2, significant deviations of spinal-pelvic parameters (segmental lordosis 5.5-10.5°, difference between pelvic index and lumbar lordosis 15.2-20°), preventive rigid stabilization is indicated.

[Long-term results and predictors of postoperative outcomes in patients with cauda equina syndrome following degenerative lumbar spine disease]. / Otdalennye rezul'taty i faktory, vliyayushchie na iskhod khirurgicheskogo lecheniya sindroma konskogo khvosta, obuslovlennogo degenerativnym zabolevaniem poyasnichnogo otdela pozvonochnika.

Cauda equina syndrome (CES) associated with acute disc extrusion or spinal stenosis often requires emergency surgery. Analysis of the Pubmed, Medline and eLibrary databases revealed a few studies devoted to long-term postoperative outcomes in patients with CES caused by degenerative spine disease. OBJECTIVE: To evaluate long-term postoperative results and predictors of clinical and neurological outcomes in patients with CES caused by degenerative lumbar spine disease. MATERIAL AND METHODS. D: Ecompressive and decompressive-stabilizing procedures were performed in 211 patients with CES caused by degenerative lumbar spine disease between 2000 and 2020. Long-term clinical parameters were available in 174 patients with mean follow-up period of 7 years. Sixty-eight patients had unsatisfactory postoperative outcomes. We assessed postoperative clinical and neurological outcomes in patients with CES and predictors of these outcomes. RESULTS: We identified the following predictors of clinical and neurological outcomes using binary logistic regression model: period between clinical manifestation and surgery >48 hours, preoperative neurological impairment, spinal canal diameter, surgical procedure, dimension of herniated disc, ASA score and long-term postoperative analgesia with narcotic analgesics. CONCLUSION: Preoperative planning and possible correction of the above-mentioned risk factors will potentially improve postoperative outcomes in patients with CES caused by degenerative lumbar spine disease.

[Comparative analysis of the results of decompressive interventions in elderly patients with cauda equine syndrome caused by lumbar spinal stenosis.]

The aim of the study was to evaluate the results of surgical treatment and the effectiveness of clinical recovery in elderly patients with cauda equina syndrome (CES) caused by degenerative spinal canal stenosis after isolated open and minimally invasive decompression. A retrospective analysis of the results of surgical treatment of 50 patients over 60 years of age who underwent isolated open (n=21) and minimally invasive (n=29) decompressive interventions for CES caused by lumbar spinal stenosis was performed. For comparative analysis, we used the technical features of the intervention, the specificity of postoperative management of patients, clinical parameters, and the number of perioperative complications. As a result, the advantages of minimally invasive isolated decompression compared to open decompression due to a smaller volume of blood loss and duration of hospitalization, low need for postoperative pain relief, a minimum number of perioperative surgical complications, as well as the dynamics of neurological symptoms, better efficiency of clinical recovery of functional state indicators according to ODI and quality life according to SF-36 in the late postoperative period.

[Analysis of unfavorable postoperative outcomes in patients with lumbosacral junction anomalies]. / Analiz neudovletvoritel'nykh rezul'tatov khirurgicheskogo lecheniya patsientov s anomaliyami poyasnichno-kresttsovogo perekhoda pozvonochnika.

BACKGROUND: The absence of a unified diagnostic approach and heterogeneous treatment strategies in patients with lumbosacral transitional vertebra contribute to registration of contradictory data on postoperative outcomes in these patients. OBJECTIVE: A retrospective analysis of postoperative outcomes in patients with degenerative lumbar spine diseases associated with lumbosacral junction anomalies and causes of unfavorable results. MATERIAL AND METHODS: Lumbosacral transitional vertebra was preoperatively verified and classified according to Castellvi A.E. in 352 cases between 2007 and 2017. Full-time examination, phone and e-mail survey covered 314 (89.2%) patients throughout 5.2-year follow-up period. There were unfavorable clinical outcomes in 42 cases. We analyzed the causes of these results and relationship of surgical strategy with the type of lumbosacral junction anomaly. RESULTS: Lumbosacral transitional vertebra Castellvi type IIA (30.9%) and IIIA (34.9%) prevailed. Unfavorable outcomes occurred in 7 cases after percutaneous interventions, in 12 patients after decompression surgery and in 23 patients after decompression and stabilization procedures. In all cases (n=42), redo surgery was performed: rigid fixation or extension of stabilization system in 16 cases, additional intracanal decompression in 10 patients, foraminal/extraforaminal decompression in 8 patients. Seven patients underwent repeated laser denervation. Of these, 5 patients underwent dorsal decompression without discectomy due to ineffective denervation. Correlation analysis showed the relationship between unfavorable outcomes after percutaneous procedures with LV transverse process dysplasia and sacralization, decompressive interventions with additional articular joints and lumbarization, decompression/stabilization procedures with LV transverse process dysplasia and sacralization. CONCLUSION: Unfavorable outcomes occurred after percutaneous interventions for anomaly type IB and IIIB, decompressive procedures for anomaly type IIA, IIB and IV, decompression/ stabilization procedures for types IA and IIIA. It is the first report devoted to analysis of relationships between unsatisfactory postoperative outcomes, surgical technique and type of lumbosacral dysgenesis.

Effects of Boron Neutron Capture Therapy on the Growth of Subcutaneous Xenografts of Human Colorectal Adenocarcinoma SW-620 in Immunodeficient Mice.

Boron neutron capture therapy (BNCT) can become an instrument for patients with malignant neoplasms of the rectum and colon. Here we evaluate the effectiveness of BNCT performed at the accelerator based epithermal neutron source at G. I. Budker Institute of Nuclear Physics, Siberian Division of Russian Academy of Sciences, in relation to subcutaneous xenografts of human colon adenocarcinoma SW-620 in SCID mice. Utilization of BNCT with boronоphenylalanine (BPA) and sodium borocaptate (BSH), which were injected intravenously into the retroorbital sinus, resulted in a significant decrease in tumor volumes compared to the control group (no radiation).

[Results of the study of functional recovery of professional athletes after minimally invasive lumbar fusion]. / Rezul'taty provedeniya minimal'no-invazivnogo poyasnichnogo spondilodeza u professional'nykh sportsmenov.

OBJECTIVE: To conduct a comprehensive clinical-neurological assessment and to study the results of functional recovery of professional athletes after minimally invasive lumbar interbody fusion. MATERIALS AND METHODS: The retrospective study included 27 patients-professional athletes who were operated on using minimally invasive decompression and stabilization techniques in the period 2010 to 2019. Clinical-neurological effectiveness was assessed when returning to previous sports activity was 14 (9; 17) weeks and 4 (3; 5) years after surgery. RESULTS: The follow-up showed a significant improvement in clinical and neurological parameters: persistent elimination of radicular and muscular-skeletal symptoms, a decrease in the level of pain according to a visual analogue scale in the lumbar spine from 68 (61; 85) mm to 3 (2; 11) mm (p=0.002) and in the lower extremities from 84 (78; 91) mm to 1 (0; 3) mm (p=0.001), change in the physical component of health from 26.18 (23.58; 28.37) to 49.82 (49.03; 53.04) (p=0.002) and the psychological component of health from 27.87 (26.22; 29.29) to 52.18 (49.12; 55.66) (p=0.001), significant improvement in the perception of physical activity according to the Borg RPE Scale from 17 (16; 18) points to 9 (8; 9) (p<0.001). In one case (3.7%), the patient did not return to his previous sports career. CONCLUSION: The use of minimally invasive rigid stabilization in the overwhelming majority of professional athletes made it possible in the shortest possible time to achieve regression of neurological symptoms, reduce pain, improve the quality of life, restore the functional state and return to previous sports activities.

Accelerated Recovery Program for Patients with Polysegmental Degenerative Lumbar Spine Disease.

The aim of the study was to evaluate the effectiveness of the accelerated recovery program for patients with polysegmental degenerative diseases of the lumbar spine. Materials and Methods: This prospective study included 53 patients who underwent two-level transforaminal interbody fusion in the LII-SI segments. Two groups were identified: in group 1 (n=24), operations were performed using the accelerated recovery program; in group 2 (n=29), open rigid stabilization was used under traditional intravenous anesthesia. The end-point parameters were the number of bed-days spent in the hospital after the operation, the number of perioperative surgical complications and adverse effects of anesthesia, and the number of re-hospitalizations within 90 days. We also recorded the time of patient activation, the level of pain around the operated zone (using a visual analogue scale), and the quality of life in the long-term postoperative period (median 18 months); the latter was assessed using the SF-36 questionnaire (physical and psychological components of health). Results: Patients under the accelerated recovery program were found to have a shorter duration of surgery and anesthesia, less blood loss, lower amounts of injected opioids, faster verticalization, and a reduced period of inpatient treatment (p<0.05 for all parameters). As compared to group 2, patients in group 1 had a lower level of pain in the surgery zone (p<0.05), better long-term indicators of the physical and psychological components of health (p<0.05), a lower number of anesthesia-associated adverse events (p<0.05), and a lower rate of postoperative complications (p<0.05). During the 90-day postoperative observation, four patients of group 2 (13.8%) were urgently referred to a medical institution for additional medical care. Conclusion: The accelerated recovery program for two-level interbody fusion showed its safety and high clinical efficiency in the treatment of patients with polysegmental degenerative diseases of the lumbar spine. The program can be used in any center for spine surgery where effective interaction between polyvalent medical and nursing teams is maintained.

[Results of minimally invasive lumbar fusion in professional athletes: a single-center retrospective study]. / Rezul'taty minimal'no invazivnogo poyasnichnogo spondilodeza u professional'nykh sportsmenov: odnotsentrovoe retrospektivnoe issledovanie.

Professional athletes have a high basic level of physical fitness and significant motivation for returning to previous rhythm of functional activity within the shortest period after trauma without deterioration of baseline level of sportsmanship. Despite the well-presented results of lumbar spine fusion in general population, these data among professional athletes are not well understood. OBJECTIVE: To analyze the results of minimally invasive lumbar fusion in professional athletes. MATERIAL AND METHODS: A retrospective study included 27 athletes (19 men and 8 women) aged 29 (26; 34) years after minimally invasive lumbar spine decompression and fusion via anterior, lateral and posterior approaches. Total lumbar lordosis, degenerative changes in adjacent segment, area of multifidus muscle, perioperative complications and timing of sports rehabilitation were analyzed within 3-5 (mean 4) years after surgery. RESULTS: We found an increase of total lumbar lordosis from 35.2° to 44.1° (p=0.02), no significant muscle atrophy (<30%) and degeneration of adjacent segment (p>0.05). There were 5 perioperative complications (18.5%). Mean period of sports rehabilitation was 14 (9; 17) weeks. One (3.7%) patient did not return to his previous sports career. CONCLUSION: Minimally invasive short-segment lumbar interbody fusion in professional athletes is characterized by low risk of fixation element failure, no significant degeneration of adjacent level and postoperative muscle atrophy. This procedure ensures early rehabilitation and returning to sports.

[A comparative analysis of clinical efficiency of laser and radiofrequency denervation in patients with primary trigeminal neuralgia]. / Sravnitel'nyi analiz klinicheskoi effektivnosti primeneniya lazernoi i radiochastotnoi denervatsii u patsientov s pervichnoi nevralgiei troinichnogo nerva.

OBJECTIVE: To compare the clinical efficacy of laser and radiofrequency denervation in patients with primary trigeminal neuralgia. MATERIAL AND METHODS: The study included 50 patients with primary trigeminal neuralgia who were operated on by laser (group I, n=25) or radiofrequency denervation (group II, n=25) in the period from 2018 to 2019. To assess the clinical efficacy, we analyzed the dynamics of the pain syndrome level according to the scale of facial pain and the quality of life according to the Short Form Medical Outcomes Study (SF-36), as well as patient satisfaction with the operation according to the Macnab scale, the presence of postoperative surgical complications and adverse effects of anesthesia. RESULTS: In the postoperative period, according to the scale of facial pain, a decrease in its intensity was noted in both study groups (p<0.001). Comparative analysis showed a comparable level of pain in the early postoperative period: at discharge (p=0.43) and 6 months after surgery (p=0.07). At the same time, after 12 months, lower scores on the scale of facial pain were noted in patients of group I (p=0.02). According to SF-36, a significant improvement in the physical and psychological components of health was determined in group I (p<0.001) and group II (p<0.05). Comparison of SF-36 scores in the long-term postoperative period revealed the best indicators in group I (p=0.02 and p=0.01, respectively). Comparative analysis verified a greater subjective satisfaction with the operation in group I, compared with group II (p<0.001). A comparable number of adverse effects of anesthesia was determined in both groups. Comparative analysis revealed a significantly greater number of postoperative surgical complications in group II (p=0.0017). CONCLUSION: Laser denervation and radiofrequency denervation are highly effective methods of minimally invasive treatment of primary trigeminal neuralgia.

[Effectiveness of simultaneous and staged minimally invasive dorsal decompression-stabilization procedures in patients with lumbar spine degenerative diseases]. / Sravnenie effektivnosti ispol'zovaniya simul'tannykh i etapnykh minimal'no-invazivnykh dorsal'nykh dekompressivno-stabiliziruyushchikh vmeshatel'stv u patsientov s degenerativnymi zabolevaniyami poyasnichnogo otdela pozvonochnika.

Minimally invasive procedures reduce the trauma of spine surgery. However, they are associated with high complexity of manipulations, long learning curve, need for expensive equipment for intraoperative navigation and significant irradiation. Various options for surgical approaches are being developed to reduce irradiation of medical staff and patients, surgery time and the number of drugs administered for general anesthesia. Simultaneous surgical interventions (SiSI) is one of these options. OBJECTIVE: To compare the effectiveness of simultaneous and staged minimally invasive dorsal decompression-stabilization procedures in patients with lumbar spine degenerative diseases. MATERIAL AND METHODS: A prospective study included 67 patients (41 men and 26 women) aged 48 (34; 56) years who underwent a single-level minimally invasive spinal root decompression and transforaminal interbody fusion via Wiltse posterior-lateral approach. Two study groups were distinguished: group I (simultaneous surgical interventions, SiSI) (n=29), in which guide spokes and transpedicular screws were installed simultaneously by two surgeons within one x-ray session from two sides; group II (staged surgical interventions, StSI) (n=38), in which staged transpedicular stabilization was performed (decompression side followed by contralateral side). Mean follow-up was 14 months in group I and 20 months in group II. We considered intraoperative fluoroscopy and irradiation dose, duration of surgery and anesthesia with calculation of doses of opioid drugs, blood loss, time of activation, hospital-stay and perioperative morbidity. Clinical outcomes were studied in long-term postoperative period. RESULTS: Simultaneous approach ensured less time of intraoperative fluoroscopy (p=0.029) and irradiation dose (p=0.035), duration of surgery (p=0.01) and anesthesia (p=0.02), amount of opioid drugs during anesthesia (p=0.017). Blood loss, duration of activation and hospitals-stay were similar in both groups (p=0.35, p=0.12 and p=0.57, respectively). There was comparable improvement in VAS score of pain in the lumbar spine and lower extremities in both groups (p=0.63 and p=0.31, respectively). According to SF-36 questionnaire, there was no between-group difference in physical and psychological components (p=0.44 and p=0.72, respectively). There was significantly greater number of adverse effects of anesthesia in the StSI group (26.2% vs. 6.8%, p=0.003). At the same time, the number of surgical postoperative complications was similar in both groups (3.4% vs. 5.3%, p=0.62). CONCLUSION: Simultaneous minimally invasive dorsal decompression-stabilization procedures have some significant advantages over staged approach regarding intraoperative parameters and adverse effects of anesthesia in patients with lumbar spine degenerative diseases. Nevertheless, there were similar clinical data and small incidence of surgical perioperative complications.

[Analysis of the results of laser destruction of the articular branch of the obturator nerve in elderly and senile patients with degenerative coxarthrosis.]

The aim of the study was to analyze the results of the use of laser destruction of the articular branch of the obturator nerve in elderly and senile patients with degenerative coxarthrosis. The results of treatment of 34 patients over 65 years of age with symptomatic degenerative diseases of the hip joint (HJD) and somatic contraindications for total hip arthroplasty have been prospectively studied. In the study group, in the period from 2017 to 2019, laser destruction of the articular branch of the obturator nerve (970 nm, frequency 9 Hz and power 3 W in a total dose of 100 J) was carried out. The average follow-up was 12 months. To assess the effectiveness of surgical treatment, the dynamics of the pain syndrome in the hip joint was analyzed according to the visual analogue scale, the quality of life according to the SF-36 questionnaire, the functional state of the hip joint according to the W.H.Harris scale and the presence perioperative surgical complications. As a result, it was found that the use of laser destruction of the articular branch of the obturator nerve in degenerative coxarthrosis in elderly and senile patients (if total hip arthroplasty was not possible) made it possible to significantly reduce the level of preoperative pain syndrome, restore the quality of life and improve the functional state of patients with low risks of surgical complications.

[Evaluation of the results of using the accelerated recovery program after performing two-level lumbar spinal fusion in patients of an older age group.]

The aim of the study was to evaluate the results of using the accelerated recovery program after performing two-level lumbar spinal fusion in patients of an older age group. The results of surgical treatment of 29 patients older than 65 years with multisegmental degenerative diseases of the lumbar region, who performed minimally invasive two-level rigid stabilization using the concept of «accelerated recovery program¼ (PAR), were retrospectively studied. We studied the technical features of surgical interventions, the specificity of the postoperative period, the number of adverse outcomes of anesthetic benefits and perioperative surgical complications, the frequency of repeated hospitalizations for 90 days. Clinical parameters were used to evaluate the effectiveness of PAR: the level of pain in the area of operation according to the visual analogue scale (VAS) during hospitalization, the quality of life of patients on the SF-36 questionnaire, and patient satisfaction with the result of treatment using the Macnab scale. As a result, it was established that the introduced PAR after performing two-level lumbar spinal fusion in patients of an older age group provides the minimum number of adverse consequences of anesthesiological aid and perioperative surgical complications, a significant restoration of the quality of life and high patient satisfaction with the treatment.

[Analysis of the results of surgical treatment of primary trigeminal neuralgia using laser destruction of the sensitive root in elderly and senile patients.]

The aim of the study was to analyze the results of surgical treatment of primary trigeminal neuralgia using laser destruction of the sensitive root in elderly and senile patients. The results of treatment of 25 patients older than 65 years with conservative treatment-resistant trigeminal pain who underwent laser destruction of the sensitive trigeminal root (970 nm, 9 Hz and 3 W power in a total dose of 100 J) in the period from 2018-2019 were prospectively studied. The average follow-up was 12 months. As a result, a significant decrease in the intensity of pain on the scale of facial pain was found from 87 (83,5; 91,5) mm to 15,5 (12,5; 18,5) mm (p=0,002) in the long-term period. On average, 12 months after the operation, a significant improvement in the indicators of the physical and psychological components of health was revealed on the SF-36 questionnaire (p=0,02 and p=0,01, respectively). In the follow-up on the Macnab scale, predominantly excellent (n=23; 92%) and good (n=2; 8%) treatment results were noted. Registered 1 (4%) perioperative complication and 2 (8%) adverse effects of anesthesiology benefits. Thus, the use of laser denervation of the sensitive root in primary trigeminal neuralgia in elderly and senile patients can significantly reduce the level of preoperative pain and improve the quality of life, with low risks of adverse effects.

[Analysis of the clinical efficacy of platelet-rich plasma therapy in the treatment of patients with isolated facet-syndrome of the lumbar spine]. / Analiz klinicheskoi éffektivnosti primeneniia PRP-terapii pri lechenii patsientov s izolirovannym fasetochnym sindromom poiasnichnogo otdela pozvonochnika.

AIM: To analyze clinical results of the surgical treatment of patients with isolated facet-syndrome of the lumbar spine using platelet-rich plasma (PRP) therapy for arcuate spine joints. MATERIAL AND METHODS: The study included 49 patients, aged 39.5 (34; 45), who, after provocative tests, were diagnosed with isolated facet syndrome and operated on from 2015 to 2018 using PRP therapy. A visual analogue pain scale (VAS), Oswestry questionnaire (ODI), Macnab subjective satisfaction scale, and the presence of complications were used to evaluate clinical efficacy. Dynamic evaluation was made on average 18 months after surgery. RESULTS AND CONCLUSION: PRP therapy is a highly effective method for treatment of patients with isolated facet syndrome caused by degenerative diseases of the facet joints. Clinical efficacy is confirmed by the persistent significant reduction of pain symptoms and restoration of functional status in the early and late postoperative periods with low risks of adverse outcomes.

[Minimally invasive spinal surgery: stages of development]. / Minimal'no invazivnaia khirurgiia pozvonochnika: étapy razvitiia.

In recent decades, spinal surgery has changed significantly. The active use of modern knowledge of anatomy, various diagnostic modules, specialized surgical equipment and high-tech tools has made it possible to transform classical surgical techniques into a new area of spinal neurosurgery - minimally invasive spine surgery (MISS). Its main goals are to reduce damage to the skin and adjacent tissues, significantly reduce the level of pain, reduce the duration of inpatient treatment and fully restore functional status in the shortest possible time. This article reflects the main criteria for MISS compliance and types of surgical interventions, provides information on the advantages of minimally invasive surgical technologies and their possible disadvantages. Currently, the use of MISS is observed in all areas of vertebrology - for degenerative diseases, tumors, inflammatory and traumatic lesions of the spine. At the same time, minimizing surgical aggression while maximizing the achievement of goal becomes the main rule of modern spinal surgery.

[Possibilities and advantages of minimally invasive dorsal decompressive-stabilizing interventions in the treatment of degenerative spondylolisthesis of the elderly patients.]

The purpose of the study was a comparative analysis of the clinical and radiographic efficacy of minimally invasive rigid stabilization techniques and the traditional open interbody fusion with transpedicular fixation in the treatment of degenerative spondylolisthesis in elderly patients. The study included 65 elderly patients (over 60 years old) divided into 2 groups: the 1st group (MIS-TLIF, n=31), who underwent minimally invasive transforaminal interbody fusion, unilateral open contralateral transcutaneous transpedicular stabilization; the 2nd group (O-TLIF, n=34), operated using rigid stabilization from the median approach. For the comparative analysis, gender characteristics (gender, age), constitutional features (height, weight, body mass index), ASA physical status, intraoperative parameters of interventions and specificity of postoperative management of patients, clinical data, radiographic outcomes, complications were used. Dynamic evaluation was performed at the time from 24 to 48 months after the operation (median 32 months). As a result, it has been established that the use of minimally invasive dorsal decompressive-stabilizing interventions allows achieving better clinical outcomes and fewer perioperative complications than open transforaminal interbody spondylodesis and transpedicular stabilization with similar radiographic results of fusion formation and reduction of abnormal vertebral displacement. Low traumatic surgery in the main study group makes it possible to use a technique for treating degenerative spondylolisthesis in elderly patients.

[Local administration of vancomycin powder in posterior lumbar fusion surgery]. / Éffektivnost' mestnogo primeneniia vankomitsina pri zadnikh dekompressivno-stabiliziruiushchikh operativnykh vmeshatel'stvakh na poiasnichno-kresttsovom otdele pozvonochnika.

AIM: To evaluate an efficacy of local administration of vancomycin powder in posterior lumbar fusion surgery for prevention of local infection. MATERIAL AND METHODS: The study included 214 patients. All patients were divided into 2 groups: I group (control) and II (experimental). Patients of the first group underwent conventional antibiotic prophylaxis of wound infections, in group II traditional antibiotic prophylaxis was supplemented by local administration of vancomycin powder 1 g prior to wound closure. RESULTS: There were 12 cases of wound infection in group I and 5 cases in group II. There were significant differences in overall incidence of wound infection and wound infections caused by S. aureus (p=0.035; p=0.044, respectively). Significant risk factors of local infection were determined in group II: obesity, diabetes mellitus, arterial hypertension, coronary artery disease, length of hospital-stay and previous lumbosacral spinal surgery. Multivariate analysis revealed following risk factors of wound infection: diabetes mellitus, arterial hypertension, coronary artery disease, the number of involved spinal segments and previous lumbosacral spinal surgery. CONCLUSION: Local application of vancomycin powder in posterior lumbar fusion surgery significantly reduces the incidence of wound infection.