OBJECTIVE: To present the results from the clinical presentation, the imaging diagnostics, surgery and postoperative status of 17 patients with cervical spine metastases, to analyse all data and make the respective conclusions and compare them with the available data in the literature. PATIENTS AND METHODS: The study analysed data obtained by patients with metastatic cervical tumours treated in St George University Hospital over a period of seven years. All patients underwent diagnostic imaging tests which included, separately or in combination, cervical x-rays, computed tomography scan and magnetic-resonance imaging. Severity of neurological damage and its pre-and postoperative state was graded according to the Frankel Scale. For staging and operating performance we used the Tomita scale and Harrington classifi cation. RESULTS: Seven patients had only one affected vertebra, 4 patients -two vertebrae, one patient -three vertebrae, 2 patients -four vertebrae, and in the other 3 patients more than one segment was affected. Surgery was performed in 12 patients. One level anterior corpectomy was performed in 6 patients, three patients had two-level surgery, and one patient -three-level corpectomy; in the remaining 2 cases we used posterior approach in surgery. Complete corpectomy was performed in 4 patients, subtotal corpectomy was used in 6 patients and partial -in 2 patients. Anterior stabilization system ADD plus® (Ulrich GmbH & Co. KG, Ulm, Germany) was implanted in 2 patients; in 8 patients anterior titanium plate and bone graft were used, and in 1 patient -posterior cervical stabilization system. CONCLUSIONS: Because of the pronounced pain syndrome and frequent neurological lesions as a result of the cervical spine metastases use of surgery is justifi ed. The main purpose is to maximize tumor resection, achieve optimal spinal cord and nerve root decompression and stabilize the affected segment.

Image-guided spinal surgery is becoming increasingly popular because it allows surgeons to achieve minimal invasiveness and maximum precision in the performed procedures. We present our initial experience with two cases operated on using O-arm-based spinal navigation at the Clinic of Neurosurgery in St George University Hospital, Plovdiv, Bulgaria. In the fi rst case, we performed removal of extradural spinal tumor of the sixth thoracic vertebra and O-arm-navigated pedicle screw fi xation. In the second case, we performed O-arm-navigated corpectomy of the fi fth cervical vertebra and anterior spinal reconstruction and fusion with titanium expandable mesh and cervical plate in connection with degenerative narrowing of the cervical spinal canal that lead to clinically manifested myelopathy. The initial experience allows us to conclude that O-arm-based image-guided spinal surgery can lead to considerably higher precision of spinal instrumented procedures. At the same time, it reduces the irradiation dose of the patient and surgical team.

In sudden occurrence of neck pain associated with neurological deficit in the arms spontaneous cervical epidural hematoma should be suspected. Spiral scanner and magnetic resonance are imaging techniques of choice in these patients. The favorable outcome of the disease depends on the prompt diagnosis and emergency removal of the hematoma.

Only a few cases of intramedullary meningiomas in the cervical and thoracic region have been reported in the literature. We present a rare case of intramedullary meningioma in the lower thoracic region. A 68-year-old woman with complaints of back pain, gait disturbance, and paresthesias in both lower extremities for 4 months was admitted to our institution. Initially, she presented with weakness in her legs that gradually deteriorated over time. The patient had been operated on for breast cancer 2 years prior to the onset of current complaints. The neurological examination revealed spastic inferior paraparesis (McCormick grade IV), hypoesthesia below Th10 dermatome, bowel and bladder disturbances. Magnetic resonance imaging of the thoracic spine demonstrated intramedullary tumor that was hypointense on T1 and T2-weighted images but showed homogenous enhancement after gadolinium administration. After gross total resection, the histopathological examination confirmed the diagnosis of atypical intramedullary meningioma. CONCLUSION: The intramedullary meningiomas are extremely rare, but they should not be excluded from the differential diagnosis, especially in cases of intramedullary tumors with homogenous enhancement on magnetic resonance imaging. The best treatment strategy is gross total removal of the tumor.

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Craniocervical fractures are socially important pathology. They represent one-third of the fractures in the cervical region. It is typical that elderly patients suffer from low-energy traumas such as falls, while younger patients suffer from high-energy traumas such as motor vehicle accidents, sport falls and etc. Craniocervical fractures are associated with an increased risk of craniocervical instability or neurological deficit. Primary therapeutic options depend on the type of fracture. Predictors of nonunions are the displacement of fractures, patients’ age, and comorbidities. The observership of the general practitioner in the postoperative period or the period of cervical immobilization could recognize possible malpositioning of the instrumentation, nonunion of the fracture, malsanation of the wound, and possible complications in case of the external immobilization. There is a lack of information on that topic. The goal of the paper is to summarise the most common fractures of the craniocervical region, their etiology, and treatment options and to present the results of our study of patients who underwent operative treatment for craniocervical fracture(s). Mastering the details, the treatment options, and the possible complication of the fractures in the craniocervical region, general practitioners could play an important role in the treatment of patients.

Цель исследования. Представить клиническое течение болезни и результаты хирургического лечения пациентов с эпидуральными абсцессами позвоночника. Материал и методы. Хирургическое лечение в 2015-2016 гг. получили 16 пациентов (7 мужчин и 9 женщин) с клиническими, нейровизуальными и/или гистологическими признаками эпидурального абсцесса позвоночника. Результаты. Средний возраст пациентов 60,200 ± 10,387 года. Период от начала болезни до госпитализации -от 15 до 120 дней. При госпитализации только у 3 (18,75 %) пациентов отсутствовали признаки неврологического дефицита. В ходе лечения 7 (43,75 %) пациентам выполнена интерламинэктомия на одном или нескольких уровнях или гемиламинэктомия. Остальным 9 (56,25 %) пациентам проводили ламинэктомию, пяти из них -с дополнительной задней транспедикулярной фиксацией. У 7 (43,75 %) пациентов после операции снизилась степень нетрудоспособности, у 7 (43,75 %) -оставалась неизменной до выписки из стационара. Умерли 2 (12,50 %) пациента. Заключение. Срочная операция -метод выбора для пациентов с эпидуральным абсцессом позвоночника, который позволяет выполнить декомпрессию нервных структур, коррекцию деформации позвоночника посредством стабилизации, с целью быстрой мобилизации пациентов.