1 ФГБУ «Федеральный центр нейрохирургии» Минздрава России, Новосибирск, Россия; 2 ГБОУ ВО «Московский государственный медицинский университет им. А.И. Евдокимова» Минздрава России, Москва, Россия Описан клинический случай сирингомиелии, ассоциированной с аномалией Арнольда-Киари 1-го типа, проведена оценка эффективности метода сирингосубарахноидального шунтирования, а также проанализированы данные литера-туры отечественных и зарубежных авторов, занимающихся изучением и лечением данной патологии. Результатом применения метода сирингосубарахноидального шунтирования в описываемом случае явился регресс пареза и гипестезии, что продемонстрировало эффективность шунтирующей методики для коррекции симптомов сирингомие-лии. Список сокращений DREZ (dorsal root entry zone) -зона входа чувствительных корешков ВКЖ -внеклеточная жидкость ЗЧЯ -задняя черепная ямка МРТ -магнитно-резонансная томография НФТО -нарушение функций тазовых органов ПСМТ -позвоночно-спинномозговая травма ПТСМ -посттравматическая сирингомиелия САК -субарахноидальное кровоизлияние САП -субарахноидальное пространство СМЖ -спинномозговая жидкость ТМО -твердая мозговая оболочка ЦНС -центральная нервная система ЦСЖ -цереброспинальная жидкость ЭОП -электронно-оптический преобразователь Сирингомиелия -хроническое заболевание спинного мозга, характеризующееся интрамедул-лярным кистообразованием. Чаще всего это не само-стоятельная нозология, а позднее осложнение ос-новного заболевания [1].Впервые сирингомиелитические полости в спинном мозге были описаны A. Portal [2] как ау-топсийная находка. Как правило, такая полость со-держит прозрачную жидкость, которая неотличима от ликвора или внеклеточной жидкости, а стенки

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Objective The incidence of adult degenerative scoliosis (ADS) among individuals over 50 years old can be as high as 68%. Surgical interventions aimed at correcting the spinal deformity in elderly patients are accompanied by a high risk of complications. The use of lateral lumbar interbody fusion (LLIF) is associated with lower rates of complications when compared with open anterior or posterior fusions. Methods Ninety-three patients with ADS (23 men, 70 women) were operated at the Federal Neurosurgical Center. The average age was 63 (52 to 73 years). Results Back pain, measured according to the Visual Analogue Scale (VAS), decreased from 5.9/6 (4;8) (format – mean/median (1;3 quartile)) to 2.6/3 (1;3) points (p <0.0001). Leg pain according to the VAS decreased from 4.6/4 (3;7) to 1.4/1 (0;2) points (p < 0.0001). Functional adaptation according to the Oswestry Disability Index (ODI) improved from 47.8±17.4 to 38.5±14.5 (p < 0.0273). Pelvic tilt (PT) before the surgery was 23.9±12.2° whereas at 12 months follow-up it was 16.8±5.9° (p < 0.0001). PI-LL mismatch pre surgery was 12.1/13 (9;16)° whereas 12 months later it was 7.9/8 (6;10)° (p = 0.0002). Conclusions Restoration of local sagittal balance in ADS patients by short-segment fixation using LLIF technology leads to a statistically significant improvement in quality of life and increased functional adaptation. A lower incidence of early and late postoperative complications, less intraoperative blood loss and shorter hospital stay makes LLIF, in combination with minimally invasive transpedicular fixation, the method of choice to correct ADS in elderly patients. Level of evidence IV; Case series.

The study objective is to analyze the effectiveness of the use of minimal invasive polyetheretherketone (PEEK) rod systems in the treatment of lumbar spine degenerative diseases.Materials and methods. The minimal invasive semi-rigid stabilization using PEEK rod systems was performed in 24 patients (4 (17 %) male and 20 (83 %) female) patients (mean age 46.3 ± 8.4, ranging from 32 to 63). The average follow-up duration was 15 months. Inclusion criteria: mechanical low back pain, White–Panjabi instability: 5 points, degenerative changes of the disc by C. Pfirrmann scale: II–IV grade. Follow-up at the 6 and 12 months postoperatively.Results. In the postoperative period, the majority of patients had a complete or significant regression of pain (on average, from 6.3 to 1.8 points on the visual analog scale). The Oswestry disability index decreased from 64/66 [64; 68] to 33/34 [32; 36] in 6 months (p <0.001) and 18/17 [16; 18] in 12 months (p <0.001). Before surgery, the height of the operated disk was 0.96 cm, after 1 year decreased to 0.91 cm. Range of rotary motion in the operated segment in all cases did not exceed 6°.Conclusion. The PEEK rod fixation in patients with mechanical low back pain provides good and excellent clinical results on the I. Macnab scale in 83.4 % of cases. Within 12 months, the minimal volume of movements on the operated segment remains, without signs of continued degeneration of adjacent intervertebral discs.

Improvement in the quality of life indicators in 48.6% of cases was achieved by decompression only; the sagittal balance parameters had no significant impact on quality of life. In 24.8% of cases, improvement in the quality of life indicators was achieved by decompression and stabilization because the dominant clinical neurological syndrome was instability. Reduced quality of life in 26.6% of patients was caused by disturbed spinopelvic relationships. Application of the XLIF technique in these patients provides statistically significant restoration of the sagittal balance parameters, PT and PI-LL, which improves quality of life.

Министерства здравоохранения РФ, г. Новосибирск, Россия 2 Федеральное государственное автономное образовательное учреждение высшего образования «Новосибирский национальный исследовательский государственный университет», г. Новосибирск, Россия 3 Федеральное государственное бюджетное учреждение «Российский научный центр "Восстановительная травматология и ортопедия" им. акад. Г.А. Илизарова» Министерства здравоохранения Российской Федерации, г. Курган, Россия The use of LLIF technology in adult patients with degenerative scoliosis: retrospective cohort analysis and literature review

1. Registration of MEPs is a highly sensitive and highly specific method for diagnosing corticospinal tract dysfunction in patients with intramedullary tumors of the cervical spinal cord. The sensitivity and specificity of MEPs recorded from the upper limbs are higher than those from the lower limb muscles. 2. The sensitivity of MEPs in patients with extramedullary intradural tumors was 0%, the diagnostic effectiveness of MEPs amounted to 86% from the upper limb muscles and 93% from the lower limb muscles. 3. When the MEP amplitude in patients with extra- and intramedullary tumors of the cervical spinal cord decreases, a change in the surgion's approach may reduce or completely eliminate surgically-induced damage to the spinal cord.

Objective. To evaluate the effectiveness of a modified Wiltse approach to the lumbar spine for extraforaminal disk herniation. Material and Methods. A total of 1020 patients with herniated lumbar intervertebral disc were operated on, out of them 30 (2.9 %) patients were diagnosed as having extraforaminal disc herniations most often observed at the L4-L5 (53.3 %) and L5-S1 (40.0 %) levels. Clinical manifestations included back pain in 20 patients (66.6 %) and radicular syndrome -in all patients, which was accompanied by movement disorders in 15 (50.0 %) cases and by sensitivity disorders in 9 (30 %). Evaluation of surgical results was performed in the early postoperative period and at 3 and 6 months after surgery. Clinical outcomes were assessed using modified MacNab criteria. Results. Based on MacNab criteria, an excellent outcome was observed in 45 %, good -in 42 %, and satisfactoryin 13 % of cases at 6 months after surgery. The volume of intraoperative blood loss was on average 52.8 ± 30 mL, the average length of hospital stay was 2.6 days. Conclusion. The modified Wiltse approach is an effective surgery to remove extraforaminal herniation in the lumbar spine, which allows achieving excellent and good results of treatment in 87 % of cases. Please cite this paper as: Klimov VS, Evsyukov AV, Kosimshoev MA. The modified Wiltse approach for treatment of extraforaminal disc herniation in the lumbar spine. Hir.Статья поступила в редакцию 02. 02.2016 Владимир Сергеевич Климов, канд. мед. наук, врач-нейрохирург, заведующий спинальным отделением; Алексей Владимирович Евсюков, канд. мед. наук, врач-нейрохирург; Муроджон Азамович Косимшоев, врач-нейрохирург, Федеральный центр нейрохирургии, Новосибирск. Vladimir Sergeyevich Klimov, MD, PhD, neurosurgeon, head of the spinal department; Aleksey Vladimirovich Evsyukov, MD, PhD, neurosurgeon in the spinal department; Murodzhon Azamovich Kosimshoev, neurosurgeon in the spinal department, Federal Center of Neurosurgery, Novosibirsk, Russia.