Surgical treatment of spinal diseases is often complicated by epidural fibrosis, which is one of the main causes of failed back surgery syndrome.The aim. To evaluate the laminectomy zone and transformation of epidural fibrosis using original gels in an experiment.Materials and methods. Laminectomy was performed on male Wistar rats. The animals were divided into four groups. The original gels were tested. The group of intact (unoperated) rats served as a comparison group for the control and groups with the tested gels, carrying and not carrying the p38 MAP kinase blocker. On day 28, the deformation of the dural sac was assessed by measuring the transverse and longitudinal sections of the spinal canal, also the adhesion of the spinal roots to the inner layer of the dura mater in epidural fibrosis and its coverage with connective tissue along the perimeter of the laminectomy window were determined.Results. In the control group, the pronounced deformation ofthe dural sac was observed. The use of all the studied gels reduced the deformation, bringing the shape ofthe dural sac closer to the norm. However, the gel with the p38 MAP kinase blocker significantly reduced the adhesion of the spinal roots to the dura mater.Conclusion. For the first time, a pharmaceutical composition containing a p38 MAP kinase blocker was used andstudied ona laminectomy model forthe prevention of epidural fibrosis, and the relationships between the transformation and change in the shape of the dural sac with an assessment of the involvement of the dura mater in the formation of epidural fibrosis were presented. The results obtained show that a gel with a p38 MAP kinase blocker is more effective for the prevention of epidural fibrosis than a gel without a blocker.

BACKGROUND: One of the causes of pain in the lumbar spine may be congenital spinal column malformations. Bertolotti syndrome is a clinical and radiological symptom complex associated with sacralization of the LV vertebra, leading to disruption of the biomechanics of the lumbosacral spine and accelerated degeneration of facet joints and intervertebral discs, followed by foraminal and central stenosis of the spinal canal. The clinical manifestations of the disease can be polymorphic, and their cause is multifactorial. Thus, along with pain in the lumbar spine, patients with sacralization of the LV vertebra suffer from numbness and paresthesia in the lower extremities. The incidence of pathology ranges from 4% to 8%, mainly affecting elderly and mature people. СLINICAL CASE DESCRIPTION: Patient S was born in 1982 with long-term nonspecific pain in the back and lower limb; she presented to the Neurosurgical Department of the Irkutsk Scientific Center for Surgery and Traumatology. During a clinical neurological examination and additional introscopic studies of the lumbar spine, dorsopathy diagnosed. Degenerative spondyloarthrosis LIV–LV grade III according to D. Weishaupt. Sacralization of the LV vertebra type IIa according to Castellvi A.E. Syndrome of lumbar ischialgia on the right. Persistent pain and muscle-tonic syndrome. Minimally invasive interventional treatment was performed: pulsed radiofrequency ablation of the dorsal ganglion and radicular nerve at the level of the foraminal openings LIV–LV on the right and thermal radiofrequency ablation of the recurrent nerve of Luschka at the level of LIV–LV and LV–SI on the right. In the postoperative period, the intensity of the pain syndrome decreased, and the patient was discharged to work. CONCLUSION: A promising method of minimally invasive surgery is radiofrequency ablation in the area of neoarthrosis for denervation and relief of pathological pain impulses. Assessing the patient’s complaints, carefully collecting anamnesis, interpreting data from a clinical and neurological examination, and introscopic methods of examining the lumbar spine enables establishing an accurate diagnosis and selecting the most effective treatment method.

Epidural pneumocysts are a rare but significant cause of severe low back pain in patients. A clinical case of diagnosis and treatment of this disease, which often remains poorly studied in the literature, is presented. It should be noted that descriptions of nerve root compression by a gas bubble are found in both domestic and foreign publications, but they are rare, which makes the problem relevant and interesting for the medical community.

The article discusses outcomes after treating 88 elderly patients with degenerative pathologies of the spine, 42 of whom had previous decompression- stabilizing surgical interventions. Clinical manifestations of the disease were characterized by prolonged pain syndrome, lumboishialgia caused by degenerative-dystrophic changes in the arch-process joints and progressive degeneration of the intervertebral discs. Surgical intervention in 65 patients included puncture laser ablation of the medial branch of the spinal nerve in the facet joint. In 23 patients, ablation of the medial branch of the spinal nerve was performed at two (n = 8) and three (n = 15) levels using four-channel radio frequency generator COSMAN G4.Excellent and good results after surgery were found in 58 (65.9%) patients. The researchers assessed intermediate results within 3 years in 55 patients, and 37 (42.01%) of them had a stable positive state. Minimally invasive laser and radiofrequency technologies in the treatment of degenerative polysegmental pathologies of the spine in elderly and old people is justifi ed, and it is an important component of their rehabilitation

Background: A prolonged course of the autoimmune inflammatory process in Bekhterev's disease is accompanied by calcification of the vertebral column’s ligaments, damage to the costovertebral and true joints of the spine, and their ankylosis, that ultimately leads to a decrease in the support capacity of the spine, so that even a minor injury can lead to a fracture. Spinal fractures in ankylosing spondylitis often have an unstable character and a high risk of the spinal cord injury. The main methods for diagnosing the spinal instability in Bekhterev's disease are multispiral computed tomography and magnetic resonance imaging, since the informative significance of survey radiography is not high. An early surgical treatment is the method of choice for unstable fractures in ankylosing spondylitis, despite the comorbid pathology and age, which significantly burden the prognosis. Сlinical case description: Patient K., born in 1969, injured on October 07, 2021 as a result of falling on his back from a height of 2 meters. An MSCT study of the thoracolumbar spine revealed a fracture of the ThXII–LI vertebrae, rupture of the anterior longitudinal ligament, and instability of the ThXII–LI vertebral-motor segment. The following diagnosis was established: closed uncomplicated injury of the thoracolumbar spine; grade I unstable compression fracture of the ThXII, LI vertebrae with a damage to the posterior support complex against the background of ankylosing spondylitis; grade I kyphotic deformity of the thoracolumbar spine; bilateral vertebrogenic lumboishialgia syndrome; pronounced persistent pain and muscle-tonic syndromes. A surgical treatment was applied which included correction of the spinal deformity and stabilization of the thoracolumbar spine using a transpedicular fixation system. The pain vertebrogenic syndrome and clinical neurological disorders regressed. The MSCT control was carried out in 6 months with the detected completed fusion at the ThXII–LI level. Conclusion: A timely diagnosis using multispiral computed tomography and magnetic resonance imaging data allows us to assess the full picture of traumatic changes in the spinal column and choose the most effective type of surgical intervention, using, if necessary, stabilizing systems.

Back and lower limb pain interferes with patients’ daily lives and ultimately reduces their quality of life. Many interventional treatments have been proposed to reduce and prevent the development of chronic pain syndrome.The aim of the study. To evaluate the effectiveness of the simultaneous use of laser nucleoplasty and radiofrequency neuromodulation of radicular nerves and ganglia in the treatment of discogenic lumbar radiculopathy.Materials and methods. The study included 20 patients; the mean age was 39 ± 9.1 years. All patients underwent laser nucleoplasty of the LIV/LV intervertebral disc and radiofrequency neuromodulation of the radicular nerve in the foraminal space of the level of interest and localization of pain. An assessment of changes in pain intensity and quality of life was carried out according to scales in the preand postoperative period and a control magnetic resonance imaging (MRI) study at the time of discharge, 3 months of observation, with an assessment of the volumetric indicators of the intervertebral disc.Results. Patients showed a decrease in pain intensity according to the Visual Analogue Scale and an improvement in quality of life assessed by the ODI (Oswestry Disability Index) and SF-36 (Short Form 36) questionnaires. According to MRI studies, volumetric indicators increased after surgery and subsequently decreased by the 3rd month of observation.Conclusion. The study demonstrates the possibility of using several interventional treatment methods simultaneously with an impact on various morphological substrates that cause the formation of pain syndrome. It is shown that a decrease in the intensity of pain syndrome correlates with an increase in the volumetric indicators of the intervertebral disc according to MRI data immediately after surgery, with a subsequent decrease by 3 months of observation. Simultaneous use of laser nucleoplasty and radiofrequency neuromodulation is justified in the treatment of radiculopathy, allowing reducing the intensity of pain syndrome and increasing the volumetric indicators of the intervertebral disc, which is a sign that increases the shock-absorbing properties of the intervertebral disc.

The aim. To study the effectiveness of using monosegmental fixation systems in surgeries involving resection of part of the facet joint in patients with posterolateral and foraminal hernias in the lumbar spine. Materials and methods. The study included 40 patients with degenerative diseases of the lumbar spine who underwent medial facet resection and the removal of posterolateral or foraminal disc hernia. Among them, 10 patients underwent unilateral single-level transpedicular fixation with interbody fusion using titanium cage (UTPF cage group), and the other 10 patients underwent unilateral monosegmental transpedicular fixation (UTPF group). The remaining 20 patients underwent bilateral transpedicular fixation (BTPF group). The amount of intraoperative blood loss, duration of surgery and length of hospital stay, as well as the frequency of perioperative complications in the groups were assessed. Visual analogue scale (VAS) pain score, Oswestry index and McNab score were assessed before and 6 and 12 months after surgery. Results. Intraoperative blood loss in the UTPF cage and UTPF groups was less than in the BTPF group, as was the duration of surgery; the differences were statistically significant (p < 0.05). Indicators of VAS score and Oswestry Quality of Life Index in the studied groups indicated the effectiveness of the technology. Discussion. Unilateral decompressive and stabilizing surgeries in patients with posterolateral and foraminal hernias of the lumbar spine can reduce the duration of the surgery, the volume of blood loss and the severity of pain in the postoperative period due to adequate decompression of the neurovascular formations of the spinal canal and stabilization of the spinal motion segment, which prevents the relapse of the disease and provides early rehabilitation of patients. Conclusion. Unilateral transpedicular fixation is acceptable and safe for lumbar degenerative diseases and improves the quality of life of the patients.

The aim. To study the frequency and treatment options for dysfunction of the dynamic stabilization system of the lumbar spine. Materials and methods. We carried out a retrospective analysis of the treatment of 58 patients with degenerative pathology of the lumbar spine and instability of the spinal motion segments, who were treated at the neurosurgical unit of the Irkutsk Scientific Centre of Surgery and Traumatology in 2011–2020. The stability of spinal motion segment was assessed using X-ray imaging, magnetic resonance imaging and multi-layer spiral computed tomography of the lumbar spine. Revision surgery was performed in 7 out of 58 previously operated patients using the dynamic fixation system of spinal motion segments “Coflex” (Paradigm Spine LLC, Germany). Results. Revision surgery was performed in 7 out of 58 patients with dynamic fixation of the spinal motion segments with an interosseous implant due to an increase in pain syndrome. In 1 patient, the reason for repeated surgery was primary instability of the hardware caused by a fracture of the spinous process. In the delayed period, 4 patients had an X-ray picture with heterotopic ossification of the implant and instability of PDS. In two observations, a recurrence of intervertebral hernia was diagnosed at the level of the operated spinal motion segment. During revision surgery, a facetectomy was performed with stabilization by a peek cage, followed by pain management and clinical manifestation regression. Conclusion. The conducted study shows that a number of patients after discectomy and dynamic stabilization of the spine using “Coflex” system have inconsistency and heterotypic ossification of the implant and neoarthrosis. Implantation of a lumbar peek cage while maintaining the “Coflex” device makes it possible to form a rigid interbody fusion, which means it is sufficient and justified surgical technology for treating the failure of the dynamic stabilization system.

The article discusses aspects of complex pathology – differential diagnosis of lesions of intervertebral discs of the lumbar spine and femoral nerve neuropathy. Assessment of patient complaints, careful collection of anamnesis, interpretation of clinical and neurological examination data, instrumental diagnostic data such as MRI, MSCT, and neurophysiological studies allows you to establish an accurate diagnosis and choose the most effective treatment method.

Objective: To identify the morphological patterns of development and prevention of experimental epidural fibrosis based on the shape of the dural sac in the area of laminectomy. Methods: Male Wistar rats aged 4-5 months underwent laminectomy at the level of L6-S1. The animals were divided into two groups with 7 animals per group. In the main group (Group A) the animals were treated with Antiadhesin® gel applied to the wound to prevent the development of epidural fibrosis, while in the group of comparison (Group B), the gel was not applied. Another 7 healthy animals were used as a control group. The animals were taken out of experiment on the 28th day. Histological slides stained with hematoxylin-eosin were used to measure the width and length of the dural sac, its area, perimeter, and calculate its deformity index. Results: In group B at the level of laminectomy, the ratio of the width to length of the dural sac was significantly higher than in the control group (p<0.05), mainly due to the enlarged width, while the length did not change significantly. In group A these parameters did not differ from the control group, which indicated that application of Antiadhesin® prevented formation of a connective tissue scar which could compress the dural sac and cause its deformation. In group A in the area of surgical intervention, granulomas with Pirogov-Langhans cells were detected, both in the soft tissues and in the lumen of the spinal canal. These findings in perioperative tissues might be related to biocompatibility and indicate their reaction to a gel as a foreign body. Conclusion: In clinical practice optimal materials for the prevention of epidural fibrosis are missing. There is an obvious need for further research in order to obtain implants capable of inhibiting and reducing the formation of epidural fibrosis. Keywords: Dura mater, epidural fibrosis, prevention, experiment, laminectomy, Antiadhesin®.

In order to find out the mechanisms of pathogenesis of degenerative-dystrophic diseases of the spine, it is of particular interest to search for body parameters which are directly or indirectly interrelated with the key factors of peripheral conversion of nidus iodothyronines and constitute a system of network interactions, affecting metabolic indicators at the local and systemic level. The aim. To search for correlations of local key factors of peripheral conversion of Ligamentum flavum iodothyronines with indicators of biochemical, hematological and hormonal blood profiles of patients with stenosing processes of the spinal canal and dural sac in the lumbar spine. Materials and methods. 33 patients (15 males, 18 females) with stenosing processes of the spinal canal and dural sac in the lumbar spine were examined (mean age – 45.73 ± 1.95 years). The expression of deiodinase genes and other candidate genes was determined in Ligamentum flavum biopsies collected during surgical treatment. Biochemical, hematological and hormonal parameters were determined in peripheral blood. The resulting data array was processed in order to find correlations between the parameters of systemic and local metabolism. Results. The relationships of deiodinases with the expression of GDF5, MMP1, MMP3 and TIMP1 in Ligamentum flavum (p < 0.05) were found. Of the hormonal profile of the blood serum, the most significant indicators were thyreotropin, free triiodothyronine and thyroperoxidase antibodies. In the biochemical profile, levels of direct bilirubin, total cholesterol, HDL and LDL cholesterol and triglycerides changed along with the expression of deiodinases. Correlative relationships with the expression of deiodinases were found for the following hematological analytes of whole peripheral blood: hemoglobin, mean corpuscular hemoglobin concentration, numbers of granulocytes, lymphocytes, eosinophils, monocytes, band neutrophils, red cell distribution width and platelet crit. The data obtained indicate the involvement of peripheral conversion factors in the pathogenetic process and provide information to form a new view on the pathogenesis of degenerative-dystrophic processes in the Ligamentum flavum of patients with stenosing processes of the spinal canal and the dural sac in the lumbar spine.

An analysis of the effectiveness of laser vaporization in 67 patients (23 men, 44 women) with the syndrome of the “adjacent level” of the lumbarspine, who had previously undergone decompressive-stabilizing operations, is presented. The mean age of the patients was 48.3 years (from37 to 54 years).The most common cause of pain syndrome recurrence was protrusion of the intervertebral discs (60 people, 90 %). A positive result of laservaporization in the early postoperative period was achieved in 62 patients (92.5 %). Analysis of the results of treatment in 32 patients in the interimperiod revealed excellent results in 5 (15.5 %) patients, good results – in 12 (37.5 %) patients, and satisfactory results – in 15 (47 %) patients.

The aim of this study was to research the clinical and radiological efficacy of corpectomy and anterior stabilization with titanium mesh cages in patients with myelopathic syndrome associated with cervical spine degenerative diseases.Material and methods. A retrospective observational cohort study was performed. The study included medical records of patients with cervical myelopathy associated with degenerative diseases of the cervical spine who underwent corpectomy and anterior stabilization with titanium mesh cages. Clinical and instrumental parameters were assessed.Results. The study included 28 medical records of respondents who underwent corpectomy and anterior stabilization with titanium mesh implants. The average age of patients was 61.9 ± 11.3 years, males prevailed (60.7 %). By the 3rd month of postoperative follow-up, the severity of myelopathy significantly decreased (p˂0.001). After 12 months, the severity of cervical myelopathic syndrome also significantly decreased (p = 0.009). The neurological status of 18 (64.2 %) respondents improved in the first 3 months after corpectomy and anterior stabilization with titanium mesh implants and 6 months after the surgery, the status improved in the remaining 8 (30.7 %) patients (p˂0.001). Preoperative values of the Cobb sagittal angle allowed us to conclude the following. In 13 (46.4 %) patients, the normolordotic axis of the cervical spine was noted, in 12 (42.8 %) – the hypolordotic axis, and in 3 (10.8 %) respondents, the Cobb angle values corresponded to the kyphotic axis of the cervical spine.Conclusion. The technique of corpectomy and anterior fixation with mesh titanium implants in patients with myelopathic syndrome against the background of degenerative diseases of the cervical spine makes it possible to improve the clinical status of the latter already 3 months after the operation was performed while maintaining normal biomechanical parameters of the cervical spine and complete decompression of the neural structures and supply their vessels.

Background: Among the modern methods of surgical treatment of the lumbar spines degenerative stenoses, decompressive-stabilizing surgical interventions using transpedicular screw-rod structures occupy an important place. The use of metal structures is justified not so much by the degenerative process specifics, degree or length of stenosis, but by the presence of instability in the spinal motion segments. In turn, the widespread use of fixing structures has naturally led to an increase in the specific complications, reaching 1020 per cent of the total number of operated patients. One of the threatening complications of decompressive-stabilizing operations is the fracture of structural elements, often with the formation of pathology at the adjacent levels. The reasons for these complications are associated with both an erroneous choice of the construct parameters and a violation of the technique for installing the transpedicular fixation system (TPS). Clinical case description: The article presents an analysis of the clinical symptoms appearing with the formation of the adjacent level syndrome due to a fracture of the TPS system screws used to treat central stenosis of the spinal canal at the LIV -LV level. The correction of the pathology was carried out with a repeated surgical intervention. Conclusion: This clinical example draws attention to the combination of the adjacent level syndrome with a fracture of the metal structure in a patient after a decompressive-stabilizing operation using screw-rod fixation. An early diagnosis and adequate correction of the pathology helps to avoid the aggravation of symptoms and disability of patients.

Background: Degenerative pathology of the facet joints of the lumbar spine remains a significant medical and social problem due to persistent pain syndrome, high incidence and disability rate. Clinical case description: A patient complaining of pain and discomfort in the lumbosacral spine on the right, arising in the upright position, intensifying with bending and flexion-extension of the trunk, and periodically spreading to the right gluteal region and along the posterior surface of the thigh, was admitted to the neurosurgical department of the Irkutsk Scientific Center of Surgery and Traumatology. A surgical treatment was performed in the form of dereception of the LIILIII, LIIILIV, LIVLV arch-process joints. In the postoperative period, the patient noted a decrease in the intensity of pain in the lumbosacral spine to 3 points by a visual analog scale and was discharged from the department on the 5th day after the surgery in a satisfactory condition. Conclusion: Facet joint pathologies represent a most common nosological form of the degenerative-dystrophic process (spondyloarthrosis) and a potential source of pain with the formation of instability of the spinal motion segment and chronic pain syndrome. The complex anatomical and topographic relationships between the facet joints, intervertebral discs, and radicular nerves force clinicians to pay attention to the pathology of facet syndrome. Understanding the morphological, clinical, and radiological features of the course of the facet joint degeneration makes it possible to increase the diagnostic capabilities for detecting facet syndrome of the lumbar spine and effectively apply transcutaneous surgical technologies for the treatment of chronic pain syndromes.

A clinical example shows a rare case of surgical treatment of facet syndrome, which is formed against the background of instability of the spinal motion segment of the spine at the LIV-LV level using the method of laser vaporization and denervation of the facet joints.The aim of the work is to consider the clinical and diagnostic indicators of facet syndrome and to assess the role of imaging research methods in the diagnosis of this syndrome. At the outpatient stage, with long-term persistent pain syndrome in the lumbar spine, non-stop conservative methods of treatment, the patient underwent survey radiography and MRI examination of this area in order to exclude a specific process (oncopathology, pathological fracture against the background of osteoporosis, spondylitis, etc.) Chronic pain syndrome with its ineffective conservative treatment leads to maladjustment of the psychoemotional and professional-labor state of the patient. Determining the source of pain impulses in the lumbar spine can be difficult, since pain can cause degenerative and pathological changes in various anatomical structures of the spine (intervertebral disc, facet joints, ligaments, muscles, etc.), which can form a clinical picture of pain syndrome with its various manifestations and symptoms, which do not always clearly determine the level and structure of the affected spine. In this connection, for the timely and correct determination of the diagnosis of all patients with chronic pain syndrome in the lumbar spine, it is necessary to be sent to specialized neurosurgical institutions, in which patients undergo a set of necessary medical and diagnostic procedures to determine the further management tactics and treatment algorithm for this category of patients.

Epidural fibrosis is a dynamic pathological process that develops and progresses over time and is a polyetiological and multifactorial complication in the postoperative period during spinal surgery.Aim of the study. To study the reparative process and the formation of epidural fibrosis and its effect on the shape of the dural sac in the area of laminectomy at different periods of wound healing.Materials and methods. To assess the dynamics of the formation of epidural fibrosis and the involvement of the dura mater in this process, laminectomy was performed at the level of the LVI vertebra in 35 male Wistar rats at the age of 4–5 months. The animals were divided into 5 periods of withdrawal from the experiment on days 3, 7, 14, 21, and 28. The histological material was studied by staining with hematoxylin and eosin. To assess the deformation of the dural sac, the ratio of the diameter to the length of the canal was assessed on histological preparations in the laminectomy zone, and these measurements were carried out in a group of intact animals at the level of the LVI vertebra (n = 7). Results. During the observation process, a change in the ratio of the sizes of the dural sac has been observed. In the period from days 3 to 14, the anterior-posterior size of the dural sac progressively decreases, in parallel, the transverse size increases, which leads to a change in its shape. On follow-up, some form correction occurs. It is possible that the change in the shape of the dural sac in terms of up to 14 days is due to edema, plasma saturation of tissues, as well as the growth of connective tissue. The subsequent decrease in edema and the restructuring of the newly formed connective tissue leads to a correction of the shape of the dural sac.Conclusion. In the work, the dynamics of morphological changes in the zone of formation of epidural fibrosis during laminectomy in the experiment was assessed. The dynamics of changes in the lumen of the dural sac was established. The early involvement of the dura mater in the pathological process, its interest during the entire observation period was noted. Also, histological preparations show the involvement of the nerve fibers of the cauda equina in the pathological process from the early stages after surgery: vacuolization and destruction of nerve fibers, adhesion of fibers to each other and to the dura mater, as well as activation of endotheliocytes in the vasa nervorum.

Pain in the spine is one of the most common pathological conditions and holds the second place in terms of disability throughout the world. Pain syndrome has a great influence on the functional capabilities of the spine and the professional activity of a person, and that carries a serious social and economic problem. The main causes of pain in the spine are: pathology of the intervertebral discs and the zygapophysial joints; dynamic instability of the spinal motor segment; spondylosis; stenosis of the spinal canal and dural sac with compression of the neurovascular structures; spondylolisthesis; osteoporotic compression fractures of the vertebrae; infectious diseases of the spine, etc. In connection with the aforementioned, of particular interest to clinicians is the pathology of the zygapophysial joints (spondylarthrosis), its diagnosis, and targeted ethiopathogenetic treatment using puncture surgical technology in the treatment of facet syndrome. This paper presents the results and features of puncture surgical technology in the treatment of facet syndrome in degenerative-dystrophic lesions of the zygapophysial joints of the lumbar spine. The analysis is based on 55 sources of literature of domestic and foreign authors. The article presents data on the anatomical and topographic features of the zygapophysial joints, their biomechanics, innervation and their function. The ethiopathogenetic features of pain during degeneration of facet joints are considered. The effectiveness of the use of methods of using radio and laser denervation of the zygapophysial joints in the treatment of facet syndrome is analyzed. The materials of the article describe the methods of using chemodeception, cryodestruction, and intra-articular administration of hyaluronic acid preparations.

Every year, the number of operations on the lumbar spine with the use of various spinal fusion techniques increases, which leads to an increase in the number of cases in the long-term period of surgical treatment, the formation of pathology of the adjacent segment (ASP), which is part of the structure of the failed back surgery syndrome (FBSS). It is known that the pathology of the adjacent segment is a general term and covers two concepts: the degeneration of the adjacent segment (ASDeg) and the disease of the adjacent segment (ASDis). ASDeg is represented by radiographic changes occurring in the adjacent spinal motion segments during spinal surgery with spinal fusion, and ASDis refers to the clinical symptoms that develop during radiographic changes in these segments. With the pathology of an adjacent segment, clinically significant degenerative changes in it are not always formed. If these X-ray changes are formed and correlate with clinical and neurological manifestations, then surgical treatment is indicated. This pathology can be treated with repeated surgical intervention, which this article demonstrate with the clinical example of surgical treatment of the adjacent segment of the spine during fusion.

Актуальность. В настоящее время совершенно не изучена экспрессия генов ацетилтрансфераз в структурах, участвующих в формировании патологического очага при развитии дегенеративно-дистрофических процессов в позвоночно-двигательном сегменте. Ведущая роль гипертрофии и оссификации жёлтой связки (Ligamentum flavum) в развитии и прогрессировании стенозирующих процессов позвоночного канала и дурального мешка, а также участие ацетилтрансфераз в метаболизме соединительной ткани определило цель исследования: выявить генетические особенности реакций ацетилирования у больных со стенозами позвоночного канала и дурального мешка на поясничном отделе позвоночника в зависимости от выраженности процессов оссификации Ligamentum flavum. Методы. В исследование включен 31 пациент (15 мужчин, 16 женщин, средний возраст 45,7 ± 2,0 лет) со стенозирующими процессами позвоночного канала и дурального мешка на поясничном уровне. У всех пациентов во время оперативного вмешательства были забраны образцы Ligamentum flavum, в которых затем общепринятыми методами патоморфологии определяли признаки наличия или отсутствия гипертрофии и / или оссификации, а также методом количественной ПЦР (кПЦР) определяли экспрессию генов NAT1 и NAT2. Результаты. В биоптатах Ligamentum flavum обнаружена экспрессия генов NAT1 и NAT2, что свидетельствует о ранее неизвестной роли процессов ацетилирования в метаболизме соединительной ткани. Варианты «медленного» ацетилирования достоверно чаще встречались у пациентов с выявленной оссификацией Ligamentum flavum. Обнаружены различные паттерны экспрессии генов NAT1 и NAT2, что свидетельствует о полиморфности клинических вариантов патологии. Часть выявленных вариантов экспрессии изоферментов ацетилтрансфераз характеризуют склонность к развитию оссификации Ligamentum flavum. Женщины чаще страдают от оссификации Ligamentum flavum по сравнению с мужчинами (χ2 = 39,1, р < 0,01), при этом, повторные оперативные вмешательства, как и избыточная масса тела, не увеличивали риск её оссификации. Активность экспрессии гена NAT2 можно отнести к информативным маркёрам, свидетельствующим о повышенном риске развития процессов эктопической оссификации Ligamentum flavum. Заключение. Выявленные особенности реакций ацетилирования у больных со стенозами позвоночного канала и дурального мешка могут помочь клиницистам прогнозировать развитие гипертрофии и оссификации жёлтой связки при оперативном вмешательстве на позвоночнике, а полученные новые фундаментальные знания лягут в основу разработки способов профилактики развития эпидурального фиброза на дооперационном этапе. Background. Expression of acetyltransferase genes in structures participating in formation of a pathological focus in development of degenerative spine conditions is presently unstudied. Hypertrophy and ossification of Ligamentum flavum play a leading role in the development and progression of stenosing processes in the spinal canal and dural sac whereas acetyltransferases are involved in metabolism of connective tissue. The aim of this study was to identify genetic characteristics of acetylation reactions in patients with stenosis of the lumbar spinal canal and dural sac depending on severity of ossification of Ligamentum flavum. Methods. This study included 31 patients (15 men and 16 women aged 45.7 ± 2.0 years) with stenosing processes of the spinal canal and dural sac at the lumbar level. Samples of Ligamentum flavum were taken from all patients at the time of surgical intervention. Signs of hypertrophy and/or ossification were detected in these samples with standard pathomorphological methods. Real time PCR was used to determine the expression of NAT1 and NAT2 genes. Results. Expression of NAT1 and NAT2 genes was found in biopsy samples of Ligamentum flavum. This indicated a previously unknown role of acetylation processes in connective tissue metabolism. Variants of «slow» acetylation were significantly more common in patients with documented ossification of Ligamentum flavum. Different patterns of NAT1 and NAT2 gene expression were identified, which suggested polymorphism of clinical variants of the disease. Some of the identified variants of acetyltransferase isoenzyme expression characterize a tendency towards development of Ligamentum flavum ossification. Women were more likely to have ossification of Ligamentum flavum than men (χ2 = 39.1, p < 0.01). Repeated surgery and overweight did not increase the risk for ossification of Ligamentum flavum. The activity of NAT2 gene expression can be classified as an informative marker for increased risk of ectopic ossification of Ligamentum flavum. Conclusion. The identified patterns of acetylation reactions in patients with spinal canal and dural sac stenosis may help clinicians to predict the development of hypertrophy and ossification of Ligamentum flavum during spine surgery and to find ways for prevention of epidural fibrosis at the preoperative stage.