Degeneration of the multifidus muscle of the back after stabilizing operations on the lumbar spine and its impact on rehabilitation measures remains understudied. There are isolated data in publications on the partial effectiveness of minimally invasive surgery, but the problem has not been completely solved, there is no data on the effect of physical therapy and physiotherapy methods on the progress of degeneration of the multifidus muscle of the back. Purpose To study the effect of electroneuromyostimulation and physical therapy in the postoperative period in decompression-stabilizing operations on the progress of adipose degeneration of the multifidus muscle of the back. Materials and methods The parameters of the multifidus muscle of the back were analyzed and determined in 3 groups of patients who underwent operations with stabilizing systems in the lumbar spine: in group I (n = 56), it was recommended to limit physical activity for 2 months after surgery and wear a semi-rigid corset; in group II (n = 41), early rehabilitation was initiated in the form of physical therapy with the continuation of the recommended exercises after discharge, in group III (n = 43), patients after discharge were recommended to limit physical activity, but with the use of electroneuromyostimulation on the paravertebral muscles 2 times a day lasting 15–30 minutes. All patients underwent clinical examination, MRI, MSCT to assess the condition of the multifidus muscle. Results In group II, there was a decrease in the rate of adipose degeneration of the multifidus muscle, but with increase in pain and decrease in life quality compared to group I. Patients of group III had the lowest rate of increase in adipose degeneration with less pain and a higher level of life quality compared to groups II and I. Conclusions A combination of early postoperative stimulation for two months with a subsequent transition to physical therapy is optimal; otherwise exceeding the functional threshold may cause disruption of adaptation systems.
Removal of large and giant vestibular schwannomas is associated with the risk of paresis of facial muscles. The probability of anatomical damage to the facial nerve is 10.3–14.0%. Treatment of mimic muscle paralysis is one of the most difficult problems in reconstructive surgery. In this study, the results of neurotization of the facial nerve by masticatory were evaluated in 4 patients after its damage during the removal of large and giant vestibular schwannomas. Neurotization was carried out 10–14 days after tumor removal. With direct neurotization of the facial nerve by masticatory in all patients, it was possible to achieve the function of mimic muscles, corresponding to grade II–III according to the House–Brackmann scale. The use of an autoinsert from the greater ear nerve led to a worse result (House–Brackmann IV).
Introduction. Central nervous system is one of the main targets in patients with HIV infection. Neurological complications in AIDS are primarily caused by opportunistic brain infections including toxoplasmosis as the most common one. Patients with cerebral toxoplasmosis are often hospitalized with diagnosed strokes, tumors, or encephalitis. At that, their HIV status may be unknown and their state severity often does not allow conducting the range of required examinations. Materials and methods. We have described our experience in management of 6 patients admitted to the neurosurgery department with single toxoplasmosis foci and diagnosed brain tumors. Results. HIV infection was initially known in 3 patients only. In 2 compensated patients, the diagnosis was confirmed via Toxoplasma IgG blood test. In 2 individuals, negative serological Toxoplasma reactions were followed by neuronavigationally controlled biopsies. A patient with an extensive perifocal edema and, as a result, dislocated midline structures underwent decompressive craniectomy and mass removal. One female patient, with an unclear diagnosis, was operated for a suspected brain tumor. After additional assessments (including 4 histologies to confirm cerebral toxoplasmosis), all the patients were transferred to the infectious disease hospital for specific treatment.
Objective. To analyze the results of microdiscectomy with preservation of the ligamentum flavum. Material and Methods. One hundred and fifty two patients underwent microdiscectomy with preservation of the ligamentum flavum. The ligamentum flavum was exposed and cut in an apron-like shape, after disk hernia total removal an «apron» of the ligamentum flavum was placed in the interarticular space. Results. Radicular pain syndrome was completely arrested in 73.7 % of patients, significant decrease in radicular pain was observed in 22.4 %, and 3.9 % of patients had no any dynamics of radicular pain syndrome. A complete regression of motor and sensitive disturbances was observed in 31.6 % of patients, incomplete recovery – in 53.3 %, and absence of any neurological dynamics – in 15.1 %. Most of patients (76.1 %) returned to their work in 3 months. Conclusion. Microdiscectomy with preservation of the ligamentum flavum is a new perspective method, which helps to minimize a surgical trauma and to improve outcomes in patients with hernia of a lumbar intervertebral disc. Preservation of the ligamentum flavum together with other epidural anatomic structures, such as epidural fat tissue and venous plexuses, is important for preventing epidural fibrosis that may cause a failed back surgery syndrome.
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