<p><strong>Aim.</strong> (1) To evaluate the efficiency of endovascular embolization of brain arteriovenous malformations (AVMs) with seizure or hemorrhage in relation to radicalness and postoperative complication development and (2) to determine the predictors of postoperative complications after endovascular embolization of AVMs.</p><p><strong>Methods.</strong> In this retrospective study, we examined the treatment of 192 patients with brain AVMs with seizure (seizure group; n = 85) or hemorrhage (hemorrhage group; n = 107). All the patients underwent total endovascular embolization of the malformations, and the follow-up period was 12 months. The two different patient groups were identified, and the predictors of the development of adverse events (hemorrhagic and ischemic complications) in the early postoperative period (hospital stay) were determined.</p><p><strong>Results.</strong> Twelve months after control cerebral angiography was performed, recanalization was observed in 7 (8.2%) and 14 (13.1%) patients in the seizure and hemorrhage groups, respectively (p = 0.432). The frequency of complications was 20% and 29.9% in the seizure and hemorrhage groups, respectively (p = 0.162). The mortality rate during hospitalization was 0% and 9.3% in the seizure and hemorrhage groups, respectively (p = 0.026). Multivariate regression analysis revealed that a history of hemorrhage, the location of AVMs in functionally significant zones, and a large maximum size of AVMs are predictors of the development of postoperative complications.</p><p><strong>Conclusion.</strong> Endovascular embolization is an effective, minimally invasive approach for the treatment of different types of brain AVMs. Considering the natural risks of brain AVMs according to the literature, endovascular embolization is associated with a low frequency of early postoperative complications.</p><p>Received 14 February 2019. Revised 24 May 2019. Accepted 28 May 2019.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p>

Objective. Comparative assessment of decompression and decompression-stabilization techniques for degenerative diseases of the lumbar spine in elderly and senile patients. Material and Methods. A total of 106 patients at the age of 60 to 83 years (mean age 65.7 years) operated on for degenerative disease of the lumbar spine were included in the prospective study. The outcomes were evaluated in 3–4 and 12–24 months. A dynamics of neurologic state, intensity of pain according to VAS, and functional activity according to Oswestry scores were evaluated. Results. Good results were achieved in 70 % of cases after decompression – stabilization surgery, as compared to 46 % after decompression only. There were 26 % of unsatisfactory results of treatment after decompression, and 5 % – after decompression and stabilization. Surgical complications were typical for these kinds of surgical interventions. There were no infectious and systemic complications as well as metal implant induced complications such as its destruction, migration or subsidence, and bone resorption around implant. Conclusion. Decompression and stabilization surgery is the most reasonable and effective technique for treatment of lumbar degenerative diseases in elderly and senile patients. Preference should be given to posterior approach surgery concluded by stabilization of operated vertebral segments.

Objectives. To estimate efficiency, safety and traumatizing impact of endoscopic discectomy in comparison with traditional microsurgical discectomy. Material and methods. A total of 330 patients underwent Destandau endoscopic discectomy and 964 – open microsurgical discectomy. The operative times, terms of patient postoperative bed and hospital stays, postoperative dynamics of neurologic deficiency, surgical complications and frequency of herniation recurrences were estimated in both groups. Pain intensity was assessed with the 10-score Visual Analog Scale (VAS), and functional activity – with the Oswestry Disability Index (ODI). Results of surgical treatment were estimated in 8–10 days, 6 and 12 months after operation. Results. VAS and ODI data have not revealed essential distinctions in pain regression dynamics after endoscopic and open surgeries. Surgical complications after endoscopic intervention were not more often, than after microsurgical discectomy. Damage of dura mater occurred in 2.4 % of cases, and increase in neurologic deficiency (hypoesthesia) – in 0.6 %. Herniation recurrences have evolved in 3.0 % of cases after endoscopic discectomy and in 4.7 % – after open microsurgical one. Conclusion. Destandau endoscopic surgery is a low invasive method of effective treatment for lumbar disc herniations, which by its technical opportunities and results is competitive with classical open microsurgical discectomy.

The presented review of scientific publications from the Medline (PubMed) and Scopus databases considers modern surgical approaches used to remove intervertebral hernias in the thoracic spine. The advantages and disadvantages of anterior and posterior approaches are analyzed. It has been revealed that the anterior approaches, providing a good opportunity to remove a hernia, are associated with the risk of serious complications, including pulmonary ones, and often lead to the formation of a post-thoracotomy pain syndrome. Mini-thoracotomy and percutaneous thoracoscopy, although less invasive, do not exclude the development of complications inherent in conventional thoracotomy. Modern posterior approaches are less traumatic and allow, with minimal contact with the spinal cord, to successfully remove not only soft tissue, but also ossified disc herniation. The choice of the optimal method of discectomy remains an unsolved problem and depends on practical skills, experience and preferences of the surgeon. For an objective and reliable assessment of the efficiency of surgical technologies and the determination of optimal indications for each of them, a prospective multicenter study is necessary.

The paper presents a descriptive kinematic radiographic study of changes in a shape, orientation and function of the lumbar spine in the sagittal plane due to various surgical interventions for lumbar degenerative disease. Literature analysis evidences for only few studies of spine shape and static interrelations in a spinal motion segment after surgical treatment. Any complex assessments of changes in a spine shape in the sagittal plane, its spatial orientation and function after surgical intervention has not been performed. The study includes a comparative kinematic computer analysis of pre- and postoperative radiographs of the lumber spine of 157 patients, including 62 patients after decompression, 50 after posterior interbody fusion, and 45 after dynamic transpedicular fixation. It was found that the overall range of motion has reduced during three years after any kind of surgical intervention; that surgery at the L5–S1 level takes the most significant biomechanical effect; and that decompressing and stabilizing procedures at the L5–S1 level facilitate a lumbar lordosis restoration. The L5–S1 interbody fusion results in interbody space increase and segmental angle decrease at the surgery level. The L4–L5 interbody fusion increases the range of motion in a subjacent motion segment; dynamic transpedicular fixation takes a minimal effect on a lumbar spine shape and vertebral interrelations and allows preserving the physiological mobility of all motion segments.