Среди всех нарушений мозгового кровообращения ишемический инсульт в вертебробазилярном сосудистом бассейне составляет 25-30 % случаев, а преходящие нарушения мозгового кровообращения-70 % [2, 3, 5, 11, 13], в половине случаев они предшествуют ишемическим инсультам, рассматриваются как предынсультные состояния.

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Objective. To assess feasibility of the proposed anterior decompression and stabilization surgery without meningoradiculolysis for recurrent herniation of the lumbar intervertebral disc. Material andMethods. Prospective randomized controlled study involved comparative evaluation of two essentially different surgical interventions performed in 130 patients with recurrent disc herniation during 2005-2012. The control group included 62 patients who underwent posterior decompression and stabilization surgery with meningoradiculolysis for the removal of herniated disc. The study group included 68 patients who underwent the proposed anterior decompression and stabilization surgery, which differs by an obligate opening of the spinal canal and intervertebral foramen to remove the disc herniation through an anterior approach without meningoradiculolysis. Results. Immediate results of anterior and posterior decompression and stabilization operations are comparable, though posterior interventions are more frequently associated with iatrogenic injury to posterior nerve roots caused by intervertebral implant insertion and meningoradiculolysis required before the disc herniation removal. Long-term outcomes of anterior operations are reliably better. Conclusion. Anterior decompression and stabilization operationsfor recurrent disc herniation compare favorably to posterior ones, since they are less traumatizing to the nerve roots and prevent herniation recurrence and epidural fibrosis progression.

To study the possibility of application of anterior decompressive and stabilizing operations in patients with complicated thoracic and thoracolumbar spine and spinal cord injury without prior posterior intervention. Material and Methods. Anterior decompressive and stabilizing operations in the thoracic and thoracolumbar spine were performed in 82 patients. Transpleural approach was used in 26 patients, transpleural transdiaphragmatic-in 46, and retroperitoneal subdiaphragmatic approach-in 10 patients. Decompression of the spinal cord was accomplished by means of subtotal resection of damaged vertebral bodies. The defect after removal of the fractured vertebral body was filled with a porous NiTi implant in 41 cases, with reinforced NiTi implant in 27 patients, and with the unique expandable NiTi implant-in 14 patients. The Vantage fixation plate added in all cases allowed manipulation of vertebrae along all axes in all directions. Results. A good regression of neurological symptoms was obtained in 28.0 % of patients, and satisfactory-in 48.9 %. Neurological deficit remained unchanged in 23.0 % of operated patients. No technique-related complications were registered. Reinforcement of porous implant with titanium rod significantly increased the interbody fusion solidity. Conclusion. Anterior decompressive and stabilizing surgery for thoracic and thoracolumbar spine and spinal cord injury provides complete decompression of the spinal cord, one-stage reduction, reclination of the spine and correction of its axis, and complete interbody fusion with porous titanium-nickel implants in combination with the Vantage fixation plate.

To analyze clinical variants of lumbar spondylolisthesis and differentiated choice of anterior stabilization and decompression-stabilization surgeries. Material and Methods. Anterior stabilization and decompression-stabilization surgeries were performed in 142 patients with lumbar spondylolisthesis. In 44 patients the clinical neurological and instrumental examinations were supplemented by preoperative diagnostic puncture to reproduce reflex pain syndromes and their elimination. Results. Clinical presentation of lumbar spondylolisthesis includes not only segmentary instability, but also reflex pain and/or compression syndromes. The method of anterior decompression of spinal nerve roots compressed by concomitant disc hernias or by posterior-upper edge of subjacent vertebral body was developed and successfully used. Conclusion. Anterolateral retroperitoneal approach provides optimum conditions not only for vertebra reposition and solid interbody fusion with porous TiNi implant, but also for decompression of a compressed nerve root. The choice of surgical approach should depend on clinical variant of the disease.