[Surgical treatment of recurrent herniated discs of the lumbar spine depending on risk factors]. / Vybor taktiki khirurgicheskogo lecheniya retsidivov gryzh diskov poyasnichnogo otdela pozvonochnika na osnovanii analiza faktorov riska ikh razvitiya.

According to the literature, recurrent disc herniation of the lumbar spine occurs in 5-10% of cases. Objective. To develop an algorithm for surgical treatment of recurrent lumbar spine disc herniation based on analysis of risk factors of relapse and assessment of intra- and postoperative period. MATERIAL AND METHODS: The study included 61 patients with recurrent intervertebral disc herniation. Thirty patients underwent repeated microdiscectomy without transpedicular fixation, 31 patients - resection of recurrent disc herniation with transpedicular fixation (PLIF technique). The control group included 63 patients without recurrent disc herniation. Mean follow-up period was 3.5 years. RESULTS: Discectomy with transpedicular fixation is characterized by larger extent, prolonged surgery time and rehabilitation period. However, there is lower risk of recurrent disc herniation and CSF leakage. Repeated microdisectomy without transpedicular fixation is characterized by smaller extent and shorter surgery time, as well as faster recovery period. Nevertheless, we have higher risk of recurrent disc herniation and CSF leakage. We developed a method for assessing the probability of recurrent intervertebral disc herniation. This algorithm allows us to predict the probability of recurrent disc herniation in a particular patient with 86.7% accuracy. CONCLUSION: We proposed an algorithm for choosing surgical treatment of recurrent disc herniation. Microdiscectomy without fixation is advisable for the risk of recurrent disc herniation <30%, discectomy with transpedicular fixation - for risk of disc herniation >30%.

[Combined use of biomaterials and revascularisation in autoplasty of ulnar nerve]. / Kombinirovannoe primenenie biomaterialov i revaskulyarizatsii pri autoplastike loktevogo nerva.

Surgical treatment of peripheral nerve injuries is effective in only 50% of cases. This is primarily due to the significant extent of the diastasis between the fragments of the damaged nerve, in which autoplasty has to be performed. The drawbacks of this technique are the formation of scar tissue, possible necrotisation of the autograft, mismatch of the donor and recipient nerve diameters. In order to overcome these drawbacks and improve the efficiency of surgical intervention, the study presents a clinical case of successful multifascicular ulnar nerve autoplasty with the use of domestic biodegradable biomaterials SpheroGel and ElastoPob, revascularization of the autograft with a connective tissue flap on a vascular pedicle. A persistent regression of local pain syndrome was observed in the early postoperative period. The effectiveness of the performed surgical intervention was confirmed by ultrasound examination: there was no evidence of neuroma in the area of the operation, regeneration of nerve bundles was noted at the site of stitching. Positive dynamics was observed in the results of VAS, DN4, DASH questionnaires.

[Genetic factors in degenerative disc disease]. / Rol' geneticheskikh faktorov v razvitii degenerativno-distroficheskogo porazheniya mezhpozvonkovykh diskov.

OBJECTIVE: To analyze available literature data on the role of genetic factors in degenerative disc disease. METHODOLOGY: We reviewed the PubMed, MEDLINE, Cohrane Library, e-Library databases using the following keywords: degenerative spine lesions, intervertebral disc herniation, pathogenesis, genetic regulation. RESULTS: Searching depth was 2002-2022. We reviewed 84 references. Exclusion criteria: duplicate publications, reviews without detailed description of results, opinions. Finally, we included 43 the most significant studies. CONCLUSION: There are literature data on proinflammatory cytokines, growth factors and osteodestructive processes in pathogenesis of degenerative disc disease. However, there is only fragmentary information about the role of genetic regulation of these processes. Some factors, such as microRNA, TGF-b, VEGF, MMP are still poorly understood.

[Surgical treatment of thoracic spine fracture in a patient with ankylosing spondylitis: case report and literature review]. / Khirurgicheskoe lechenie pereloma grudnogo otdela pozvonochnika na fone ankiloziruyushchego spondilita: klinicheskii sluchai i obzor literatury.

OBJECTIVE: To describe the features of diagnosis and surgical treatment of thoracic spine fracture in a patient with ankylosing spondylitis. MATERIAL AND METHODS: We present a patient with ankylosing spondylitis, blunt thoracic spine trauma and Th10-Th11 fracture, spinal cord compression and contusion and moderate lower extremity paresis. Preoperative and postoperative CT and MRI (after 8 months) were performed for control of decompression. RESULTS: The authors identified the main factors affecting the quality of life of patients with spine fractures following ankylosing spondylitis and formulated treatment algorithm. CONCLUSION: Active strategy is advisable for spine fractures following ankylosing spondylitis: spinal cord decompression, creation of anatomical compliance in the damaged vertebral segment and its fixation by transpedicular system. A similar surgical treatment of spine fractures following ankylosing spondylitis makes it possible to achieve early activation of patients and reduce rehabilitation period.

[Severe spine lesion following alkaptonuria. Case report]. / Tyazheloe porazhenie pozvonochnika pri alkaptonurii. Opisanie klinicheskogo sluchaya.

Alkaptonuria is a rare autosomal recessive disease. In these patients, melanin-like compounds as the final products of impaired metabolism of homogentisic acid are deposited mainly in connective tissue, including cartilage tissue of intervertebral discs. Similar to other degenerative spine diseases, lumbar segment is often damaged. The authors report a 67-year-old patient with alkaptonuria. Compression of cauda equina by damaged cartilage masses of intervertebral discs and spine ligaments with deposits of ochronotic pigment is described. Previously diagnosed alkaptonuria in this patient was confirmed by surgical findings (black pigmentation) and histological data.

[The use of intraoperative electrophysiological monitoring in patients with decompression of the ulnar nerve near the elbow joint].

At the elbow, the ulnar nerve may be compressed either in the retrocondylar groove, in the cubital tunnel, or compressed by Osborne's band. Optimal surgical therapy should be directed at the specific site of involvement. It is more difficult to identify the level of ulnar nerve compression. Anatomical variations may make it difficult to identify the causes of ulnar neuropathy at the elbow. The data obtained by inspection, probing, or electroneurography do not allow one to reliably identify the compression level. Intraoperative electroneuromyography performed in conjunction with 14 ulnar nerve explorations helped localize the precise site of compression in 12 cases. Intraoperative studies helped identify compression by Osborne band in 8 patients. We conclude that intraoperative electroneuromyography identifies compression levels of ulnar neuropathy more accurately than the conventional examination methods do.

[Clinical manifestation and surgical treatment of superior lumbar disc herniation].

On the basis of analysis of presentation and surgical treatment of 103 patients with lumbar disc herniation the authors performed comparative assessment of symptoms and therapeutic techniques in patients with higher and lower lumbar disc disease. Short-term and long-term results were evaluated using visual analogue scale and Oswestry disability index (ODI). Statistically significant differences in dynamics of pain and ODI were not present. In spite of differences in clinical presentation, the results of surgical treatment in both groups were similar. They depended on severity of preoperative neurological deficit regardless of level of lesion. Specific features of surgical procedure in superior lumbar disk herniation are described.

[Methods of intraoperative control in resection of intraparenchymal brain tumors].

Primary CNS tumors represent 1.4% of all malignant neoplasias and 2.4% of total oncological mortality. The principal goal of tumor resection is maximally possible radical removal with minimal injury of normal brain tissue. This is due to correlation between intraoperative trauma of the brain and postoperative neurological deficit and quality of life. Recently intraoperative ultrasonic and fluorescent methods of guidance have been widely introduced in neurosurgical practice. In conditions of altered anatomy ultrasonographic guidance is intended to optimize approach to intracerebral tumors considering eloquent areas and main vessels. This allows decrease of neurological deficit in the postoperative period. Fluorescent guidance provides possibility of visual differentiation of tumor and normal tissue thus defining the borderline. Combination of these two techniques may lead to more radical resection of tumors and minimize injury of normal brain. We operated 70 patients with primary and metastatic intraparenchymal brain tumors. Intraoperative ultrasonographic guidance was applied in 58 cases, fluorescent guidance--in 21, both methods--in 9.

[The effect of dimephosphon, sermion and piracetam on the reactivity of the cerebral vessels, on local cerebral blood flow and on oxygen tension in brain tissue]. / Vliianie dimefosfona, sermiona i piratsetama na reaktivnost' mozgovykh sosudov, lokal'nyi mozgovoi krovotok i napriazhenie kisloroda v tkani golovnogo mozga.

The paper gives the results of experimental and clinical studies of the nootropic agents dimephosphone, sermion, and piracetam on local cerebral circulation, cerebrovascular responsiveness and O2 tension. The vasoactivity of the parameters studied has been shown to be displayed by their ability to normalize cerebrovascular responsiveness and it is associated with decreased brain tissue oxygen consumption when dimephosphone is applied and with its increased one when sermion and piracetam are used.

[The effect of dimephosphon on the cerebral circulatory regulation system in patients with brain tumors]. / Vliianie dimefosfona na sistemu reguliatsii tserebral'nogo krovoobrashcheniia u bol'nykh s opukholiami golovnogo mozga.

The paper provides the results of studies of the effects produced by the new vasoactive agent Dimephosphone, which normalizes the function of the nervous system, on the performance of the regulatory mechanisms responsible for the circulatory provision of chemical and physical homeostasis of the brain in patients with cerebral neoplasms. A five-day course of Dimephosphone monotherapy was demonstrated to normalize the cerebral circulatory regulatory system in the preoperative period. Preoperative Dimephosphone normalization of the regulatory mechanisms of cerebral circulatory provision ensures the tolerance of the cerebral circulatory system to intraoperative injury. The drug used in the course treatment of patients accelerates the normalization of cerebral vascular responsiveness at the site of surgical intervention.

[The control of the regulatory system of intracranial blood circulation in neurosurgical patients]. / Kontrol' sistemy reguliatsii vnutricherepnogo krovoobrashcheniia u neirokhirurgicheskikh bol'nykh.

The authors suggest the principles of evaluation of the condition of the system regulating the circulatory provision of cerebral physical and chemical homeostasis, as well as a measurement complex and a set of instrumentally recorded values for control over the cerebral arteries' and veins' response to unified loads of physical and chemical nature in patients with neurosurgical pathology. The scientific and practical significance of such an approach to evaluation of cerebral blood circulation is reasoned by the results of accumulated experience in controlling the activity of some regulations of circulatory provision of the brain in healthy females and males differing in age and in 114 patients with brain tumors.