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.

Malignant neoplasms remain the leading cause of death worldwide. The spine is a target for metastasis more often than other skeletal bones. This article details the principles of diagnosis, treatment, and the clinical picture of secondarylesions of the spinal column. The causes of pain syndrome in cancerous lesions of the spine are reviewed: compression of nerve structures, pathological fractures, spinal instability, lytic foci and paraneoplastic pain syndrome. The causes and patterns of each type of pain syndrome are described in detail. The article presents the scales used to predict the life expectancy of these patients: Tokuhashi, Tomita and Bauer. The effectiveness of these scales is compared. The selection criteria for surgical treatment of patients with metastatic lesions of the spine are described in detail. Modern methods of surgical treatment of secondary lesions of the spinal column are presented: palliative, subtotal, total (enblock resections). The indications and contraindications for each type of surgical treatment are described. Methods of intraoperative hemostasis are described, with the special attention given to preoperative tumor embolization. The errors and complications of this technique are described in detail. The correlation dependence of intraoperative blood loss volume on the embolization terms is presented. Modern trends in the development of surgical methods in metastatic spinal tumors are described in conclusion.

1240% of people with low back pain have spinal instability in degenerative-dystrophic diseases of the spine. The paper highlights the biomechanical basis for the development of segmental instability and discusses various hypotheses for the development of this condition. The authors describe the modern methods of neuroimaging used in the diagnosis of segmental instability, such as radiography, functional spondylography, CT, functional CT, MRI. Further, the paper presents provocative tests used in the diagnosis of instability: passive extension of the lumbar spine, standing, sitting, pron-instability, "scissors", compression of spinous processes, forward lean in standing position, and some others. The authors shared their experience in diagnosing segmental instability. However, the discrepancy between the data of instrumental examinations and patient complaints, poorly studied rotational and lateral instability in osteochondrosis indicate the need for a more detailed study of the instability of the spine as a whole.

8590% of the elderly people are diagnosed with spondyloarthrosis There are various synonyms for this disease in the literature: facet syndrome, facet pain syndrome, arthrosis of the intervertebral joints, zygapophysial joint arthrosis and spondyloarthropathy. The article analyzes the pathogenesis, clinical picture and methods of diagnosis of this disease. Modern types of conservative and surgical treatment are presented. The advantages and disadvantages of the surgical methods for the facet syndrome treatment are analyzed: instrumental denervation (radio frequency, laser, etc.), chemical denervaion and intraarticular administration of drugs. The results of our own clinical work are presented. The facet joint denervation appears to be a productive minimally invasive method of treatment of the reflex forms of spondyloarthrosis. In the early and long-term postoperative period, it leads to a persistent decrease in the intensity of pain and improvement of the quality of life with a low risk of perioperative complications.

Background. The distribution of idiopathic scoliosis is quite large and ranges from 50 to 80 % among all spinal deformities. Materials and methods. Preoperative clinical and radiological data and data 5 years after surgery in patients with idiopathic thoracic scoliosis operated on with the use of posterior transpedicular fixation and posterior fusion were analyzed. 179 patients (154 women, 25 men) aged from 10 to 25 years old (mean age is 16.1 years old) were examined and operated, divided into 2 two groups. Group I with mobile deformities included 72 patients (69:3), in whom only the main curvature arc was included in the area of posterior spondylosyndesis and fixation. Group II with rigid arches included 107 patients (85:22) with a more extensive spondylosyndesis zone. The average degree of correction was 78 % (from 45 to 98 %). Results. There were no statistically significant demographic or perioperative indicators between the groups, except for the average number of levels of posterior spondylosyndesis (group I: 9.6 (from 4 to 13), group II: 11.5 (from 8 to 15); p < 0.001) Conclusions. The use of prognostic formulas to determine the indices of mobility and deformity correction made it possible for mobile deformities (group I) to limit the extent of interventions and to include only the main thoracic arch of the deformity in the zone of posterior spondylosyndesis. In rigid deformities (group II) with compensatory lumbar and residual arches> 25 ° (calculated from functional radiographs), the zone of fixation and posterior spondylosyndesis was extended by two or three spinal motion segments in the caudal direction to ensure 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.

Оver the past 70 years, the number of victims with spinal cord injury has increased by 200 times.Russia annually recorded about 8-9 thousand cases of spinal cord injury, in 80% of cases it is the prerogative of persons of 15-45 years.The problem of treatment of victims with spinal injury is an acute problem of domestic neurosurgery.The article presents a review of the literature on the errors of neurosurgical treatment of injuries of thoracic and lumbar vertebrae.Of the main tactical errors, the authors identified inadequate instrumental fixation in extremely unstable fractures (type B and C).The paper deals with the causes of post-traumatic deformation of the spine.The following tactical errors are also identified: inadequate decompression, failure or failure in deformation correction, purposeful destruction of the rear support column.Technical errors: violations in the technique of metal implantation, fracture and malposition of rods; fracture, dislocation and malposition of transpedicular screw.Close attention is paid to the mistakes made by the patient and the shortcomings of metal structures.Particular interest is paid to infectious (pneumonia, uroinfection, bedsores, suppuration of postoperative wounds) and neurological (liquorrhea, durotomy, radiculopathy) complications.The causes of these complications were studied in detail and measures to reduce them were proposed.In conclusion, the authors proposed ways to reduce the complications of surgical treatment of spinal cord injury.