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Objective. To analyze and compare the results of treatment of lumbar spinal stenosis using minimally invasive unilateral decompression and classical laminectomy. Material and Methods. The retrospective comparative monocentric study included 68 patients (2 groups of 34 patients each) operated on in 2018–2021 for spinal stenosis in the lumbar spine who met certain eligibility criteria. Patients of one group were operated on using minimally invasive bilateral decompression through a unilateral approach, while patients in the other group were operated on using classical laminectomy. The results of surgical treatment were compared during 24 months by assessing pre- and postoperative indicators of the intensity of pain in the back and lower extremities using a 10-point VAS, and the patient’s functional activity – using the Oswestry index. Results. A statistically significant clinical effect of surgical treatment was noticed in both groups. At the end of the follow-up period, the results of back pain relief in the minimally invasive surgery group were significantly better (0.3 vs 0.9, respectively), and the improvement in functional activity was comparable to the laminectomy group (8.8 vs 9.8, respectively). A clinical effect of pain relief in the lower extremities was obtained in both groups (up to 1.2 and 1.4, respectively). The length of hospital stay, time to activation, and volume of blood loss were significantly lower in minimally invasive decompression group. Conclusion. Minimally invasive unilateral decompression of the spinal canal for lumbar spinal stenosis demonstrates a better effect in relieving back pain than classical laminectomy, with no significant difference in relieving pain in the lower extremities. The minimally invasive technique allows patients to rehabilitate as quickly as possible and return to everyday life and work. It has socio-economic advantages compared to classical laminectomy – a shorter period of activation and hospital treatment, and less blood loss.

Objective. To evaluate the long-term results of surgical treatment of patients with monosegmental stenosis of the lumbar spine after using minimally invasive and standard open techniques. Material and Methods. The open cohort randomized prospective study included 132 patients. Long-term results were assessed in 110 patients, some patients discontinued participation in the study for natural reasons. Patients were operated on in 2009–2011 in the volume of minimally invasive decompression and stabilization surgery (Group 1) and decompression and stabilization surgery through conventional posteromedial approach (Group 2). The following parameters were analyzed: Oswestry Disability Index and VAS pain intensity. Formation of an interbody block was assessed using the Tan scale, and the fatty degeneration of the paravertebral muscles – according to the Goutallier scale. Development or aggravation of the course of degeneration of the adjacent segment was also evaluated. Statistical analysis was performed using the R packages for data processing and plotting. Results. At long-term follow-up (144 months), when assessing back pain according to VAS and ODI, a statistically significant difference p < 0.001 in favor of minimally invasive interventions was revealed. Both surgical methods resulted in high rates of fusion and low reoperation rates. In the group of minimally invasive surgical interventions, there is a lower incidence of fatty degeneration of the paravertebral muscles and damage to the adjacent segment. Conclusions. Open and minimally invasive surgical interventions have comparable long-term clinical and morphological results. Open surgical interventions in the long term are fraught with aggravation of fatty degeneration of the paravertebral muscles and more frequent development of the adjacent level syndrome. Minimally invasive techniques are an effective and safe alternative to traditional open surgery and can reduce trauma, preserve the intact posterior support complex of the spine at adjacent levels, while performing adequate decompression and stabilization, followed by the formation of a bone block.

Objective. To perform comparative analysis of the clinical efficacy and safety of indirect decompression of the spinal roots and interbody fusion through the lateral pre-psoas approach (OLIF) with anterolateral (OLIF-AF) and posterior percutaneous (OLIF-PF) screw fixations in the surgical treatment of single-segment lumbar stenosis. Material and Methods. A retrospective comparative analysis of treatment of 88 patients aged 29 to 72 years with single-level lumbar stenosis was carried out. Posterior instrumental fixation (OLIF-PF) was performed in 60 cases, and anterolateral (OLIF-AF) – in 28. Results. The compared groups did not statistically significantly differ from each other in terms of age, gender, body mass index, clinical picture and duration of symptoms before surgery, assessment of neurological status according to the Zurich Claudication Questionnaire (ZCQ), preoperative diagnosis, localization of stenosis, pain assessment in the back and leg before surgery according to a digital rating scale, physical status (ASA), health assessment (SF-12, ODI), follow-up period, as well as smoking and the presence of comorbidities (p > 0.05). In the OLIF-AF group, compared to the OLIF-PF group, a statistically significant advantage was found in terms of blood loss, duration of surgery and anesthesia, the level of radiological exposure, duration of patient’s hospitalization and hospital stay in the postoperative period, as well as the duration of antibiotic prophylaxis and intraoperative volume of infusions (p < 0.05). Despite earlier discharge and less use of local anesthesia (35.7 % vs 73.3 %; p = 0.001), patients in the OLIF-AF group had statistically significantly lower level of back pain on the day of discharge (3.0 vs 3.5; p = 0.034) and were less likely to need opioids (3.6 % vs 31.7 %; p = 0.003). With regard to complications and adverse events, there were no statistically significant differences during dynamic follow-up period from 3 to 50 months in both groups (17.9 % vs 28.3 %; p = 0.290), including depending on the timing of complications (early or late). In addition, no statistically significant differences were found for neurological, infectious, gastrointestinal, urological, or implant-related complications (p > 0.05). Conclusions. Indirect decompression of the spinal roots and interbody fusion through the lateral pre-psoas approach in combination with OLIF-AF is an effective and safe technique for the surgical treatment of single-segment lumbar stenosis. This method allows to reduce the invasiveness of surgery and severity of the pain syndrome and to create conditions for enhanced recovery after surgery. Further multicenter randomized trials are needed to comprehensively evaluate long-term outcomes.

Objective. To analyze the clinical efficacy of anterior fusion through a minimally invasive retroperitoneal approach in the treatment of patients with pseudoarthrosis after decompression and stabilization surgery for degenerative spinal stenosis. Material and Methods. Twenty six patients with previously performed decompression and stabilization surgeries for degenerative spinal canal stenosis underwent repeated surgical interventions using anterior/anterolateral fusion due to clinical and radiographic signs of pseudoarthrosis resistant to complex conservative therapy for at least 12 weeks. The outcomes of surgical treatment were analyzed based on the assessment of clinical and radiological characteristics before and after surgery. Results. At a follow-up examination 12 months after surgery, leg pain aggravated after exercise bothered 5 patients (19.2 %). According to CT data, 16 (61.5 %) patients had signs of the formation of grade 1 interbody bone block. In 2 (7.7 %) patients, instability of the fixation system developed and there were no signs of union, which required repeated surgical interventions. Conclusion. Anterior interbody fusion in the treatment of patients with pseudoarthrosis allows safe removal of the preinstalled interbody implant and creation of optimal conditions for the formation of interbody fusion. Despite clinical improvement, significant functional disorders persist in most patients.

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.

Background. The results of treatment of the elderly patients operated for spinal stenosis allow us to suggest that a cascade of degenerative changes in the spinal motion segments causes the formation of an adjacent level syndrome, pseudarthrosis, and in some cases – the instability in the fixing structure.The aim of the study. To determine the prognostic factors for the adjacent level syndrome in patients after decompressive and stabilizing spinal surgeries.Methods. We carried out a retrospective cohort study of the surgical treatment of 129 elderly patients (over 60 years of age) for the period from January 2018 to March 2022, who underwent surgery at the lumbosacral level of spine for degenerative spinal stenosis.Results. The outcomes of surgical treatment of 129 patients and the results of discriminant analysis of morphometric studies of computed tomography data indicate that the most significant indicators for the development of the adjacent level syndrome are the lordosis angle in the segment adjacent to the operated one (the mean value in the analyzed group is 12.87 ± 2.22°; in the control group – 11.92 ± 2.97°); the anterior height of the adjacent intervertebral disc (the mean value in the analyzed group is 12.70 ± 2.44 mm; in the control group – 11.46 ± 3.58 mm) and the difference of anterior and posterior disc heights at the adjacent level (the mean value in the analyzed group is 5.48 ± 2.84 mm; in the control group – 6.27 ± 2.71 mm).Conclusion. When analyzing the treatment outcomes of 129 elderly patients operated for degenerative spinal stenosis using instrumented spinal fusion, we revealed that in 16 patients, the adjacent level syndrome developed with an increase in the lordosis angle at the level adjacent to the operated segment. An increase in the anterior height of the adjacent intervertebral disc and the decrease in the difference of anterior and posterior disc heights at the adjacent level can be considered as unfavorable prognostic factors (p = 0.83).

Aim – to evaluate clinical and instrumental correlation (MRI data) in patients with lumbar intervertebral disc herniation complicated by spinal canal stenosis for optimizing the indications for differentiated surgical treatment. Materials and methods. Clinical and neurological manifestations and MRI data in 80 patients (men – 36, women – 44), aged 27 to 72 years with a diagnosis of intervertebral disc herniation complicated by spinal canal stenosis were retrospectively analyzed. Depending on the size of the spinal canal, there were 2 groups: the first – with relative spinal canal stenosis (n = 20) – 75–100 mm2, and the second group – with absolute spinal canal stenosis (n = 60) – less than 75 mm2. We examined the correlation between the clinical and neurological presentations and MRI findings. Results. Our retrospective analysis has found that the first group consisted mainly of younger patients (46 years) and with a mean intervertebral disc herniation of 8.35 mm, while the second group included older patients (51.7 years) and the mean size of intervertebral disc herniation was 7.3 mm. The group of relative spinal canal stenosis was dominated by patients with radiculopathy syndrome (70 %) and pain in one lower limb (85 %). Radiculoischemia syndrome (50 %), pain in both lower extremities (33 %), neurogenic intermittent claudication syndrome (46.6 %), knee reflex disorders (58.3 %), pelvic organ dysfunction (11.6 %) were more common in the second group of patients. In addition, the longest disease duration (more than 24 months) was observed among patients of this group. We have found a relationship between pain syndrome (according to VAS), muscle strength, the disease duration and the spinal canal area. Conclusions. The correlation of clinical and instrumental methods of examination in patients with intervertebral disc herniation complicated by spinal canal stenosis allows the indications for differentiated surgery to be optimized.

Objective. To analyze surgical technique and possibilities of using bilateral laminoplasty technique with simultaneous foraminotomy for extended stenosis of the cervical spine. Material and Methods. The analysis included results of surgical treatment of 26 patients (18 males and 8 females, mean age 60.2 ± 1.3 years) operated on by the method of bilateral laminoplasty with simultaneous foraminotomy from January 2016 to April 2020. Pre- and postoperative clinical condition of patients was assessed, including using VAS, JOA and Nurick scales. An objective assessment of stenosis degree (linear dimensions, areas, volume of the stenotic spinal canal) was performed using standard measuring tools of the RadiAnt DICOM Viewer software. To assess the statistical significance of the obtained results, nonparametric Wilcoxon-T and Mann – Whitney-U tests were used. Differences were considered significant at p < 0.05. Results. Upon admission to the hospital, all patients had specific neurological symptoms with varying degree of pain, myelopathic and radicular symptoms. According to neurovisualisation, the average number of involved in the process levels (stenotic) was 3.2 ± 0.1, (the average length of stenosis was 5.1 ± 0.2 cm). In the postoperative period, all patients showed positive dynamics in the form of a decrease in the severity of neurological disorders and pain (from 7.2 ± 0.1 to 5.07 ± 0.1 according to VAS, p < 0.001). The manifestations of myelopathy decreased according to Nurick scale from 2.08 ± 0.71 to 1.84 ± 0.10 points (p < 0.05). According to MRI data, the average area of the dural sac objectively increased from 1.25 ± 0.30 cm2 to 2.26 ± 0.27 cm2 (p < 0.001), and the volume of spinal canal in the area of stenosis increased from 7.2 ± 0.2 cm3 to 13.4 ± 0.1 cm3 (p < 0.001). Patients were mobilized on the 2nd day after surgery. The duration of inpatient treatment ranged from 4 to 17 days (on average, 7.1 ± 0.4 days). Intraoperative complications were not observed in the presented series. Mild postoperative complications were detected only in two out of 26 operated patients. Conclusion. Bilateral laminoplasty with simultaneous foraminotomy using titanium miniplates and osteoinductive material has a number of advantages and can be the surgery of choice in the treatment of patients with extended cervical stenosis complicated by myelopathy and radicular pain syndrome.

One of the main causes of pain in the cervical spine, which causes the development of neurological deficit, is the stenosing process of the spinal canal with compression of the neurovascular structures. To determine the tactics of treatment, to predict the consequences of the disease, timely diagnosis of the functional state of neural structures is of great importance.Materials and methods. An informative method for diagnosing stenosing processes of the cervical spine, along with radiography and MRI, is electroneuromyography (ENMG). The analysis was based on 35 patients with a stenosing process of the spinal canal at the cervical level (17 men, 18 women), the average age of patients was 47.7 ± 9.9 years.Results. In the study of changes in the functional state of the axillary, radial, ulnar and median nerves, with stenosing processes, a unidirectional deviation of the entire ENMG complex of indicators of the limb with pain syndrome and contralateral limb was noted. A decrease in the amplitude of the maximum M-responses is recorded due to damage to the peripheral motor neuron and axon degeneration. Selective damage to the slow-conducting anterior motoneurons does not cause a decrease in the speed of impulse conduction due to demyelination. Bilateral changes in late electroneuromyographic phenomena (F-wave) are possibly caused by a general reaction of the peripheral and central nervous systems.Conclusion. In patients with a stenosing process of the cervical spine with severe clinical manifestations, ENMG values can be used both to determine indications for surgical treatment and to assess the dynamics of changes in the postoperative period.

Cervical discopathy is an important medical problem widespread in society. Symptoms are often upper limbs radicular pain, local pain in the cervical spine, and vetrebrobasilar cerebrovascular insufficiency. In the case of ineffective conservative treatment and severe pressure on nerve structures, surgical treatment is indicated. Cervical discopathy is most common at the age of 30 - 60 with a predominance of women. The authors of this manuscript analyzed the medical data of patients operated on due to cervical discopathy on their own material. Cervical discopathy was found to be more common in women, which is consistent with world references. A relationship was found between cervical myelopathy and critical spinal canal stenosis and C4-C5 stenosis. Stenosis on C3-C4 has also been rare in female patients and more common in men. Obtained data on own material are generally consistent with reports from world literature and constitute its complement in reference to the region of the Kuyavian-Pomeranian Voivodeship.

Objective. To analyze the influence of somatic comorbidity on the results of surgical treatment of elderly and senile patients with degenerative lumbar spinal stenosis. Material and Methods. The study design corresponds to a single-center non-randomized retrospective cohort study with level 3 evidence (OCEBM Levels of Evidence Working Group. “The Oxford 2011 Levels of Evidence”). The influence of somatic comorbidity on quality of life after surgery for degenerative lumbar spinal stenosis was analyzed in 962 patients 60–85 years old. Analysis and evaluation of the results of the study was carried out in two groups of patients with radicular compression syndrome: Group 1 (less than 5 points according to White – Panjabi criteria) included 625 (65%) patients, and Group 2 (5 or more points according to White – Panjabi criteria) – 337 (35%) patients. Results. Body mass index of patients in Group 1 was statistically significantly lower than in Group 2. Repeated surgical interventions performed during the first year after the primary operation were statistically significantly more frequent in Group 1, and those performed after 3–4 years were more frequent in Group 2 (BMI ≥ 30) due to the development of adjacent level disease. In obese patients, the duration of surgery, blood loss and postoperative hospital stay are statistically significantly increased. One year after surgery, a statistically significant negative effect of increase in BMI on the parameters of back pain, lower limb pain, functional adaptation, and quality of life was revealed in both groups of patients. No association of obesity and complication rates was noted. In Group 2, the incidence of adjacent level disease 2–5 years after the primary operation was higher in patients with BMI ≥ 30 compared with patients with BMI < 30 and with patients in Group 1. It was found that somatic comorbidity and the age of patients statistically significantly prolonged postoperative hospital stay in Group 1 and did not affect its duration in Group 2. No effect of the comorbidity index on the quality of life was noted. Osteoporosis was statistically significantly associated with an increase in the frequency of technical complications during surgery (malposition of pedicle screws, cage migration, and damage to the vertebral endplates). Conclusion. Obesity is statistically significantly associated with an increase in postoperative hospital stay, surgery duration and blood loss, and is a predictor of the development of instability of the spinal motion segment and adjacent level disease. Obese patients have higher levels of back and lower limb pain and worse quality of life parameters after surgical interventions than patients with normal body weight. When using minimally invasive technologies in the surgical treatment of degenerative lumbar spine pathology, the number of complications in obese patients is not higher than in patients with normal body weight. The effect of comorbidity on the results of minimally invasive surgery for degenerative lumbar pathology was not detected. Osteoporosis affects the frequency of technical complications during surgery.

Objective Demonstrate an outcome of comprehensive treatment of an adolescent with fracture-dislocation of the thoracic spine accompanied by deep lower paraplegia and pelvic floor dysfunction using noninvasive percutaneous spinal cord stimulation and mechanical stimulation of the foot bearing surface. Case study Comprehensive treatment was performed for a 17-year-old patient who sustained a combined injury during roller ski training. The patient presented with back pain, breathing difficulty, being unable to perform active movements of lower extremities. He reported loss of sensitivity in the lower part of the body, perineum and lower limbs. The injury was classified as ASIA grade B with motor impairment scored 50 and overall sensory score of 88. Surgical intervention was produced within the first hours after injury and was followed by rehabilitation program including stimulation of the foot bearing surface with Korvit plantar support load simulator and noninvasive percutaneous spinal cord stimulation. Neurologic status of the patients was graded as ASIA level D at one-year follow-up with motor score of 85 and sensory level improved to 175. Conclusion Surgical treatment produced for the patient with spinal cord injury within the first hours after trauma using noninvasive percutaneous spinal cord stimulation and mechanical stimulation of the foot bearing surface provided regress of neurological disorders facilitating more intense lower-limb motor recovery and other important gait characteristics. The patient could regain voluntary control of muscle activity, stand unassisted and walk with a cane at one year post-injury.

Objective. To identify the risk of the spinal motion segment instability after local foraminotomy in elderly and senile patients with lumbar spinal stenosis associated with degenerative scoliosis. Material and Methods. A prospective study included data on 50 patients treated by surgery and 50 patients who underwent conservative treatment in 2013–2017 for leg pain associated with degenerative scoliosis and secondary spinal stenosis. All patients were older than 60 years. Conservative treatment was carried out using vascular drugs, NSAIDs, analgesics, decongestants, and various blockades. In surgery group, patients underwent local foraminotomy for decompression at the involved levels. The average postoperative follow-up period was 3.8 years (from 6 months to 4 years). The study was performed using four-field tables to determine the relative risk. Results. The performed studies showed that there is no statistically significant risk of instability of the spinal motion segment after foraminotomy in the lumbar spine. Conclusion. Local foraminotomy in the lumbar spine is not a risk factor for instability in the spinal motion segment. Local foraminotomy in the area of lumbar spinal stenosis combined with degenerative scoliosis can be recommended for the treatment of patients only in the absence of proven instability in the involved spinal motion segment at the preoperative stage.

The main goal of the primary and metastatic spinal tumors treatment are local control, preservation of weight bearing and protective function of the spine with improvement patients quality of life. Objective. To develop mathematical algorithm for selection of surgical treatment volume in spinal tumor cases. Methods. Spinal instability neoplastic score supplemented with additional signs such as ASIA scale, tumor type, epidural spinal cord compression scale by Bilsky, local kyphosis, adjacent vertebras lesions was used for the model developing. Point system that takes 9 signs has been tested in 237 metastatic spinal tumor patients. Cluster analysis for the decision tree development was applied. Results. It has been confirmed the hypothesis about decreasing surgical volume with higher SINS score. But, it was not defined which boundary indicator to define specific volume of the surgery is precise. Two patients clusters were defined, that have differences in the surgical volume, degree of tumor lesion, epidural compression and local kyphosis, neurological symptoms. Cluster I included 115 patients with higher score (severe condition, higher volume of the surgical intervention) in comparison with 122 patients from the cluster II. Decision tree for the surgical volume selection in spinal tumor patients has been developed. Conclusions. The most important signes that affect the choice of the surgical volume selection are: neurological symptoms, type of vertebra lesion, spinal stenosis and type of the surgery (radical vs palliative). Application of the developed decision tree in the clinical practise gives the opportunity to select appropriate volume of the surgical intervention in spinal tumor patient with the high significance level that provides satisfactory treatment outcome. Key words. Spinal tumor, surgical treatment, instability scale SINS, decision tree, cluster analysis. [ABSTRACT FROM AUTHOR]

Objective. To analyze early results of surgical treatment in patients with lumbar spinal stenosis using minimally invasive techniques for recon- struction of the spinal canal and fixation of the spine. Material and Methods. A total of 168 patients were treated with minimally invasive unilateral microsurgical decompression for spinal stenosis at the lumbar level. Results. The average length of post-operative inpatient care was 5.8 ± 2.8 days. When assessing the pain intensity in the legs and lumbar spine, as well as in daily activity, positive dynamics was noted after 1 and 6 months. Of the installed 732 screws, 18 (2.4 %) screws were displaced into the spinal canal by less than 2 mm and 4 (0.5 %) – by less than 4 mm. Signs of persistent subcompensated spinal stenosis at the operated level were detected in 5 (2.9 %) patients. The average intraoperative blood loss was 121.1 ± 22.0 ml. All patients were activated at the first day after surgery. Conclusion. Minimally invasive unilateral decompression, if necessary in combination with correction and fixation with percutaneous pedicle screw system and TLIF, eliminates factors causing compression of neural structures, reduces intraoperative blood loss, allows early activation of patients and shortens the length of hospital stay.

The paper presents a case study of surgical treatment of a 14-year-old patient with multiple skeletal malformations, con- genital kyphoscoliosis of the thoracic spine, non-fusion of vertebral arches and vertebral bodies from the C5 to the sacrum (bodies are separated from arches with slit-like defects along the whole length), and spinal compression syndrome.

As the results of complex examination of patients with compressive syndromes accompanied by spinal stenosis we determined main factors and types of compression of spinal cord roots. We analyzed electroneuromyography of 64 patients who had in their anamnesis osteochondrosis of the 2-3rd gestation period complicated with diskogenic lumbosacral radiculitis with clinical and neurological manifestation and pain syndrome of different severity level. It was established that demyeliniation is accompanied with segmental disorders expressed in the deficiency of supraspinal and suprasegmental influences that manifested as a result of ischemic process of conduction tract of spinal cord at the stenosis. Decrease of the range of reflex response (H-reflex) and afterpotential (F-wave) or their fallback is possibly connected with hypostasis of the root without its local demyeliniation. Increase of latent period of H-reflex and F-response and also band broadening of the rate of conduction of excitation correspond to the moderate changes at the pathology of proximal segment of the nerve that is the sign of local demyeliniation of the root at the absence of peripheral axonopathy. Expressed disorders correspond to the dissociation of impulse conduction velocity on the proximal segment and to the signs of axonal neuropathy of distal segment of neuromotor apparatus. Thus, the changes of such electroneuromyographic indices as impulse conduction velocity and inflammability that correspond to the manifestations of L-spinal stenosis of are caused by the compression of roots and their vessels both on injured and intact limb with development of their ischemia. Rate of conduction of excitation significantly decreases at demielinising processes caused by stenosis. Obtained data allows the clinicians to develop adequate and pathogenetically caused scheme of treatment of patients with spinal stenosis.

At the analysis of neuromyographic indices of patients with central spinal stenosis it was determined that evident decrease of electroneuromyographic parameters corresponds to the clinical manifestations of stenosis, that give an indication offunctional suppression of motoneurons in consequence of metastasis ad nervos. Obtained data allows the clinicians to develop an adequate and pathogenetically proved scheme of treatment of patients with spinal stenosis.

The authors report retroperitoneal echinococcosis with destruction of the bodies and left transverse processes of L4-5 vertebrae, recurrence and pathological fracture of L4-5 vertebrae with secondary spinal stenosis and left-sided monoparesis. Retroperitoneal echinococcectomy, pericystectomy, decompressive laminectomy L5 and foraminotomy L5-S1 on the left were performed. Therapy with albendazole was prescribed in postoperative period.

The purpose of the study was to compare the clinical and radiological efficacy of 2-level anterior cervical discectomy and fusion (ACDF) and 1-level anterior cervical corpectomy and fusion (ACCF) in the treatment of two-segment degenerative stenosis of the cervical spine in elderly patients. The retrospective study included 74 elderly patients (over 60 years old), two cohorts were identified: the 1st (n=38) - patients who underwent staged 2-level ACDF; the 2nd (n=36) - patients operated on using the technique of 1-level ACCF. For comparative analysis, we used general information about patients (gender, age, body mass index, physical status according to ASA), characteristics of surgical interventions (time of surgery, volume of blood loss), features of the postoperative period, clinical data, radiological outcomes, and the presence of complications. Analysis of the results was carried out in a minimum period of 36 months. As a result, it was found that 2-level ACDF in the treatment of two-segment degenerative stenosis of the cervical spine in older patients is associated with less blood loss and the level of local pain syndrome. At the same time, better clinical outcomes and fewer revision interventions after 1-level ACCF were recorded in the long-term postoperative period.

Degenerative lumbar spine stenosis is one of the main causes of chronic pain and radiculopathy in advanced age people. Along with increase in average life expectancy, degenerative lumbar spine stenosis becomes the most common indication for spinal surgery. There is still no consensus regarding the most optimal surgical approach due to the variety of modern surgical methods. In recent years, minimally invasive spinal surgery has become a more advisable alternative to open surgery due to its advanced technical features combined with less soft tissue damage, lower risk of complications and shorter postoperative recovery.

This article describes for the first time in the domestic literature a clinical case of the therapeutic effect of neuromodulation on the permanent form of atrial fibrillation and chronic heart failure in an elderly patient with spinal stenosis which led to the development of pain syndrome and movement disorders. For the treatment of neurological pathology, at the beginning epidural administration of drugs was applied, followed by spinal cord stimulation trial and implantation of permanent neurostimulator. At each stage of treatment conducted by a functional neurosurgeon the patient had a spontaneous restoration of sinus rhythm, and during continuous neurostimulation a stable retention of sinus rhythm and regression of heart failure symptoms have been observed throughout a long observation period. The article also presents the data of a few experimental and clinical studies on the use of neuromodulation in cardiology, describes the method of implantation of spinal electrodes and analyzes possible mechanisms of modulation of the autonomic innervation of the heart, implemented by spinal cord stimulation.

Objective: To determine the effect of various methods of perioperative analgesia on the rate of failed back surgery syndrome in patients operated on for spinal stenosis., Material and Methods: A total of 122 patients were operated on for spinal stenosis in 2010-2016. The patients were assigned to groups according to the type of received analgesia: Group K (n=19) underwent analgesia on-demand. Patients in the PMA group (n=21) received preventive multimodal analgesia (PMA) with ketoprofen, paracetamol and morphine. Patients in the PMA+PG (n=20) and PMA+N (n=20) groups additionally received pregabalin and nefopam, respectively. Patients in the PMA+E group (n=22) received continuous epidural analgesia with a combination of ropivacaine and morphine. In patients in the PMA+I group (n=20), the wound was infiltrated with ropivacaine and ketorolac., Results and Conclusion: In Group K, analgesia was not adequate during five postoperative days. Analgesia with PMA resulted in significant pain reduction during three postoperative days compared to Group K. Wound infiltration in addition to PMA was followed by more significant pain relief during six postoperative hours (compared to the PMA group). Administration of pregabalin or nefopam, as well as epidural analgesia, did not improve quality of postoperative analgesia. Five to seven months after the surgery, 66% (57; 75%) of patients had low back and/or leg pain; 41% (32; 50%) of patients had leg pain. Among patients suffering from pain, 32-41% patients had the severe chronic pain syndrome that resulted in sleep disorder, disability and significant deterioration of quality of life. The rate of failed back surgery syndrome did not depend on the perioperative analgesia regimen.

Magnetic resonance imaging (MRI) of lumbar spine is a very frequent examination in any computer tomography unit. However, there are still no scan standards or standards for scan interpretation in the world's medical community. In this article based on our experience we describe common problems encountered by a radiologist during MRI examination of lumbar spine and its subsequent description. The literature survey and analysis are presented with a summary of current recommendations. We examined routine sequences, which could be included in MRI protocol, discussed common terminology, and showed the incidence of different pathologies. The special emphasis is made on assessing lumbar canal stenosis. In this article we focus on qualitative and quantitative criteria of lumbar spinal stenosis.

The process of distractive regenerates of the vertebral arch was studied histologically in mature outbred dogs in modelling of vertebral canal by G. A. Ilizarov technique. During the process of distraction regenerate was shown to have a zonal structure i.e. to include 2 bone regions and connective tissue layering. Its growth is based on the fibers of that layering. The possibility of the increase of vertebral canal sagittal diameter up to 90-100% within 2-2,5 months due to the formation of vertebral arch distractive regenerates is supported by the results of present study and opens the perspective of this technique use in clinical practice.