We review the current approaches and their feasibility to treat dystonic anterocollis by injecting longus colli muscle (LCo) with botulinum neurotoxin (BoNT) as well as present our personal experiences in this field compared with the findings from previously published studies. First, we searched the PubMed database for the publications reporting patients who received LCo injections for anterocollis; we also thoroughly examined the references included in each of the found publications. Second, we present and analyze our own experiences in injecting LCo under EMG guidance in patients with dystonic anterocollis due to heredodegenerative disorders. We found 11 publications describing administration of LCo injections for the treatment of dystonic anterocollis in a total of 28 patients with primary dystonia aged between 21 and 80 years. The mean age of our patients was 44.8 years with the mean anterocollis duration being 15 months. OnabotulinumtoxinA in a dose of up to 35 U per LCo muscle was not associated with the development of transient dysphagia. The mean percentage of patient satisfaction was 36.3%, and the mean duration of the beneficial effect was 2.5 months. All patients agreed to receive a repeat injection. We provide a set of empirically based suggestions on the current use of BoNT injections to LCo for managing anterocollis in outpatient clinics, including pretreatment work-up, injection technique, and dose range.

Классическая шейная спондилогенная миело-патия (нижний спастический парапарез, вялый па-рез верхних конечностей, чувствительные расстрой-ства проводникового типа) встречается довольно редко. Как правило, больные, обращающиеся за по-мощью, имеют один или несколько симптомов: Цель исследования -провести анализ результатов хирургического лечения пациентов с шейной миелопатией методом ламинопластики. Материал и методы. Проанализирован опыт хирургического лечения 30 больных (средний возраст 59,4 года) с шейным стенозом, осложненным миелопатией. Ламинопластика по Hirabayashi выполнена 26 больным, методом Kurokawa -4 больным. У всех пациентов был диагностирован протяженный стеноз позвоночного канала на уровне шей-ного отдела. Диагноз устанавливался на основании результатов обследования: динамического клинико-неврологического осмотра, рентгенографии, компьютерной томографии, магнитно-резонансной томографии, соматосенсорных вызван-ных потенциалов, транскраниальной магнитной стимуляции. Для оценки выраженности миелопатии использовались Nurick scale, шкала Японской ортопедической ассоциации (JOA) и шкала расчета восстановления (Recovery rate). Резуль-таты. Оценены отдаленные результаты клинического статуса, рентгенологических и нейровизуализационных показателей у пациентов с шейной миелопатией после ламинопластики. Выводы. Ламинопластика является методом выбора в лечении протяженного спондилогенного шейного стеноза. Правильный подбор пациентов, с учетом клинических проявлений, оценки протяженности стеноза, данных неврологического осмотра и нейровизуализации позволяет добиться отличных результатов.Ключевые слова: шейная миелопатия, ламинопластика, стеноз шейного отдела позвоночника. Surgical treatment of severe spondylogenic cervical myelopathy by laminoplasty M.D. DREVAL', A.O. GUSHCHA, S.O. ARESTOV, O.S. KOREPINA Scientific Center of Neurology, Moscow, RussiaObjective. The objective of this study is to analyze the results of surgical treatment of patients with cervical myelopathy by laminoplasty. Material and methods. The experience of surgical treatment of 30 patients (mean age 59.4) with cervical stenosis complicated with myelopathy was analyzed. Hirabayashi laminoplasty was performed in 26 patients and Kurokawa laminoplasty was performed in 4 patients. All patients were diagnosed with extended cervical spinal stenosis. Diagnosis was based on the survey results, including the dynamic clinical and neurological examination, x-ray study, CT, MRI, SSEP, and TMS. Nurick scale, the scale of the Japanese Orthopaedic Association (JOA), and the recovery rate scale were used to assess the severity of myelopathy. Results. The long-term outcome of the clinical status, radiographic and neuroimaging parameters in patients with cervical myelopathy who underwent laminoplasty was evaluated. Conclusion. Laminoplasty is the method of choice in the treatment of extended spondylogenic cervical stenosis. Proper selection of patients based on clinical symptoms, assessment of the extent of stenosis, neurological examination and neuroimaging da...

Objective: Degenerative diseases of the spine are the most common disorder seen in the practice of the neurosurgeon. According to many surgeons, microdiscectomy is the “gold standard” of surgical treatment. Analyzing the current literature, it is seen that the use of endoscopic techniques in spinal surgery is increasing. However, due to the lack of detailed information on the advantages and disadvantages of these methods, there is a need for continuing research in this area. Work to clarify the features of these methods, their specificity and algorithmization will increase the effectiveness of surgical treatment. Methods: This study included patients with herniated lumbar intervertebral discs, the presence of pain in the leg, and failed of conservative therapy. In the period 2014 to 2017, 172 endoscopic lumbar discectomies were performed, using microendoscopic discectomy and percutaneous endoscopic lumbar discectomy. The effectiveness of each technique was evaluated through comparative analysis. Results: In both groups, the methods used obtained high efficacy rates. Comparative analysis showed the advantages of the percutaneous technique in terms of shortening the return to normal activity time, hospitalization time, and disability, and reducing back pain in the early postoperative period. On the other hand, the microendoscopic discectomy enabled greater radicality to be achieved in cases with herniated disc ossification and complex anatomy of the vertebral segment. Conclusions: Analysis of the data obtained led to the formulation of an algorithm for selecting the optimum endoscopic method for achieving positive results of surgical treatment. Level of Evidence II; Therapeutic studies, investigating the results of treatment.

Ц Це ел ль ь и ис сс сл ле ед до ов ва ан ни ия я.. Анализ результатов микрохирургической и эндоскопической дискэктомий и оценка возможностей малоинвазивных эндоскопических операций при различных вариантах грыж межпозвонковых дисков поясничного отдела позвоночника. М Ма ат те ер ри иа ал л и и м ме ет то од ды ы.. Микрохирургическая дискэктомия проведена у 37 пациентов (средний возраст 43,4 ± 1,9 года), эндоскопическая дискэктомия по Ж. Дестандоу 31 пациента (средний возраст 38,7 ± 1,7 года). Все пациенты были с грыжами межпозвонковых дисков пояснично-крестцового отдела позвоночника. Диагноз ставился на основе результатов, полученных при комплексном обследовании, включающем динамический клинико-неврологический осмотр, рентгенографию, КТ, МРТ и электромиографию. Для оценки выраженности и динамики корешкового болевого синдрома использовалась Шкала болевого аудита, оценка и динамика качества жизни пациента производились по Европейскому опроснику качества жизни. Р Ре ез зу ул ль ьт та ат ты ы.. Регресс клинических симптомов заболевания в обеих группах не различался. Качество жизни пациентов, оперированных микрохирургическим методом, после операции было существенно ниже, чем у пациентов, оперированных эндоскопически. Сроки активизации и временной нетрудоспособности пациентов, оперированных эндоскопическим методом, существенно короче, чем у пациентов, оперированных микрохирургически. З За ак кл лю юч че ен ни ие е.. Эндоскопическая дискэктомия, обладая рядом преимуществ, является методом выбора при лечении грыж межпозвонковых дисков пояснично-крестцового отдела позвоночника, не уступающим по эффективности микрохирургической дискэктомии. К Кл лю юч че ев вы ые е с сл ло ов ва а: : грыжа межпозвонкового диска, эндоскопическая микродискэктомия, эндоскопическая дискэктомия, пояснично-крестцовый отдел позвоночника.

No abstract

No abstract

Objective.To study the efficacy of differentiated surgical treatment for primary spinal neoplasms based on estimation of clinical condition of a patient, survival rate, and early postoperative complications. Material and Methods. Surgery was performed in 55 out of 68 patients with primary spinal tumors involved in the study. The primary examination included CT and MRI study of the affected area of the spine. In some cases, a biopsy was performed. Results. According to histological structure, spinal tumors were identified as aggressive hemangioma, chondrosarcoma, aneuyrismal bone cyst, plasmocytoma, chordoma, giant-cell tumor, or eosinophilic granuloma. Neurological status was characterized by local pain in 18 (38 %), and by pain combined with nerve conduction disorders in 20 (40 %) patients. In accordance with the spine instability neoplastic score (SINS), most patients had stable destructions of vertebra. Evaluation of neurological status did not reveal severe deficiency: 65 % of patients had grade D or E on Frankel scale. Conclusion. Patients with tumors of the spine require careful choice of a multidisciplinary treatment. Increasing the life expectancy of patients with malignant tumors and improving the quality of life in patients with tumors of different histological structure are decisive factors in the choice of tactics and dictate the variability of approaches to treatment.Please cite this paper as: Gushcha AO, Konovalov NA, Arestov SO, Kashcheev AA, Dreval MD. Surgical treatment of primary spinal tumors: tactics and results. Hir.

Objetive: Thecaloscopy is a less invasive method of exploration of the spinal subarachnoid space, using an ultra-thin, flexible endoscope and endoscopic fenestration of scars and adhesions. Thecalopscopy was used in Russian neurosurgery for the first time. Methods: Since 2009, we have operated on 32 patients with the following diagnoses: 17 - spinal adhesive arachnoiditis (8 - local forms, 9 - diffuse forms), 12 - spinal arachnoid cysts (7 - post-traumatic cysts, 5 - idiopathic cysts), and 3 - extramedullary tumors (thecaloscopic videoassistance and biopsy). In all cases, we performed exploration of subarachnoid space and pathologic lesion with endoscopic perforation of the cyst or dissection of adhesions using special instrumentation. The mean follow-up time in our group was 11.4 months. Results: Neurological improvement (mean 1.4 by the modified Frankel scale, 1.8 by the Ashworth spasticity scale) was seen in 87% of patients operated for spinal arachnopathies. Temporary neurological deterioration (mild disturbances of deep sensitivity) was seen in 9% of patients and managed successfully with conservative treatment. One patient (3.1%) was operated three times due to relapse of adhesions. There were no serious intraoperative complications (e.g. severe bleeding or dura perforation). Postoperative complications included one CSF leakage and one case of postoperative neuralgic pain. The mean hospitalization time was 7.6 days. Conclusion: According to our data, we conclude that thecaloscopy is efficient and safe method, and should be widely used for spinal arachnopathies, adhesive arachnoiditis and arachnoid cysts. Taking into account that adhesive spinal arachnoiditis is a systemic process, and that spinal arachnoid cysts may also be extended, thecaloscopy may be regarded as the most radical and less-invasive form of surgical treatment that currently exists in neurosurgery.