Metastasis of malignant tumors in the spine is a common problem of cancer patients. Modern neuroimaging methods make it possible to identify secondary lesions of the spinal column at an early stage. Currently, the approach to the treatment of metastatic spinal lesions is multidisciplinary and requires the approach of doctors of different specialties: neurosurgeon, radiologist, chemotherapist, neurologist and rehabilitologist. Currently, a combination of several treatment methods is optimal: surgery, radiation and drug therapy. Systemic drug therapy is an integral part of long-term control of spinal metastases and depends on the histological structure of the malignant neoplasm and its ability to respond to drug exposure. The article also describes modern methods of radiation therapy. To date, there is no unity of views and an unambiguous standardized, scientifically based approach to solving the existing problem, however, further study of it will be able to ensure the choice of the optimal algorithm for the curation of patients with metastatic spinal lesion. After all, proper treatment of secondary damage to the spinal column will allow the patient to prevent neurological deficit and persistent pain syndrome, to maintain an optimal quality of life.

Throughout the world, back pain affects a large part of the population. Degenerative-dystrophic diseases of the spine are one of the most important problems of modern medicine. The share of this disease affecting people in the most active social group is from 20% to 80% of cases of temporary disability. The goal is to present the history of the development of surgical methods for the treatment of degenerative diseases of the spine. Materials and methods. The literature presented in the PubMed, eLibrary and Cochrane databases is analyzed. Results. This paper describes all types of surgical interventions used for degenerative diseases of the lumbar spine: decompressive, decompressive-stabilizing and reconstructive-stabilizing. The indications for each of the methods of operative aid are described. The results of decompressive interventions were compared: microsurgical, tubular and endoscopic microdiscectomies. Modern approaches to the lumbar spine are described and compared: PLIF, TLIF, XLIF, ALIF. Further, the paper describes the basic principles of reconstructive and stabilizing operations: measurement of vertebral-pelvic ratios, classification of vertebrotomies. Conclusion. Endoscopic spine surgery is a prerogative in the treatment of degenerative diseases of the lumbar spine due to a shorter stay in the clinic, less tissue trauma, lower use of analgesics and rapid recovery. Decompression-stabilizing operations are currently used in patients without violation of the sagittal and frontal balances. The choice of the method of fixation (back, front or a combination of them) should depend on the experience of the clinic, the skills of the surgeon and the anatomical features of the patient. Vertebrotomies are performed only when there is a violation of the sagittal and frontal balance.

12–40% лиц с болью в пояснице имеют нестабильность позвоночника при дегенеративно-дистрофических заболеваниях позвоночника. В работе освещены биомеханические основы развития сегментарной нестабильности и представлены различные гипотезы развития данного состояния. Приведены современные методы нейровизуализации, применяемые в диагностике сегментарной нестабильности: рентгенография, функциональная спондилография, КТ, функциональная КТ, МРТ. Также в работе приведены провокационные тесты, применяемые в диагностике нестабильности: пассивное разгибание поясничного отдела позвоночника, стояние, сидение, прон-нестабильность, «ножницы», компрессия остистых отростков, в положении стоя наклон вперед и др. Авторы поделились своим опытом диагностики сегментарной нестабильности. Несоответствие данным инструментальных обследований и жалоб пациента, малоизученные ротационная и боковая нестабильность при остеохондрозе указывают на необходимость более детального изучения нестабильности позвоночника в целом.

Objective. To analyze tactical approaches and types of surgical interventions for post-traumatic deformity of the spine. Material and Methods. Study design: retrospective monocentric cohort study. The study included 116 patients: Group 1 consisted of 50 patients with primary post-traumatic deformities, and Group 2 of 66 patients with secondary deformities after previously performed decompression and stabilization surgery who were admitted for revision interventions. The average age of patients was 42.1 ± 11.6 years, the long-term follow-up period varied from 2 to 60 months (16.6 ± 10.2). Methods used in the study were clinical (neurological status, ASIA, VAS) one, evaluation of treatment results according to MacNub scale, radiography, CT, radiometry (local kyphosis according to Cobb, Surgimap Spine), MRI, and statistical methods. Results. The follow-up period of Group 1 patients was 31.3 ± 28.1 months, of Group 2 patients – 60.3 ± 48.1 months. Injuries were predominantly localized at the level of the thoracolumbar junction. In Group 2, more severe neurological disorders (ASIA) prevailed. All patients underwent primary or revision transpedicular fixation and Schwab vertebrotomy variants through posterior approach. The following types of primary deformities according to Rajasekaran were observed: type IIA in 16 (32 %) patients, IIIA in 30 (45 %), and IIIB in 4 (6 %). Patients with secondary deformities had failure of posterior instrumental fixation (100 %), failure (56 %) or absence (73 %) of anterior fusion, and progression of deformity (100 %). In Group 1, local kyphosis was 32.0° ± 9.9° before treatment and 12.5° ± 8.8° after treatment, pain VAS score before treatment 76.6 ± 6.9, and after treatment 47.6 ± 8.8. In Group 2, local kyphosis was 31.8° and 10.1°, and pain score 80.6 and 48.4, respectively. Complications were registered in 10 % of cases. Treatment results were assessed as good/satisfactory in 32 (64 %)/18 (36 %) Group 1 patients, and in 38 (57 %)/28 (42 %) Group 2 patients, respectively. Conclusion. Classification options and tactical approaches for primary post-traumatic spinal deformities were defined; for secondary posttraumatic deformities there is no classification defining treatment tactics and criteria for assessing the parameters of local and global body balances. Joint multicenter studies are necessary for the adoption of consensual conclusions in the revision surgery of post-traumatic spinal deformities.

Introduction Currently, there is no single concept of interspinous process stabilization. Some authors consider the procedures to be a trade-off for the elderly population with vague morphological changes and neurogenic claudication whereas others do not support the practice, and still others offer it as an alternative to conservative and conventional surgical treatment for lumbar spinal stenosis (LSS). Material and methods The study included 22 patients with LSS. The patients were followed for 6 months. The clinical outcomes measures were neurological assessment, the Wong-Baker pain rating scale, Oswestry Disability Index (ODI). Radiographic evaluation and statistical analysis were also used. Surgical treatment included distraction laminoplasty and placement of interspinous dynamic fixator. Results Interspinous dynamic fixation and distraction laminoplasty resulted in regression of neurological deficiency and did not lead to deterioration of segmental and local imbalance. Clinical assessment of pain, radicular motor and sensory deficit and intermittent neurogenic claudication was performed. Morphological evaluation showed relative central spinal canal stenosis, foraminal stenosis and enduring degenerative spondylolisthesis (grades I and II). Conclusion Interspinous dynamic fixation is the method of choice for patients with lumbar spinal stenosis in presence of specific morphological and clinical manifestations.

Background: Aortic injuries because of pedicle screw placement are quite rare, consequently management strategies to avoid vascular complications are lacking. Intraoperative or postoperative images to reveal the accuracy of screw placement in scoliotic misalignment with freehanded placed pedicle screws is therefore essential. Case Report: A 13-year-old girl with adolescent idiopathic scoliosis (AIS) was presented at the outpatient clinic of the authors department. Operative correction of the scoliotic misalignment including dorsal pedicle screw and rod placement with fusion from T3 to L4 was performed. Computed tomography scan after surgery showed left T9 screw malposition, accompanied by lateral compression of thoracic aorta. No clinical manifestations of aortic stenosis were noted. To avoid severe vascular complications, the thoracic screw was removed with the help of a specialized team of vascular as well as thoracic surgeons through extrapleural thoracotomy. After the removal of the malpositioned screw, the correction maneuvres were applied without the left T9 screw. No posttraumatic aortic aneurysm and other wall injury were identified after the revision surgery. The patient was discharged after 20 days of inpatient stay without the use external immobilization. The girl was in a good clinical condition after the 1-year follow-up visit without vascular or neurological complications. Conclusions: Malpositioned pedicle screws after dorsal correction in patients with adolescent idiopathic scoliosis might be challenging. Aortic injuries because of malpositioned screws are rare; nevertheless, the presence might be a life-threatening condition despite a clinical asymptomatic patient. As a consequence, the authors recommend to perform routine postoperative computed tomography scans combined with angiography in the case of significant lateral screw positioning.

Исследование проведено у 150 пациентов с хирургическими вмешательствами на позвоночнике из заднего оперативного доступа.По инвазивности операций больных разделили на группы.Первая группа -29 человек с грыжами поясничных межпозвонковых дисков.Вторая группа -85 пациентов с дегенеративно-дистрофическими заболеваниями и посттравматическими деформациями поясничного отдела позвоночника на одном-трех позвоночно-двигательных сегментах.Третья группа -37 больных с многоуровневыми деформациями позвоночника.В 1 группе ввиду малоинвазивного характера оперативного вмешательства дренирование послеоперационных ран не применялось.Больные 2 и 3 групп были разделены на подгруппы с использованием и без использования активного дренажа.Для анализа использовались параметры: возраст пациентов, вес, продолжительность операции, величина кровопотери, длина и глубина раны, продолжительность дренирования раны, количество раневого отделяемого, количество пункций ран и объема пунктата, продолжительность пребывания в стационаре после операции, наличие сопутствующих заболеваний (артериальная гипертензия, сахарный диабет, ожирение и другие хронические заболевания в стадии ремиссии), наличие инфекционных осложнений в послеоперационном периоде (поверхностное или глубокое воспаление), проведение гемотрансфузии, неврологические осложнения вследствие эпидуральной гематомы.Использовали метод вариационной статистики: вычисление средней арифметической (М) и ее ошибки (± m), коэффициент корреляции r-Пирсона с оценкой по шкале Челдока, для оценки достоверности различия средних использовали t-критерий Стьюдента с определением показателя статистической достоверности.Результаты и обсуждение.Большинство исследований, проводимых для оценки эффективности использования дренажей, показывает отсутствие различий в заживлении раны, инфекционных осложнениях и эпидуральных гематомах при вмешательствах на позвоночнике.Различные по объему, продолжительности, технике и инструментальным аспектам вмешательства определяют разные требования к дренированию ран.Дискотомиии и одно-трехуровневые декомпрессивно-стабилизирующие операции поясничного отдела позвоночника не требуют дренирования ран.Заключение.Результаты лечения и частота осложнений не зависят от наличия дренажа операционной раны.При многоуровневых стабилизирующих операциях на грудном и поясничном отделах позвоночника с вариантами вертебротомий дренирование раны повышает частоту гемотрансфузий в послеоперационном периоде

A case report is presented which demonstrates the result of the combined pathology of lumbar spine and the hip for surgical treatment of articular and vertebrogenic factors. Complex sophisticated differential diagnostics is required at the stage of preoperative preparation in treatment of patients with the hip-spine syndrome in order to determine a dominant factor in the formation of the hip-spine syndrome clinical picture, as well as prioritization and feasibility of performing surgical treatment in one of the hip-spine syndrome components.

A case report is presented which demonstrates the result of the combined pathology of lumbar spine and the hip for surgical treatment of articular and vertebrogenic factors. Complex sophisticated differential diagnostics is required at the stage of preoperative preparation in treatment of patients with the hip-spine syndrome in order to determine a dominant factor in the formation of the hip-spine syndrome clinical picture, as well as prioritization and feasibility of performing surgical treatment in one of the hip-spine syndrome components.