Relevance. Patients with long-standing discogenic low back pain who do not show clinical improvement after conservative treatment are referred for surgical treatments such as lumbar fusion or total disc arthroplasty. The purpose –– to evaluate the long-term effectiveness and safety of total intervertebral disc arthroplasty (TDA) and lumbar interbody fusion (LIF) in patients with degenerative lumbar intervertebral disk disease. Material and methods. A comprehensive literature search strategy was developed in the PubMed/Medline and Cochrane Central Register of Randomized Controlled Trials databases. Studies were searched between January 2005 and May 2024 without restrictions on level of evidence or publication status. Both English-language articles and domestic publications were analyzed. Results. The systematic review included four randomized controlled trials covering the long-term outcomes of surgical treatment of 1325 patients with degenerative lumbar intervertebral disk disease. There are no differences in the operating time in the total intervertebral disc arthroplasty and lumbar interbody fusion groups. In the lumbar interbody fusion group, the volume of blood loss exceeded that in the total intervertebral disc arthroplasty group of intervertebral disks. There were no differences between the total intervertebral disc arthroplasty and lumbar interbody fusion groups in the severity of low back pain on the visual analogue scale. In the total intervertebral disc arthroplasty group, the level of patient disability according to the Oswestry Disability Index is on average 9 % higher than in the lumbar interbody fusion group. The percentage of satisfaction with the operation in the group of patients after total intervertebral disc arthroplasty exceeds this indicator in the group of patients who underwent lumbar interbody fusion. The analysis of the incidence of complications demonstrated the absence of differences between the compared techniques. The frequency of reoperations in the total intervertebral disc arthroplasty group of intervertebral disks at the lumbar level is 48 % less than that in the lumbar interbody fusion group. Conclusion. The obtained clinical results of total intervertebral disc arthroplasty of intervertebral disks at the lumbar level with preservation of the range of motion of the operated segment and the entire lumbar spine suggest that this technique is a promising alternative to lumbar interbody fusion.

As is known, the issues of pathogenesis, diagnosis and treatment of the new coronavirus infection COVID-19 are the most priority areas of scientific research in the modern clinic of internal diseases. The rate of emergence of new scientific data in the leading libraries PubMed, Medline, Cochrane Library and eLibrary, which can potentially be important in the correction of ongoing therapy for infection and its complications, is extremely high. In turn, this dictates the need for a comprehensive discussion of the results of newly published studies. These issues include clinical and neurological manifestations of COVID-19 and other coronavirus infections. The exact mechanism by which the SARS-CoV-2 virus enters the structures of the central nervous system is unknown. Thus, two pathways for the penetration of the COVID-19 pathogen are most actively discussed: the hematogenous pathway (through the systemic circulation into the vessels of the brain with a low linear blood flow velocity, which allows the virus to adhere to the surface of the endothelium and penetrate into the nervous tissue through damage to the latter) and the contact pathway (through the cribriform plate and the olfactory bulb). It should also be noted that a number of experimental works clearly demonstrate the pathogenic effect of other members of the Coronaviridae family on the neurons of the respiratory and vasomotor centers. The review presents an analysis of current literature data on the study of clinical and neurological manifestations of COVID-19 and other coronavirus infections. It is important to emphasize that patients with a severe course of COVID-19 deserve special attention, requiring observation in the intensive care unit in order to prevent the development of fatal neurological complications.

Until recently, imaging of peripheral nerves was limited from a technical point of view, as there was no established “gold standard” study protocol for the purpose of qualitative visualization of nerve trunks in normal and pathological conditions. With technical advances in magnetic resonance imaging and the advent of specialized high-resolution magnetic resonance neurography, it has become possible to visualize peripheral nerves of varying diameters. A literature search in the Pubmed, Medline, EMBASE, Cochrane Library, and eLibrary databases demonstrated the presence of several studies examining the capabilities of magnetic resonance imaging in visualizing the pudendal nerve in normal and pathological conditions. It must be emphasized that the results of these studies are consistent and largely complement each other. A generalization of the available data on the capabilities of magnetic resonance neurography of the pudendal nerve was the impetus for writing this literature review. Magnetic resonance neurography is a tissue-specific imaging method optimized for assessing the condition of peripheral nerves, including changes in the morphology of their bundle structure, signal, the diameter and length of nerve trunks, which can be caused by both anatomical features and pathological processes. Three-dimensional (3D) imaging is critical for studying the topography of peripheral nerves, identifying areas of compression or traumatic injury, and for preoperative planning. Magnetic resonance imaging in certain modes and sections allows to clearly visualize the pudendal nerve along almost its entire length, determine the nature of its branching and the features of its topographic and anatomical location. The anatomical characteristics of the pudendal nerve and its pathological changes obtained using magnetic resonance neurography can be used in everyday clinical practice by urologists, obstetricians-gynecologists and neurosurgeons for planning surgical interventions.

Searching of literature data revealed only a few reports devoted to long-term postoperative outcomes in patients with lumbosacral spine synovial cysts. These results are ambiguous and largely contradictory. OBJECTIVE:To analyze the long-term postoperative outcomes in patients with lumbosacral spine synovial cysts. MATERIAL AND METHODS:A retrospective observational cohort study was performed between January 2015 ando September 2022. The study included patients who underwent surgical treatment for lumbosacral spine synovial cysts with clinical and neurological manifestations. There were 94 medical records of respondents (36 (38.3%) men and 58 (61.7%) women aged 18-82 years). Mean postoperative follow-up period was 24.6±7.5 months. RESULTS:Patients underwent various surgical interventions for synovial cysts. VAS scores of pain syndrome after 3, 6, 9, 12 and 24 postoperative months revealed significant pain relief in the lower back and extremities (p<0.01). In long-term follow-up period, we observed significantly lower disability (Oswestry Disability Index) (p<0.001). Adverse postoperative events occurred in 9 (9.6%) cases. CONCLUSION:Interlaminectomy with cyst wall resection and preservation or partial resection (no more than 1/3) of facet joint without segmental fusion is an effective and preferable surgical method with minimal incidence of adverse clinical events.

OBJECTIVE:To analyze the short- and mid-term results of posterolateral endoscopic discectomy (PLED) in patients with lumbosacral junction intervertebral discs (IVD) herniations. MATERIAL AND METHODS:A retrospective observational cohort study included 95 medical records of respondents (35 (36.8%) males, 60 (63.2%) females, age 21 - 72 years), who underwent PLED for lumbar IVD herniations. Mean postoperative follow-up period was 14.4±3.2 months. Clinical outcomes and incidence of complications were studied. RESULTS:VAS scores of back and lower limb pain significantly decreased after 1, 3, 6, 9 and 12 months (p<0.01). Disability significantly improved in short- and mid-term follow-up period (Oswestry Disability Index, p<0.01). Analysis of subjective satisfaction with surgical intervention (modified MacNab scale) revealed that 92 (92.9%) respondents had excellent results. Complications occurred in 5 (5.2%) patients. CONCLUSION:PLED is effective and safe in patients with lumbosacral joint IVD herniations. No significant complications were noted in our respondents.

According to various researchers, the prevalence of unruptured cerebral aneurysms (CAs) in the general population varies from 2 to 5 %. In the vast majority of cases, CAs do not have clinical and neurological manifestations and are discovered incidentally during routine neuroimaging studies. CAs can cause intracranial hemorrhage. As a rule, hemorrhages of this type occur in patients aged 40–60 years. It has been established that about 10–15 % of patients die from an aneurysmal hemorrhage before they receive specialized medical care. Recurrent aneurysmal intracranial hemorrhage is the main cause of high mortality and disability in this group of patients. The search for literature sources in the scientific databases PubMed/Medline, EMBASE, Cochrane Library and eLibrary demonstrated the existence of numerous studies devoted to the study of molecular biology and biophysical mechanisms of formation, growth and rupture of CAs. Combining the results of these studies was the motivation for writing this literature review. The paper reflects in detail the role of inflammation and molecular genetic factors in the growth and rupture of the CAs, and presents the biophysical factors of the rupture of the CAs. The authors pay special attention to the shape, size and coefficient of the CAs as the most important geometric risk factors for the formation and rupture of the CAs. This review presents current data on mathematical modeling of various types of CAs with an assessment of the risk of rupture of the latter, which has found its application in wide clinical practice. The authors also attempted to describe the hemodynamic features in various types of CAs. In turn, the type of blood flow in the CAs cavity largely depends on the size and shape of the latter and the geometry of the carrier artery, which is the basis for preoperative planning and the choice of tactics for surgical treatment of patients with unruptured CAs.

Background: Caused by the degenerative spine disease (DSD), the pain syndrome in the lumbosacral spine and lower extremities represents a socioeconomic problem. Nowadays, minimally invasive methods of treatment, in particular, epidural injections (EI), are commonly used.Objective: To do a literature review on translaminar EIs and their mechanism of action in treating patients with radicular and vertebrogenic pain symptoms arising from the DSD.Materials and methods: We analyzed the most recent literature data in which the efficacy of epidural corticosteroid injections for DSD was evaluated.Conclusions: Translaminar EIs with corticosteroids are effective in relieving symptoms in the short term (up to 6 months) and delaying the surgery, but the evidence of their long-term benefits is yet to be found.

The search for literature sources in domestic and foreign databases showed the absence of works devoted to the study of the influence of the degree of distraction of the facet joints in elderly and senile patients who underwent anterior cervical discectomy and fusion (ACDF). The purpose of the study was to study the effect of the degree of facet joint distraction on clinical outcomes in patients of the older age group who underwent ACDF. A single-center retrospective study included 47 elderly and senile patients who underwent ACDF for radiculopathy due to degenerative diseases of the cervical spine. A statistically significant correlation was found between the differences in the value of the interfacet distance and the severity of pain in the cervical spine according to VAS (p<0,01). Patients with X-ray semiotics of facet distraction more than 0,55 mm 12 months after the operation were significantly more likely to experience increased pain in the cervical spine according to VAS (p=0,028) and significantly limited daily activities due to pain in the neck NDI (p=0,043). The choice of indications for ACDF in patients of the older age group should be based on a rigorous analysis of facet distraction, cervical sagittal parameters in combination with the functional status of patients.

The aim . To analyze the role of the spine adipose index (SAI) in predicting the risk of septic spondylodiscitis after lumbar percutaneous laser disk decompression (PLDD). Material and methods . A retrospective observational single-center study was performed. Various clinical and instrumental parameters have been studied, including the spine adipose index, which are potential risk factors for the development of postprocedural septic spondylodiscitis. Results . The study included 219 patients who underwent PLDD for degenerative lumbar disk disease. The average period of postoperative observation was 30.8 ± 13.3 months. Signs of septic spondylodiscitis were detected in 5 (2.28%) cases. Multivariate analysis showed that III degree of anesthesiological risk by the American Society of Anesthesiologists (ASA) scale (p = 0.021), a high value of body mass index (more than 25 kg/m 2 ) (p = 0.043) and a high value of SAI (over 0.7) (p = 0.037) are statistically significantly associated with the development of septic spondylodiscitis in patients who underwent lumbar PLDD. Conclusion . The value of SAI is statistically significantly associated with the development of spondylodiscitis in patients who underwent PLDD for degenerative lumbar disk disease.

Intramedullary abscesses of the spinal cord are the rarest form of infectious lesions of the central nervous system. We report surgical treatment of a patient with intramedullary cervical abscess caused by L. monocytogenes. Features of this case are absence of primary purulent focus and atypical infectious agent. The patient underwent surgical treatment for intramedullary cervical abscess and subsequent antimicrobial therapy. Subtotal regression of neurological symptoms was noted in early postoperative period. The authors emphasize strict collegial decision-making regarding diagnosis of this disease and choice of optimal treatment strategy.

The search for literature sources in domestic and foreign databases showed the absence of works devoted to the study of risk factors for venous thromboembolic events (VTE) in patients of the older age group with diabetes mellitus who are planned to undergo surgical interventions on the spine, which was the impetus for this study. The aim of the study was to study the risk factors for VTE in elderly and senile patients with diabetes mellitus who are scheduled for spinal surgery. A single-center retrospective study included 119 elderly and senile patients (64 men, 55 women, mean age 74,2±6,5 years) who underwent various surgical interventions on the spinal column. According to the binary logistic regression model, the following parameters are statistically significantly associated with the development of VTEC in the studied group of respondents: age of patients over 75 years (p=0,048), HbA1C levels over 7,5% (p=0,007) and D-dimer over 0,5 mg /l FEU (p=0,034), as well as high risk (5 points or more) of VTE according to Caprini scale (p=0,012). In order to reduce the incidence of VTE in elderly and senile patients with diabetes mellitus who are planned to perform surgical interventions on the spine, it is necessary to verify the above clinical and laboratory parameters in the early stages of hospitalization.

ABSTRACT Objective: to investigate the frequency of recurrent lumbar disk herniation (rLDH) and evaluated risk factors of rLDH in Russian population. Methods: this was a retrospective clinical study. From January 2015 to March 2022, 218 patients having single-level LDH at three institutes were included in this clinical study and who were then observed for a minimum of 5 years postoperatively. All the patients or relatives gave informed consent to participate in this study. The levels of disk herniation were L4-L5 in 132 cases (60.5 %), and L5-S1 in 86 cases (39.4 %). Results: The rLDH group was composed of 31 male and 12 female, whose ages ranged from 18 to 57 years (34.8±9.5 years). The non-rLDH group was composed of 97 male and 78 female, whose ages ranged from 19 to 73 years (47.5±9.8 years). According to the constructed binary logistic model, body mass index (p=0.021), current smoking (p=0.017), stage of disk degeneration (p=0.043), facet tropism (p=0.037), disk height index (p=0.018) and apparent diffusion coefficient (p=0.009) are significantly associated with incidence of rLDH. Conclusions: patients with these risk factors should be paid more attention for prevention of rLDH. Level of Evidence III; Retrospective Study.

ABSTRACT Objective: This study was designed to evaluate the prevalence and grading of heterotopic ossification (HO) at five years, among patients after cervical disk arthroplasty (CDA). Methods: The CDA procedure with Activ C and M6-C prostheses was performed on 127 patients. The mean age of the cohort of patients was 38.4 years (range 18-49). The mean follow-up time was 58.4 months, ranging from 51 to 66 months. Results: Grade 1 ossifications were present in 11 (8.6 %) levels. A total of 45 (35.4 %) segments showed grade 2 HO. HO that led to restrictions in range of motion were present in 13 (10.2 %) cases. Five years after surgery, 9 (7.0 %) patients with grade 4 ossifications were found only in the M6-C artificial disk prosthesis group. In the analysis of patient survival following the occurrence of HO, all patients showed median survival of 28.3±5.6 months. The group that received the Activ C artificial disk prosthesis showed statistically longer survival (49.5±7.8 months) than the M6-C disk group. Conclusions: In our study 61.4% of patients exhibited HO after a mean follow-up of 58.4 months. In the analysis of patient survival after HO, all patients showed median survival of 28.3±5.6 months. The group that received the Activ C artificial disk prosthesis showed statistically longer survival (49.5±7.8 months) than the M6-C disk group. Level of evidence III; Cross-sectional Observational Study.

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.

Глиомы представляют собой наиболее распространенную группу первичных опухолей головного мозга, составляя не менее 80% от всех типов неоплазий центральной нервной системы. Особого внимания заслуживают глиомы высокой степени злокачественности (анапластическая астроцитома и олигодендроглиома, анапластическая плеоморфная ксантоастроцитома, а также три молекулярно-генетических подтипа глиобластом) ввиду наличия неблагоприятного прогноза для выживаемости пациентов. Поиск источников литературы в отечественных и зарубежных базах данных продемонстрировал наличие нескольких исследований, посвященных изучению новых методов лечения при глиомах высокой степени злокачественности головного мозга, в том числе и при глиобластомах. Объединение результатов указанных исследований и явилось побудительным моментом к написанию данного обзора литературы.

There are few studies comparing clinical efficacy of decompression/fusion surgery (transforaminal lumbar interbody fusion (TLIF) + transpedicular interbody fusion) and minimally invasive microsurgical decompression (MMD) in patients with single-segment lumbar spinal stenosis.OBJECTIVETo compare the results of TLIF + transpedicular interbody fusion and MMD in patients with single-segment lumbar spinal stenosis.MATERIAL AND METHODSA retrospective observational cohort study included medical records of 196 patients (100 (51%) men, 96 (49%) women). Age of patients ranged from 18 to 84 years. Mean postoperative follow-up period was 20.1±6.7 months. Patients were divided into 2 groups: group I (control) included 100 patients who underwent TLIF + transpedicular interbody fusion, group II (study) included 96 patients who underwent MMD. We analyzed pain syndrome and working capacity using visual analogue scale (VAS) and Oswestry Disability Index (ODI), respectively.RESULTSAnalysis of pain syndrome in both groups after 3, 6, 9, 12 and 24 months clearly demonstrated stable relief of pain syndrome (VAS score) in the lower extremities. In group II, VAS score of lower back and leg pain was significantly higher in long-term follow-up period (after 9 months or more) compared to the 1st group (p<0.05). In long-term follow-up period (after 12 months), there was significant decrease in degree of disability (ODI score) in both groups (p<0.001) without between-group differences. We assessed achievement of treatment goal in 12 and 24 months after surgery in both groups. The result was significantly better in the 2nd group. At the same time, some respondents failed to achieve the final clinical goal of treatment in both groups (group I - 8 (12.1%), group II - 2 (3%) patients).CONCLUSIONAnalysis of postoperative outcomes in patients with single-segment degenerative lumbar spinal stenosis revealed similar clinical effectiveness of TLIF + transpedicular interbody fusion and MMD regarding decompression quality. However, MMD was associated with less traumatization of paravertebral tissues, blood loss, fewer unwanted phenomena and earlier recovery.

Extramedullary spinal cord tumors at the level of craniovertebral junction are a rare group of neoplasms with their own characteristics. Taking into account the peculiarities of clinical course and complex anatomy of craniovertebral complex, these tumors present a complex diagnostic and surgical problem. A systematic review of literature data on epidemiology, clinical picture, diagnostic methods and dorsal minimally invasive methods of surgical treatment of patients with extramedullary spinal cord tumors of craniovertebral junction was performed.

OBJECTIVE:To develop a new validated classification of intervertebral disc degeneration.MATERIAL AND METHODS:A retrospective observational single-center study included medical records of patients with and without degenerative disease of lumbar intervertebral discs. The interval values of apparent diffusion coefficient (ADC) of intervertebral discs were grouped into degeneration classes.RESULTS:The study included medical records of 100 patients. A quantitative analysis of data showed that mean ADC has a significant correlation with severity of lumbosacral disc degeneration according to classification by Pfirrmann et al. Lumbar intervertebral discs with degeneration grade 3-4 were less homogeneous compared to grade 2-3. Among discs with degeneration grade 4, mean ADC was significantly higher in case of hernia (p=0.01). Conversely, mean ADC was significantly higher in the absence of hernia for discs grade 3 (p=0.04). Combination of all data is presented as original classification of lumbosacral disc degeneration based on mean ADC.CONCLUSION:The developed classification can be recommended for radiologists, neurologists and neurosurgeons.

OBJECTIVE:To study the risk factors of unsatisfactory clinical results after percutaneous laser decompression of the lumbar intervertebral disc (PLDD).MATERIAL AND METHODS:A retrospective observational single-center study included medical records of patients who underwent lumbar PLDD for degenerative spine disease. We analyzed clinical and instrumental parameters potentially affecting the results of lumbar PLDD.RESULTS:Clinical study included 82 patients who underwent PLDD for lumbar intervertebral disc degenerative disease. Mean postoperative follow-up period was 30.8±13.3 months. In 22 (26%) patients, unsatisfactory clinical outcomes were observed. According to binary logistic regression model, comorbidities (p=0.03), duration of disease over 12 months (p=0.03), low preoperative quality of life according to ODI score (more than 50%) (p=0.04), high body mass index (over 25 kg/m2) (p=0.02), severe intervertebral disc (p=0.04) and facet joint degeneration (p=0.01) and intervertebral disc height decrease more than 50% (p=0.01) were significantly associated with unsatisfactory clinical outcomes after lumbar PLDD for degenerative spine disease.CONCLUSION:Identification of these risk factors of unsatisfactory clinical outcomes is important stage of preoperative preparation in patients scheduled for lumbar PLDD.

The purpose of the study – to present an analysis of clinical trials to study the clinical efficacy and safety of the technique of percutaneous laser decompression of intervertebral discs based on a review of Russian and foreign studies.The review article presents modern literature data covering the issues of indications, contraindications, technique, efficacy and safety of percutaneous laser disc decompression in patients with degenerative disease of the lumbar intervertebral discs. The publication present modern data on the choice of the most rational tactics for surgical treatment of patients with this pathology. Relevant, unresolved issues are indicated, which dictates the need for large randomized placebo-controlled clinical trials, with the inclusion of the latter’s results in systematic reviews and meta-analyzes.