Цель исследования -оценка эффективности мониторинга внутричерепного давления (ВЧД) у пострадавших с тяжелой черепно-мозговой травмой в многопрофильном стационаре.

The objective is to present a clinical case of successful treatment of a patient with recurrent spondylitis at the cervical level.Clinical case. A 65-year-old patient was diagnosed with purulent spondylodiscitis at the level of C6-C7 vertebrae with the epidural and paravertebral abscesses and spinal cord compression. Emergency left colotomy, paravertebral abscess dissection, corporectomy of the C6 vertebra, abscess removal, anterior spondylodesis with bone autograft and titanium plate were performed. Massive antibacterial therapy was prescribed. After the operation, the volume of movement in the left limbs was restored, and on the 15th day after the operation, the patient was discharged. On the 36th day after discharge, she was hospitalized again with hematuria. A recurrence of suppuration in the area of the operation and phlegmon of both feet was revealed. Revision of the surgical wound and rehabilitation of the purulent focus on the neck, surgical intervention for phlegmon were performed. In purulent foci, Staphylococcus aureus was verified, which is sensitive to the main antibacterial drugs. Antibacterial therapy was continued, then, after changing the microflora in the wound, other antibiotics were prescribed. There was a pain in the area of the left spinal root C5. The connection of the fistula course with the titanium plate, the increase of pathological kyphosis at the level of the overlying vertebrae was found. The wound was examined, the titanium plate was removed, and the halo device was applied to correct the pathological kyphosis. After the operation, the radicular pain syndrome regressed, and the axis of the cervical spine was restored. After 1 month, the posterior combined fixation of the cervical spine at the C3-Th7 level was performed, and the halo device was dismantled. After 6 months, the patient was stopped wearing the Philadelphia neck collar, no recurrence of suppuration was observed, and a complete regression of neurological disorders was noted. After 1 year, a complete bone block is preserved between the C4-C7 vertebrae.Conclusion. The presented clinical case clearly illustrates the complexity of managing patients with inflammatory diseases of the cervical spine. Currently, there is no single treatment strategy for patients with spondylitis.

The study objective is analyze the modern ideas about the influence of time factor on the treatment outcome of patients with spinal cord injury. Results. Experimental studies clearly demonstrate the effectiveness of early decompression. According to the results of meta-analyses, in patients who underwent early decompression of the cervical segment of spinal canal, the outcomes of treatment may be better compared with the treatment outcomes of patients who underwent delayed intervention. The benefit of early decompression of the thoracic and lumbar spinal cord is not statistically significant. The difference in the rate of intraand postoperative complications and lethality between early and late decompression groups is also statistically insignificant.Conclusion. Early decompression of the spinal canal and spinal stabilization (≤24 h) should be performed in a specialized hospital as fully as possible and as early as the severity of the patient condition allows.

Background. We developed a Protocol based on the results of a previous study of risk factors for infection of a postoperative wound: do not use monopolar coagulation on the skin and subcutaneous fat; remove hemostatic material from the wound; relax the established wound expander every 65 minutes; refuse to suture the muscles in the area of laminectomy, refuse to use an intradermal suture.The study objective is a verification of the received Protocol.Materials and methods. A comprehensive retrospective cohort study evaluated the results of surgical treatment of 575 spinal patients who were under the authors’ supervision in 2014–2016. Patients were divided into groups: operated in the period from 2014 to 2016 (control group), operated in 2017, in the treatment of which the Protocol for reducing complications was applied (main group).Results. It was found that after the introduction of the Protocol, the percentage of patients with postoperative wound infection decreased from 6.0 to 1.3 %.Conclusion. The resulting Protocol is an effective tool for reducing wound infection and can be recommended for prevention of the postoperative wound infection in patients with spinal with diseases and injuries.

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