BackgroundCurrently, there is no consensus about how to reduce the intraoperative risk of hemorrhage in spinal decompression surgery of hypervascular spinal tumors, such as aggressive hemangioma, multiple myeloma, plasmacytoma, metastasis of renal cell carcinoma.MethodsA retrospective study of 110 patients, operated in our institute was held in the period between 2003 and 2013. There were 69 male and 41 female patients with extradural hypervascular spinal tumor. The study included 61 patients with metastasis of renal cell carcinoma, 27 with multiple myeloma, 15 with plasmacytoma and 7 with aggressive hemangioma.The first group included 57 patients who underwent preoperative tumor embolization. The second group consisted of 53 patients, which were treated surgically using intraoperative local hemostatic agents. We performed 2 types of treatment options: palliative decompression and total spondylectomy. The first group was divided into two subgroups: 30 patients with palliative decompression (1PD) and 27 with total spondylectomy (1TS). In the second group there were: 28 patients with palliative decompression (2PD) and 25 with total spondylectomy (2TS). The parameters under evaluation were the blood loss volume, drainage loss, operation time, hemoglobin level, possible complications and time of hospital stay.ResultsThe average intraoperative blood loss for all embolized patients was slightly less than in subgroups with local hemostatic agents. No significant difference in blood loss volume was found between groups 1PD and 2PD (p > 0.05). In groups 1TS and 2TS, we did get significant difference (p < 0.05).Statistically significant difference in the average drainage loss was found between two methods of hemostasis in both subgroups (p < 0.05). The operation time was not significantly different between groups. Postoperative hemoglobin level reduce is almost equal in both groups of patients. Postoperative complications were also nearly equal in the groups. The average hospital stay was significantly less (p < 0.05) in groups with 2PD and 2TS.ConclusionsThe research proves that for patients with hypervascular spinal tumors, who underwent palliative decompression, there is no significant difference between two methods of reducing blood loss. Therefore, we do not see reasons to use expensive and risky procedure of embolization for such patients. While for patients with total spondylectomy preoperative embolization is efficient to reduce intraoperative bleeding.

Spinal deformity correction is a more aggressive surgical procedure compared to isolated decompression. However, the efficacy of the former operation is higher.

Objective: Instrumentation failure in spine tumor surgery is a common reason for revision operation. Increases in patient survival demand a better understanding of the hardware longevity. The study objective was to investigate risk factors for instrumentation failure requiring revision surgery in patients with spinal tumors.Methods: A retrospective cohort from a single tertiary care specialty hospital from January 2005 to January 2021, for patients with spinal primary or metastatic tumors who underwent surgical intervention with instrumentation. Demographic and treatment data were collected and analyzed. Kaplan-Meier analysis was performed for overall survival, and separate univariate and multivariate regression analysis was performed.Results: Three hundred fifty-one patients underwent surgical intervention for spinal tumor, of which 23 experienced instrumentation failure requiring revision surgery (6.6%). Multivariate regression analysis identified pelvic fixation (odds ratio [OR], 10.9), spinal metastasis invasiveness index (OR, 1.11), and survival of greater than 5 years (OR, 3.6) as significant risk factors for hardware failure. One- and 5-year survival rates were 57% and 8%, respectively.Conclusion: Instrumentation failure after spinal tumor surgery is a common reason for revision surgery. Our study suggests that the use of pelvic fixation, invasiveness of the surgery, and survival greater than 5 years are independent risk factors for instrumentation failure.

Goal: Because of the outbreak of coronavirus infection, healthcare systems are faced with the lack of medical professionals. We present a system for the differential diagnosis of coronavirus disease, based on deep learning techniques, which can be implemented in clinics. Methods: A recurrent network with a convolutional neural network as an encoder and an attention mechanism is used. A database of about 3000 records of coughing was collected. The data was collected through the Acoustery mobile application in hospitals in Russia, Belarus, and Kazakhstan from April 2020 to October 2020. Results: The model classification accuracy reaches 85%. Values of precision and recall metrics are 78.5% and 73%. Conclusions: We reached satisfactory results in solving the problem. The proposed model is already being tested by doctors to understand the ways of improvement. Other architectures should be considered that use a larger training sample and all available patient information.

Introduction Today in a review of the world literature there is no consensus about the main risk factor for the symptomatic adjacent segment disease, as well as the terms and conditions of its occurrence. Furthermore there are more and more questions about the reasons for the early development of ASD in the event of a short fixation, which according to some authors, should be associated with the wrong tactics of treatment and regarded as a complication of surgery. Material and Methods This study evaluated 146 patients who underwent one level 360° fusion lumbar surgery from 2005 to 2012 for the treatment degenerative conditions of the lumbar spine. It should also be noted, that patients with L5-S1 fusion were excluded from the study due to the peculiarities of the biomechanics of the segment. So we compare 2 groups according to the presence and extent of initial degenerative changes in the adjacent upper segment. These groups were similar of major risk factors for ASD, such as obesity, age, smoking, menopause, global balance disturbance. Patients in both groups had no significant differences in sex and age composition, the level of quality of life and daily physical activity. First group include 86 patients with no pre-existing or 1 to 3 stage degenerative changes by Pfirrmann modified, second group include 60 patients with initial adjacent disk degenerative changes of stage 4 and above according Pfirrmann modified classification. The average follow-up period was 42.2 months (range, 28–112 months). Results In the I group symptomatic ASD was found in 14 (16,3%) cases and ASD average development time was 35 (8–56) months. In the II group during the follow-up period 24 (40%) patients had ASD with average development time 21,5 (3–46) months. Symptomatic adjacent segment pathology was significantly more frequent in the II group (p < 0.05). The timing analysis of the symptomatic ASD showed statistically significant data on the earlier development of this disease in the second group (p < 0.05). Conclusion Patients with pre-existing degenerative changes in adjacent levels above stage 3 by Pfirrmann must be assigned to a high risk group for early ASD development even in the short lumbar fusion.