Відділення малоінвазивної і лазерної нейрохірургії з рентгенопераційною, Інститут нейрохірургії ім. акад. А.П. Ромоданова НАМН України, Київ, Україна 2 Відділення нейрохірургії з ліжками інтенсивної терапії, КУ «Запорізька обласна клінічна лікарня» ЗОР,

Objective: to conduct a retrospective analysis and evaluate the results of various methods of surgical treatment of patients with intervertebral disc herniation (IDH), which is complicated by spinal canal stenosis (SCS) of the lumbar spine.Materials and methods: 80 patients (36 (45%) men and 44 (55%) women) with a diagnosis of IDH complicated by SCS took part in the study. The average age of patients is under 50 years. All patients were operated on in the neurosurgery department of Zaporizhzhya Regional Clinical Hospital between 2016 and 2020. Patients were divided into two groups depending on the area of ​​the spinal canal and the method of surgical treatment. Group A (n=20) – relative SCS, area of the spinal canal – 75‒100 mm2, the presence of IDH >6 mm (according to magnetic resonance imaging). These patients underwent a standard microdiscectomy. Group B (n=60) ‒ absolute SCS, spinal canal area <75 mm2, the presence of IDH <6 mm (according to magnetic resonance imaging). This category of patients underwent surgery with wide decompression of the spinal canal and stabilization of the spinal motion segment using the method of interbody and transpedicular fixation of the corresponding spinal motion segment. The postoperative follow-up period is up to 6 months. A visual analogue scale was used to assess the pain syndrome in the lower limb and back and the degree of its reduction in the postoperative period. The impact of surgical treatment on the quality of life of patients with IDH complicated by SCS was assessed using the Oswestry Disability Index questionnaire (ODI).Results. Before the operation in group B, an inversely proportional dependence of the pain syndrome level on the visual analogue scale on the age of the patients (p<0.05) and the duration of the disease (p<0.05) was recorded. No such dependence was found in group A. In both groups, a significant decrease in pain syndrome was noted at the end of the first day after surgery, with a further gradual decrease until the end of the observation period. When comparing groups at the end of the first day after surgery, after 3 and 6 months, no statistically significant differences were found (p>0.05). In both groups, a significant decrease in the Oswestry index was registered immediately after surgery and its further decrease until the end of the follow-up period. When comparing the groups at the end of the first day after the operation, after 3 and 6 months, no statistically significant differences were found (p>0.05), but preoperative Oswestry index was significantly higher in group B, (р=0.04 according to the Mann‒Whitney test).Conclusions. In group A, the treatment effectiveness of patients reached 80‒85%, in the observation period on the 3 and 6 months. In group B, the treatment effectiveness of patients was also high and amounted to 75‒80%, in the observation period on the 3 and 6 months. Thus, taking into account the high variability of clinical and morphological changes in patients with IDH complicated by SCS, it is optimal to use differentiated surgical treatment tactics.

Aim. The purpose of the work was to determine the relationship between degenerative changes of the L5-S1 and L4-L5 intervertebral discs with collagen mononucleotide variants COL2A1rs2276454, rs1793953, COL9A1rs1135056, COL11A1rs1676486 among ethnic Ukrainians. Materials and methods. The following subjects were investigated: 90 persons of the case group with degeneration of the intervertebral disc L5-S1; 50 persons of the case group with degeneration of the intervertebral disc L4-L5; 66 people of the control group. The object of the study was the venous blood of patients with degenerative lesions of the intervertebral discs and healthy donors. Venous blood was obtained as a result of venipuncture. Typing of COL2A1rs2276454, COL2A1rs1793953, COL9A1rs1135056, COL11A1rs1676486 was performed using the Tag Man Universal PCR Master Mix kit (Applied Biosystems, USA) and Tag Man SNP Genotyping Assays for the determination of polymorphisms (Applied Biosystems, USA). The research was carried out by specialists in the field of molecular biology and biochemistry of the Department of Neurobiochemistry of the SI “Romodanov Neurosurgery Institute, National Academy of Medical Sciences of Ukraine”, using the CFX96 device (Bio-Rrad, USA). Certificate of determination of measuring capabilities No. PT-322/21 from 07/28/2021 to 08/27/2023. Results. COL2A1rs2276454 may have a protective value for the development of degeneration of the intervertebral disc L5-S1 among men (OR (95 % CI): 0.27 (0.10–0.80), χ2 = 6.02, P = 0.015). Genotype C/T (COL9A1rs1135056) is 3.25 times more common among male patients with degeneration of the intervertebral disc L5-S1 in comparison with the female case group (OR (95 % CI): 3.25 (1.20–8.84), χ2 = 5.50, P = 0.02). The presence of the genotype G/A (COL11A1rs1676486) in the general group of patients with degeneration of the intervertebral disc L5-S1 is observed 5.46 times more often among male patients (OR (95 % CI): 5.46 (1.60–18.47), χ2 = 8.29, P = 0.004); G/A is registered 4.17 times more often among men compared to the group of women (OR (95 % CI): 4.17 (1.070–16.82), χ2 = 4.17, P = 0.04). Comparison of the odds of observing the genotype G/G, G/A, AA in the group of men with degeneration of the intervertebral disc L5-S1 showed a statistically significant 4.06 times predominance of the genotype G/A (OR (95 % CI): 4.06 (1.23–13.38), χ2 = 4.17, P = 0.04). The most probable model of heredity for COL11A1rs1676486 is dominant OR (95 % CI): 2.08 (1.03–4.21), χ2 = 4.26, P = 0.04. Associations of COL2A1rs2276454, rs1793953, COL9A1rs1135056, COL11A1rs1676486 structure-forming collagens of the gelatinous nucleus with degeneration of L5-L4 intervertebral discs were not detected. Conclusions. The COL2A1rs2276454 may be protective for the development of L5-S1 intervertebral disc degeneration in men (OR (95 % CI): 0.27 (0.10–0.80), χ2 = 6.02, Р = 0.015). COL2A1rs1793953 is not associated with degeneration of intervertebral discs L4-L5, L5-S1. С/T COL9A3rs1135056 genotype is associated with L5-S1 intervertebral disc degeneration among males (OR (95 % CI): 3.25 (1.20–8.84), χ2 = 5.50, Р = 0.02) compared with L5-S1 females. G/A COL11A1rs1676486 genotype is associated with L5-S1 intervertebral disc degeneration among male patients (OR (95 % CI): 5.46 (1.60–18.47), χ2 = 8.29, Р = 0.004) and compared to female patients (OR (95 % CI): 4.17 (1.07–16.82), χ2 = 4.17, Р = 0.04). The type of inheritance COL11A1rs1676486 is dominant.

Aim. To evaluate the association of COL11A1 gene C4603T polymorphism with the risk of cervical and lumbar disc herniation among Ukrainian people. Materials and methods. In total, 97 patients (48 women and 49 men with a mean age of 34.49 ± 6.75 years) with lumbar and cervical disc herniation and 60 (30 women and 30 men with a mean of 35.00 ± 6.51 years) control subjects were included in the study. All participants underwent T2-weighted magnetic resonance imaging (MRI). Single nucleotide polymorphism С4603Т (rs1676486) of COL11A1 gene was detected by real-time polymerase chain reaction using Tag Man Universal PCR Master Mix (Applied Biosystems, USA) and Tag Man SNP Genotyping Assays (Applied Biosystems, USA). Results. The study revealed the association of the COL11A1 gene C4603T polymorphism with a risk of lumbar L5-S1 herniation in the dominant (OR = 3.20; 95 % CI (1.34–7.50); P < 0.008) and multiplicative models (OR = 2.82; 95 % CI (1.34–5.93); P < 0.006). A statistical association of the polymorphism with lumbar L4-L5 herniation was not found. Carriers of the 4603Т allele had a four-fold higher risk of cervical herniation in the dominant model (OR =4.00; 95 % CI (1.37–11.79); P < 0.01), and three-fold higher – in the multiplicative model (OR = 3.12; 95 % CI (1.26–7.69); P < 0.05). Conclusions. The study has shown the statistically significant association of the COL11A1 C4603T polymorphism with cervical and lumbar disc herniation among Ukrainian people. The 4603T allele presence should be considered when a sports career planning or occupational choice related to a heavy load on the cervical or lumbar spine.

Aim – to evaluate clinical and instrumental correlation (MRI data) in patients with lumbar intervertebral disc herniation complicated by spinal canal stenosis for optimizing the indications for differentiated surgical treatment. Materials and methods. Clinical and neurological manifestations and MRI data in 80 patients (men – 36, women – 44), aged 27 to 72 years with a diagnosis of intervertebral disc herniation complicated by spinal canal stenosis were retrospectively analyzed. Depending on the size of the spinal canal, there were 2 groups: the first – with relative spinal canal stenosis (n = 20) – 75–100 mm2, and the second group – with absolute spinal canal stenosis (n = 60) – less than 75 mm2. We examined the correlation between the clinical and neurological presentations and MRI findings. Results. Our retrospective analysis has found that the first group consisted mainly of younger patients (46 years) and with a mean intervertebral disc herniation of 8.35 mm, while the second group included older patients (51.7 years) and the mean size of intervertebral disc herniation was 7.3 mm. The group of relative spinal canal stenosis was dominated by patients with radiculopathy syndrome (70 %) and pain in one lower limb (85 %). Radiculoischemia syndrome (50 %), pain in both lower extremities (33 %), neurogenic intermittent claudication syndrome (46.6 %), knee reflex disorders (58.3 %), pelvic organ dysfunction (11.6 %) were more common in the second group of patients. In addition, the longest disease duration (more than 24 months) was observed among patients of this group. We have found a relationship between pain syndrome (according to VAS), muscle strength, the disease duration and the spinal canal area. Conclusions. The correlation of clinical and instrumental methods of examination in patients with intervertebral disc herniation complicated by spinal canal stenosis allows the indications for differentiated surgery to be optimized.