The study presents a clinical case of complex treatment of a patient with high comorbidity (Charlson comorbidity index = 6 points) who had severe sepsis (SOFA score = 8 points) with multiple foci of pyogenic infection (spinal epiduritis, paravertebral and subdural abscesses, purulent meningitis, bilateral lower lobe pneumonia). The syndrome-based approach with the use of minimally invasive approaches in the early stages (no later than 12 hours from the onset of clinical manifestations of the disease) ensured a favorable outcome. Based on the results of surgical treatment, a conclusion was made about the tactics of surgical treatment in patients with spinal infection against the background of sepsis.

Based on the analysis of modern literature, surgical approaches to the treatment of chronic pain syndrome in cancer patients are presented. The definition and classification of chronic pain syndrome is given, its pathophysiology is described. The frequency of occurrence in the population and its dependence on the stage and localization of malignant neoplasm is shown. For practical use, an algorithm for the diagnosis of chronic pain syndrome and the basic principles of its therapy are presented. As the 4th step of the World Health Organization pain relief ladder, surgical methods for the treatment of chronic pain syndrome are separately considered. Three main types of surgical interventions (neuromodulating, neurodestructive and anatomical) are described, indications and contraindications to their use are indicated.

Fibular tunnel syndrome is the most common tunnel syndrome of the lower extremity. The compression of the peroneal nerve leads to motor and sensory disorders, which is manifested by weakness of the muscles that normally provide dorsiflexion of the foot and toes, abnormal gait, and loss of sensitivity. The paper presents the etiology, pathogenesis, and clinical picture of this disease. Particular attention is paid to modern methods of treating this pathology. Decompression of the common peroneal nerve is an effective and safe treatment for fibular tunnel syndrome. At the moment, the majority of clinicians do not associate the clinical manifestations with damage to the peroneal nerve, which leads to diagnostic errors and, as a result, to incorrect treatment tactics and a decrease in the patients’ quality of life for a long time.

INTRODUCTION Critical lower limb ischemia is a widespread disease that occurs due to atherosclerotic lesions of the arteries with progressive narrowing of their lumen. Clinically critical ischemia is manifested by pain at rest, resistant to narcotic analgesics, and/or ulcerative necrotic process on the legs. In the absence of treatment, patients undergo amputation of the lower limb. Almost all patients die 10 years after amputation of the lower limb at the level of the thigh. Currently, there are following methods of treatment of critical ischemia: conservative therapy, direct revascularization, lumbar sympathectomy and neurostimulation.AIM OF STUDY To present the data of modern scientifi c literature on the use of lumbar sympathectomy and epidural spinal cord stimulation in the treatment of critical lower limb ischemia.MATERIAL AND METHODS This review presents the latest data obtained as a result of studying domestic and foreign literature on the treatment of critical lower limb ischemia with lumbar sympathectomy and epidural spinal cord stimulation. Currently, lumbar sympathectomy is performed by surgical (open, mini-access and endoscopic) and percutaneous (chemical or radiofrequency) methods. Percutaneous access is becoming widespread due to its minimally invasiveness, maximum accessibility, ease of performance and low cost. Epidural spinal cord stimulation is performed for resistant pain syndrome. The mechanism of action of spinal stimulation is to block the transmission of nerve impulses at the level of the gelatinous substance of the posterior horns of the spinal cord during stimulation of afferent fi bers of a larger diameter (type A-alpha and A-beta fi bers).CONCLUSION Spinal neurostimulation and lumbar sympathectomy are promising methods of treatment for critical lower limb ischemia in case of impossibility of direct revascularization. Lumbar sympathectomy can reduce the intensity of pain and improve the quality of life of patients. According to a number of studies, epidural spinal cord stimulation signifi cantly reduces the likelihood of amputation of the lower limb, and also reduces the intensity of pain in patients refractory to conservative therapy, as well as in those who are not indicated for direct revascularization of the arteries of the lower extremities. More large-scale studies are needed to determine the indications for the above methods.

The article presents a review of the literature on the topic of interventional treatment of pain in oncological practice. The epidemiology, classification and mechanism of oncological pain are presented. Aspects of the use of interventional methods of pain syndrome treatment, including neurolysis and blockade, are considered. The technique, indications, contraindications, complications are described for each minimally invasive intervention.

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.

Tumors of the spinal cord include several nosological units and are classified depending on their location and histological type. The article presents the general characteristics, classification, and epidemiology of spinal cord tumors. The paper presents the clinical manifestations of intradural extramedullary tumors of the spinal cord. The main methods of diagnosing extramedullary tumors of the spinal cord are highlighted. Furthermore, the paper details the modern aspects of the surgical treatment of spinal cord tumors. Particular emphasis is placed on the complications of surgical interventions. The radicality of neurosurgical treatment of spinal cord tumors depends not only on the location and size of the tumor, but also on its histological structure, which determines the outcome of the disease.

The article highlights the history of Morton's neuroma study. The epidemiology, etiology, and main risk factors that act as a trigger in the development of this pathology are presented. The main pathogenesis links are revealed. Modern ideas about the development of the pathological process and the results of morphological studies are reflected, indicating that a pseudoneuroma is formed on the intermetatarsal nerve during microtrauma. Modern methods of diagnostics and criteria for making a diagnosis are listed. The role of CT, MRI, radiography, and ultrasound is shown. The clinical picture of the disease is presented. The measures for the prevention and conservative treatment of Morton's neuroma are described. The significance of therapeutic and diagnostic blockades is indicated, as consequent regression of the pain syndrome is a confirmation of Morton's neuroma in the patient. The diseases with which it is necessary to differentiate the described pathology are listed. The main methods of surgical interventions performed for Morton's neuroma are presented.

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.

Reconstructive plastic surgery procedures — cranioplasty in particular — are finding their way into the current dayto-day neurosurgery practices. A defect in the skull bones leads not only to cosmetic defects and related psychological problems, but can also cause neurological disorders. Reconstruction of skull defects is considered an important neurosurgical stage of craniocerebral injury victims’ recovery. Currently, there are no clear established algorithms or timing for cranioplasty. This paper presents data on the history and stages of the development of reconstructive neurosurgery. The efficiency of treatment of the syndrome of the trephinated with cranioplasty has been proven. The key materials used to close the skull bones defects are presented and the requirements for the material used for closing cranial defects are described. Advantages and disadvantages of materials currently used — autograft bone, allograft bone, reperen, polyetherketone, polymethylmethacrylate, titanium, hydroxyapatite — are presented in detail. A separate section of the article is devoted to the methods of transplant modelling — 3D printing and stereolithography. This is followed by the stipulation of the key principles of cranioplasty.

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.

Pain in the lumbar spine is the most common among people of working age. All open surgery, including endoscopic, to eliminate a disc-radicle conflict, associated with a large number of complications. This increasingly encourages doctors to use conservative and minimally invasive techniques. This article presents modern methods of treatment of facet syndrome: chemical denervation, radiofrequency ablation, intraarticular injection of drugs into the cavity in the intervertebral joints. Further research work revealed modern methods of treatment of elimination of a disc-radicle conflict: chemical denervation of the disc, chemonucleolysis, mechanical decompression, intradiscal used electrothermal therapy, laser nucleotomy, hydrodiscectomy, nucleoplasty, laser disc reconstruction. The pathogenetic substantiation of the above methods is considered, the positive and negative sides of each of them are revealed. Presented their own clinical results the Results showed a 70-80% efficiency in the next observation period without serious complications.

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.

Из-за увеличения числа транспортных средств, модернизации и бурного развития травмоопасных отраслей промышленности количество травматических повреждений позвоночника прогрессивно увеличивается. Повреждения шейного отдела позвоночника составляют 55-80% в структуре всех травм позвоночного столба. В статье подробно изучена эпидемиология и социальная значимость хлыстовой травмы шейного отдела позвоночника. Рассмотрены основные причины и механизм развития травмы шейного отдела позвоночника. Выделены возможные этиологические факторы, приводящие к развитию болевого синдрома. Досконально описана клиническая картина хлыстовой травмы шейного отдела позвоночника. Проанализированы теории патогенеза развития многообразных и полиморфных клинических проявлений хлыстовых повреждений шеи, таких как координаторные нарушения движений и постурального контроля, вестибулярные и глазодвигательные расстройства, вегетативные, аффективные, поведенческие и когнитивные нарушения. В данной научной работе подробно описано лечение данного вида патологии, основанное на ряде исследований. Относительно обоснованными лечебными рекомендациями в остром периоде хлыстовой травмы можно считать лишь мероприятия по ранней активизации пациента и восстановлению физиологического объема движений в шейном отделе позвоночника. Отсутствие единых алгоритмов диагностики и лечения хлыстовой травмы шейного отдела позвоночника требует проведения дополнительных исследований.

Nonspecific infectious lesions of the spine are relatively rare, difficult to diagnose and severe diseases of the spine. The urgency of treating nonspecific infectious spinal diseases is explained by an increase in the frequency of these diseases, new antibiotic-resistant strains of microorganisms, and the severity of the course and unsatisfactory treatment outcomes. In this review, we describe spondylodiscitis and epiduritis in detail. On the basis of literature data, we thoroughly studied and described etiology, clinical pattern and diagnosis of these diseases. We thoroughly covered modern laboratory and radiologic methods for the diagnosis of spondylodiscitis and epiduritis, such as spondylography, computed tomography, magnetic resonance imaging, scintigraphy, positron emission tomography of the spine and biopsy and described modern methods of conservative and surgical treatment. The particular attention is paid to the technique of surgical treatment of spondylodiscitis and epiduritis.