Objective: Degenerative diseases of the spine are the most common disorder seen in the practice of the neurosurgeon. According to many surgeons, microdiscectomy is the “gold standard” of surgical treatment. Analyzing the current literature, it is seen that the use of endoscopic techniques in spinal surgery is increasing. However, due to the lack of detailed information on the advantages and disadvantages of these methods, there is a need for continuing research in this area. Work to clarify the features of these methods, their specificity and algorithmization will increase the effectiveness of surgical treatment. Methods: This study included patients with herniated lumbar intervertebral discs, the presence of pain in the leg, and failed of conservative therapy. In the period 2014 to 2017, 172 endoscopic lumbar discectomies were performed, using microendoscopic discectomy and percutaneous endoscopic lumbar discectomy. The effectiveness of each technique was evaluated through comparative analysis. Results: In both groups, the methods used obtained high efficacy rates. Comparative analysis showed the advantages of the percutaneous technique in terms of shortening the return to normal activity time, hospitalization time, and disability, and reducing back pain in the early postoperative period. On the other hand, the microendoscopic discectomy enabled greater radicality to be achieved in cases with herniated disc ossification and complex anatomy of the vertebral segment. Conclusions: Analysis of the data obtained led to the formulation of an algorithm for selecting the optimum endoscopic method for achieving positive results of surgical treatment. Level of Evidence II; Therapeutic studies, investigating the results of treatment.

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Objective.To study the efficacy of differentiated surgical treatment for primary spinal neoplasms based on estimation of clinical condition of a patient, survival rate, and early postoperative complications. Material and Methods. Surgery was performed in 55 out of 68 patients with primary spinal tumors involved in the study. The primary examination included CT and MRI study of the affected area of the spine. In some cases, a biopsy was performed. Results. According to histological structure, spinal tumors were identified as aggressive hemangioma, chondrosarcoma, aneuyrismal bone cyst, plasmocytoma, chordoma, giant-cell tumor, or eosinophilic granuloma. Neurological status was characterized by local pain in 18 (38 %), and by pain combined with nerve conduction disorders in 20 (40 %) patients. In accordance with the spine instability neoplastic score (SINS), most patients had stable destructions of vertebra. Evaluation of neurological status did not reveal severe deficiency: 65 % of patients had grade D or E on Frankel scale. Conclusion. Patients with tumors of the spine require careful choice of a multidisciplinary treatment. Increasing the life expectancy of patients with malignant tumors and improving the quality of life in patients with tumors of different histological structure are decisive factors in the choice of tactics and dictate the variability of approaches to treatment.Please cite this paper as: Gushcha AO, Konovalov NA, Arestov SO, Kashcheev AA, Dreval MD. Surgical treatment of primary spinal tumors: tactics and results. Hir.

Objective: Fail back surgery syndrome (FBSS) is a common cause of pain following spine surgery, and is associated with persistent or recurrent pain despite anatomically correct intervention. Spinal cord stimulation (SCS) is regarded as one of the most effective methods of treatment for fail back surgery syndrome. Methods: We studied 34 patients who underwent test stimulation and chronic SCS for FBSS. Results: Six months postoperatively, mean improvement by the visual analog scale (VAS) of average and maximum daily pain, and the painDETECT score, were 54.4%, 50.7% and 57.3%, respectively. This meets the criteria for effectiveness of the method, according to the literature. Most of patients reported significant improvements in life quality and less need for analgesics. Complications were seen in nine patients (26.4%) and included: intraoperative dura injury (one patient, 2.9%), wound infection (one patient, 2.9%), and electrode displacement (seven patients, 20.5%). No cases of postoperative neurological deterioration were seen. Conclusions: SCS is safe and effective for the treatment of neuropathic pain caused by FBSS. Level of Evidence IV; Case series.