Lower back pain (LBP) is a common complaint of a significant number of the athletes. Both young and elite athletes consult the doctors with complaints about LBP. One of the main causes of LBP is diskal hernia or spondylolysis. The main methods of the treatment of this disease are: spondylosis and surrogation of the lumbar disc. In the medical reports there are positive clinical results using both methods. However, the scientific disputes continue over the comparative evaluation of the effectiveness of the methods of spondylolysis and surrogation of the lumbar disc. The authors analyzed the results of the surgical treatment of the 18 professional athletes. In the period from 2012 to 2013 an operation was performed to these athletes to replace the degenerative intervertebral disk disease at the level of L5-S1. A total resection of the intervertebral disc at the level of the lumbar spine with decompression of the dural sac and the subsequent installation of the functional endoprosthesis-M6-L Artificial Lumbar Disc was performed to the first group of athletes (n = 10). The transforaminal lumbar interbody fusion (TLIF) and transpedicular screws after removing the diskal hernia L5-S1 was performed to the second group of athletes (n = 8). The best clinical result was achieved in the first group of the athletes. Only 8 out of 10 athletes with surrogation of the lumbar disc were able to return to their previous level of sporting achievements for two years after the operation. X-ray results showed the safety of endoprosthesis functions throughout the study period. The six athletes from the second group completed their sports career within 2 years after the spondylolysis. The cause was the increase in degenerative processes at the adjacent spine level and an increase in LBP.

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.

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.

Among all adverse perioperative events, medical error is one of the most serious, associated with possible complications for the patient, severe psychological trauma for the surgeon, and often with the involvement of the Investigative Committee in assessing the results of treatment. At the same time, among the researchers of this issue there is still no consensus on what exactly is meant by «medical error». In modern legal scientific publications, they often call for abandoning this term and using the concept of «negligence» for lawyers. It is all the more important in the professional community to define the concept of «medical error» and distinguish it from other undesirable events associated with the treatment of the patient. This review presents different approaches to the definition of the concepts of «medical error» and «surgical error», what is their main difference from iatrogenic, medical negligence, complications of surgery. Some classifications of errors in surgery are presented. The most common factors of surgical errors are identified, such as lack of competence and experience of the doctor, impaired interaction and communication of staff, excessive workload and fatigue, emergency operations, unusual patient anatomy, lack of necessary equipment and instruments. Using the example of neurosurgical practice, such errors as performing a craniotomy on the wrong side, surgery on the spine at the wrong level, leaving foreign bodies in the wound, and others are considered. In conclusion, the main measures for the prevention of errors in surgery in general and in neurosurgery in particular are described.

The article presents an overview of modern scientific publications on echinococcosis and alveococcosis of the brain, which occur in 1–4 % of cases among all volumetric formations of the central nervous system. Despite the fact that these parasitic diseases are more common in endemic areas of developing countries in Asia, South America, Australia and New Zealand, isolated clinical cases are observed everywhere, including due to population migration, and they must bedifferentiated, first of all, from intracerebral cysts, abscesses, cystic tumors. Clinical manifestations of echinococcosis and alveococcosis of the brain include the development of hypertensive symptoms, focal neurological deficit, convulsive syndrome (with cortical localization of cysts). The article presents the modern possibilities of diagnostic methods (among which the main role is played by neuroimaging methods, such as multislice computed tomography and magnetic resonance imaging using contrast/paramagnet), and surgical and medical treatment of patients with echinococcosis and alveococcosis of the brain. The article also describes two own clinical observations of patients who were hospitalized in the neurosurgical department of the Regional Clinical Hospital (Krasnoyarsk).