Objective. The assessment of porous NiTi interbody implants use in various decompressive and stabilizing operations for lumbar spine degenerative diseases.

Material and methods. Porous NiTi interbody implants were used in 459 patients operated on for lumbar spine degenerative disease. Various types of stabilizing and decompressivestabilizing surgical procedures were performed in all cases. Operations were performed through anterior extraperitoneal or posterior approaches, and endoscopically through abdominal approach. Surgical treatment results were studied at 3- to 24-months follow-up. Pain syndrome dynamics was evaluated for by Visual Analog Scale, Oswestry Disability Index score. X-ray, MRI, and CT findings provided the evidence of interbody block formation after spondylodesis. Radiologic observation included the measurement of interbody height and of segmental angular flexion-extension difference (the range of segmental angulation in flexion-extension).

Results. Functional results in 18-20 months after surgery were good or satisfactory in 94.1 % of cases. Radiological observation has shown no one case of interbody implant fracture and migration into vertebral bodies. Implant migration within interbody space was observed in 4 cases (0.9 %). Radiological and CT observation confirmed the bone integration properties of the NiTi: the bone tissue accretion at implant was noted with a consecutive formation of interbody bone-metal block. In 94.8 % of cases the operated spine segments were stable that is in agreement with literature data on the effective application of other interbody implants.

Conclusion. Porous NiTi implants can be successfully used for interbody fusion of different kinds. Nickel titanium provides a formation of interbody bone-metal block without autologous bone application that makes a surgery more simple and less traumatic.

Forty-two patients with lumbar spondylolisthesis and radicular pain underwent surgery after failure of conservative treatment for 6 months. Operative treatment included microdiscectomy, posterior interbody fusion with cages and transpedicular fixation. Results were assessed functionally and radiographically. The follow-up was an average of 20 months (range, 12 to 36 months). Good results were achieved in 38 patients (90.4 %).

Current concept review on treatment of dysplastic spondylolisthesis is based on the consecutive available literature mainly published during last 15 years. The authors used Ukrainian, Russian and foreign periodicals, books and MEDLINE potentials for analysis of contemporary trends in management of this pathology.

All 123 examined patients admitted to the Neurosurgical Clinic for cervical intervertebral disc herniation had a combination of compressive and noncompressive (reflex) syndromes. Reflex syndromes were caused by pathologic impulses originated from both herniated and nonherniated discs. Disc puncture, as a treatment-and-diagnostic procedure, followed by denervation of clinically significant intervertebral discs, was performed in order to identify the correlation between reflex syndrome and pathologic disc and to arrest this syndrome. In 60 patients who received complex treatment, i.e. disc denervation followed by surgical intervention, the results were found to be clinically better than those in 63 control patients who underwent surgical treatment without preliminary pain provocation and elimination of concomitant reflex syndromes by disc denervation.

Basing on the experience in surgical treatment of lumbar osteochondrosis the variants of surgical tactics for various manifestations of this pathology, including degenerative scoliosis and spondylolisthesis, are presented. The purpose of the study was the determination of the role and indications for application of transpedicular metal fixatives at surgical treatment of lumbar osteochondrosis. Microcirculation in neural structures has been studied before and after hernia removal; the improvement in circulation after discectomy was noted. The material is presented by 82 patients in whom due to various indications transpedicular fixatives were used and if required the interbody spinal fusion was performed. The follow-up period was from 6 months to 6 years. The results of treatment are presented, and the complications that we have observed in our practice are analyzed. Such complications included radicular disorders and disturbance of spinal circulation in the early postoperative period.

Objectives. Assessment of the effectiveness of decompression laminoplasty with porous nickel titanium for degenerative stenosis of the cervical and lumbar spinal canal.

Materials and methods. Spine specimens after laminectomy (control group), and after laminoplasty with autobone, with porous NiTi and with porous NiTi combined with autobone (experimental groups) were examined. Radiographic, X-ray contrast and microscopic examinations were performed in 3, 6 and 12 months. Decompression laminoplasty with porous NiTi in the cervical and lumbar spine was performed in 54 patients with degeneative stenosis of the cervical and lumbar spinal canal. The neurologic status dynamics, Osvestry score, and pain intensity according to visual-analogue scale were determined, radiography and myelography were performed after surgery alongside with kinematic analysis of the spine shape and orientation in the sagittal plane.

Results. Experimentally it was revealed that plate of porous nickel titanium delimited dura mater from paravertebral soft tissues and autobone. Clinical results of a 4-year-follow up were studied. Pain syndrome regress and positive neurologic dynamics were registered in all patients. The comparisons of the dural sac contour before and after surgery revealed its postoperative enlargement. The correlation of biomechanical characteristics of the spine shape and orientation in a sagittal plane with clinical signs of spinal canal stenosis was revealed. Correction of the spine shape and orientation without development of segmental instability is registered in a postoperative period.

The problem of a chronic pain in the cervical spine is actual and not decided completely. This paper reports the experience of treatment of 37 patients with diskosis and spondylarthrosis in the cervical spine segments by radio-frequency denervation facets and intervertebral disсs. The given method appeared effective and safe. It can be regarded as an adequate addition to the complex conservative therapy, allowing to improve the efficiency of treatment.

The tactics of surgery in patients previously operated on the lumbar spine is presented in the article. The causes of failure after primary intervention, the outcomes of revision surgeries and factors affecting their results are indicated. 106 revision surgeries in patients with spine degenerative diseases have been performed. Good results were achieved in 75 patients (71.0 %), satisfactory - in 27 (25.2 %), and unsatisfactory - in 4 patients (3.8 %). In 96 cases mini-ALIF was applied, in 7 cases - circumferential spinal fusion and in 3 cases - posterior decompression and transpedicular fixation. The author considers that positive result in patients without evident epidural fibrosis can be achieved by radical surgery with application of low invasive techniques.

Results of vertebroplasty in 20 patients with various vertebral tumors are analyzed. The technique of percutaneous vertebroplasty is demonstrated. High efficiency of this minimally invasive method is shown for vertebral hemangioma and reinforcement of the anterior spine column. Vertebroplasty can also be used for treatment of multiple vertebral tumors, for example vertebral metastases, myeloma etc.

The purpose of the study was to define and compare the prevalence of depressive frustration among random sample of the adult population complaining of long term low back pain (LBP), and the patients who have been admitted for treatment in a specialized neurologic clinic. Tests are used for definition of a degree of depression and intensity of painful sensation. Three groups of the respondents consisting of the general population older than 18 years (1061 person), patients with complaints of LBP who underwent out-patient treatment or did not (432 person), and patients with neurologic complications of a lumbar osteochondrosis admitted to hospital (207 person) were questioned. Comparative study of the received data revealed that prevalence of a chronic LBP among adult population has made 40.7 %.Prevalence of depressive frustration among the general population was 44.0 %, among those with complaints on long or constant LBP who underwent out-patient treatment or did not - 55.8 % and among those admitted to specialized clinic - 72.0 %. A degree of depression in general population correlated with sex and age and in persons with complaints on LBP - with sex and intensity of pain. In patients admitted to hospital, the degree of depression was not connected to demographic factors, duration of a pain syndrome, term of invalidity, and to a lesser degree than in outpatients it was connected to intensity of pain. It is supposed, that depression is conditioned both by behavioral factors, which are more expressed in outpatients, and the common pathogenetic mechanisms of depression and chronic pain.

Objective. To assess the influence of psychological factors on results of surgical treatment for pain syndrome at lumbar degenerative disease.

Materials and Methods. A prospective study of psychological status influence on patients' subjective perception of surgery results for vertebrogenic pain syndrome was performed. In total 106 patients operated on for lumbar spine degenerative disease were examined. Out of them 58 patients were men, 48 - women, the age was from 23 to 62 years (44.6 ± 5.2 years). The pain syndrome intensity dynamics was evaluated by Visual Analog Scale, Oswestry Index score, and psychological status of patients was studied including the anxiety and depression level, the attitude to disease, and the quality of life.

Results. The performed study revealed the influence of psychological factors on results of surgical treatment for vertebrogenic pain syndromes. In patients with a high preoperative level of anxiety and depression the regression of pain syndrome was less expressed, and postoperative score of life quality were lower than in patients with a normal emotional background.

Conclusion. A high level of preoperative anxiety and depression should be considered as a psychological factor negatively affecting the results of pain syndrome treatment. Anxiety and depressive changes are determined mainly by personality and less by situational responses.

Literature review is dedicated to an important problem - treatment of neurological manifestation of vertebral osteochondrosis by minimal invasive method, i.e. endoscopic nucleotomy. Consistent stages of method transformation from intervertebral disc puncture to complete decompression under endoscopic control have been followed. Indications and contra-indications, complications and results of treatment are analyzed in detail. Potentialities inherent in various techniques of visual intraoperation control (CT, MRI, fluoroscopy) are discussed. The reported information convincingly proves great potential of endoscopic nucleotomy.

The review of state of the art of surgical treatment of lumbar intervertebral hernias with videoendoscopic technique is presented. Advantages and lacks of surgical techniques for lumbosacral osteochondrosis have been analyzed. The basic attention is paid to microsurgical removal of intervertebral hernias under video monitoring. It has been pointed out that this method is little traumatic, rather safe and effective, resulting in a quick rehabilitation of the patients.

A retrospective analysis of 180 cases of general anaesthesia in elderly and senile patients operated on for spine degenerative disease was performed. A technique of total intravenous anaesthesia on the basis of dormicum and clophelin was suggested, and intraoperative and early postoperative clinical course was studied. It was established that this kind of anaesthetic management minimally affects a hemodynamics and reduces manifestations of an operational stress. The high controllability of the technique facilitates the patient rehabilitation.

Objectives. Pedicle screws were machined from five different materials used in orthopaedic surgery. The bone tissue reaction to these materials implanted as unloaded pedicle screws was investigated mechanically and histologically.

Methods. Ten pedicle screws of the same material were implanted per sheep in the lumbar region from L1 to L5. The bone tissue reaction to Ti alloy, c.p.Ti grade 1 and 4, 316L stainless steel and Vitallium fixation (unloaded pedicle screws) was evaluated mechanically and histologically.

Results. Ti alloy, c.p.Ti grade 4 and 316L stainless steel screws showed significant pull-out strength as compared to Vitallium and c.p. Ti grade 1 screws (p < 0.005). Histological analysis revealed direct bone contact to c.p. Ti and Ti alloy screws and the formation of new compact bone around the implant within the cancellous bone. The 316L stainless steel histological sections displayed few areas with direct bone contact, whereas Vitallium sections showed bone resorption all around the implants.

Conclusions. The five materials (screws) showed great pull-out forces but better osteointegration was observed with c.p.Ti and Ti alloy screws compared with Vitallium and 316L screws. Even if the 316L stainless steel material showed high pull-out strength, histologically its osteointegration was not as relevant as titanium material. Therefore, 316L stainless steel is more susceptible to the loosening than titanium.

Morphological and ultrastructural investigations have shown that cultivated cells from the embryonic spine at the stage of chondrogenic differentiation preserve their phenotype during cultivation. The chondroblasts at various differentiation stages (junior, young, and mature) ensure both reparative regeneration and homeostasis of an injured cartilage matrix at the expense of the synthesis of proteoglycans and collagen. The data obtained are the basis for use of primary chondroblast culture in cell engineering for treatment of spine injuries and diseases.

The author reports a case of successfully performed surgery for spine osteochondrosis and posterior-median hernia of the lumbar disc in a patient with severe haemophilia A.