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Background. The development of the adjacent level syndrome and, as a consequence, adjacent segment degenerative disease are currently the most common complications of decompression and stabilization surgery with the development of segmental instability.The aim of the study. To conduct a comprehensive neuroimaging assessment of the proximal adjacent segment after rigid fixation and dynamic stabilization in degenerative lumbar disease.Materials and methods. We conducted a prospective multicenter study of the results of surgical treatment of 274 patients with degenerative-dystrophic diseases of the lumbar spine, who underwent monosegmental decompression and stabilization surgery using the TLIF (transforaminal lumbar interbody fusion) technique and open transpedicular rigid fixation, as well as open hemilaminectomy with stabilization of the operated segments with nitinol rods. The study included radiography, diffusion-weighted magnetic resonance imaging and computed tomography (dualenergy mode) of intervertebral discs and isolated facet degeneration of the upper adjacent level.Results and discussion. Combination of the initial proximal segment degeneration in the form of facet joints degeneration (density of cartilaginous plate – 163.5 ± 14.2 HU, density of external facet – 709.35 ± 13.6 HU, density of internal facet – 578.1 ± 12.1 HU), Pfirrmann III, IV grade degeneration of intervertebral disc and a measured diffusion coefficient of less than 1300 mm2/s cause high risks of developing adjacent segment degenerative disease, which regulates the use of monosegmental dynamic fixation with nitinol rods, or preventive rigid fixation of the adjacent segment.Conclusion. Using complex neuroimaging in the preoperative period makes it possible to predict the results of surgical treatment, take timely measures to prevent degenerative diseases of the adjacent segment, and to carry out dynamic monitoring of processes in the structures of the spinal motion segment.

Objective. To study the effect of arthroplasty and anterior interbody fusion in the cervical spine on degenerative changes in the adjacent intervertebral joints. Material and Methods. A retrospective cohort study included 46 patients (22 with cervical total disc arthroplasy – CTDA, and 24 with anterior cervical discectomy and fusion – ACDF) with symptoms of cervical spondylogenic compression myelopathy and/or radiculopathy. The degree of degeneration of facet joints adjacent to the operated segments was evaluated 12 months after surgical treatment. Degenerative changes in the cervical spine were assessed using CT according to the Okamoto classification. Vidar Dicom Viewer 3.2 software was used to view images and evaluate intervertebral joints. Statistical processing was performed using IBM SPSS Statistics 23. Data were presented as median and 25th and 75th percentiles – Me [Q1; Q3]. Results. The mean age of patients in both groups was 47 [39; 52] years (Mann – Whitney U-test, p = 0.047). In the ACDF group it was 48 [42; 55] years and in the CTDA group – 42 [36; 52] years. Comparison of degenerative changes in the ACDF group before and after treatment (Wilcoxon analysis) showed a statistically significant difference in the cranial (p = 0.023), and caudal (p = 0.001) joints, with the progression of degeneration degree. In the CTDA group, no difference between pre- and post-treatment degeneration degree (Wilcoxon analysis) was found in either cranial joints (p = 0.157) or caudal joints (p = 0.161). Conclusion. Surgeries to stabilize spinal segments in degenerative diseases undeniably affect the development of the adjacent level syndrome. However, the use of endoprosthetic technology makes it possible to aggravate the degree of degenerative changes in the intervertebral joints of adjacent segments to a lesser extent.

Introduction. According to the literature, the development of adjacent-level syndrome 10 years after posterior rigid stabilization is noted in 6.7–80 % of patients, of which 24 % require revision surgery.The aim: to conduct a comprehensive analysis of the results of surgical treatment of patients with degenerative diseases of the lumbar spine using rigid fixation systems.Materials and methods. A multicenter retrospective study of the results of surgical treatment of 268 patients with degenerative-dystrophic diseases of the lumbar spine, who underwent mono- or bisegmental decompression-stabilizing intervention with the implementation of the TLIF (Transforaminal Lumbar Interbody Fusion) technique and open transpedicular rigid fixation, was conducted. The study included radiography, MRI and CT (in 2-energy mode) of intervertebral discs and isolated facet degeneration of the upper adjacent level.Results and discussion. The combination of the initial degeneration of the adjacent spinal motion segment in the form of disc degeneration of grade III and higher according to Pfirrmann with threshold values of the density of the outer cartilaginous plate from 161.7 ± 18.8 to 164.8 ± 14.2 HU, the density of the outer facet – from 702.43 ± 12.3 to 713.65 ± 13.6 HU and the density of the inner facet – from 580.5 ± 11.6 to 582.1 ± 15.1 HU, as well as with signs of segmental instability of the adjacent segment can be considered as risk factors for the development of its degeneration. With the progression of degeneration of the upper intervertebral disc, revision interventions were performed within 12–60 months after surgery.Conclusion. Bisegmental stabilization with signs of initial degeneration in the intervertebral disc and facet joints in the upper segment has proven its clinical and instrumental effectiveness in the period of 36 months and reduces the risks of developing degenerative disease of the adjacent disc.

Background: Degenerative pathology of the facet joints of the lumbar spine remains a significant medical and social problem due to persistent pain syndrome, high incidence and disability rate. Clinical case description: A patient complaining of pain and discomfort in the lumbosacral spine on the right, arising in the upright position, intensifying with bending and flexion-extension of the trunk, and periodically spreading to the right gluteal region and along the posterior surface of the thigh, was admitted to the neurosurgical department of the Irkutsk Scientific Center of Surgery and Traumatology. A surgical treatment was performed in the form of dereception of the LIILIII, LIIILIV, LIVLV arch-process joints. In the postoperative period, the patient noted a decrease in the intensity of pain in the lumbosacral spine to 3 points by a visual analog scale and was discharged from the department on the 5th day after the surgery in a satisfactory condition. Conclusion: Facet joint pathologies represent a most common nosological form of the degenerative-dystrophic process (spondyloarthrosis) and a potential source of pain with the formation of instability of the spinal motion segment and chronic pain syndrome. The complex anatomical and topographic relationships between the facet joints, intervertebral discs, and radicular nerves force clinicians to pay attention to the pathology of facet syndrome. Understanding the morphological, clinical, and radiological features of the course of the facet joint degeneration makes it possible to increase the diagnostic capabilities for detecting facet syndrome of the lumbar spine and effectively apply transcutaneous surgical technologies for the treatment of chronic pain syndromes.

Objective To study the radiologic characteristics of facet joints at different stages of the degenerative process in the lumbar spine to determine the indications for various methods of fixing the affected segment and to evaluate the results of treatment.Material and Methods To determine the radiologic aspects of facet joints in the affected area and in adjacent segments of the lumbar spine, two groups were formed, including 136 patients who underwent multispiral computed tomography in two-energy mode before surgery and 12 months after surgery. Group I included patients who underwent rigid fixation of the spine (360°), and group II included patients who underwent dynamic fixation using nitinol rods (180°).Results Based on a comprehensive instrumental study, it was found that the degeneration of the intervertebral disc according to Pfirrmann II and III revealed an increase in the density of the cartilaginous plate in facet joints (HU). These digital indicators confirm the preservation of joint functionality, both in the affected area and in adjacent segments. With severe degrees of disk degeneration in Pfirrmann IV and V and facet joints, deep pathological changes occurred, directed towards the loss of facet joints functionality.Conclusion The obtained digital indicators of dual-energy computed tomography for the state of facet joints in combination with the results of magnetic resonance imaging can be used as criteria in a complex of patient studies to assess the degree of degeneration of the vertebral motion segment in the affected area and adjacent segments. We recommend using these criteria as a diagnostic component for finding optimal methods of surgical treatment.

Objective To study morphological and radiological parameters of facet joints depending on the grade of the intervertebral disk degeneration. Materials and methods To study the facet joints of the lumbar spine in 145 patients with various grades of degeneration according to Pfirrmann and treated using rigid fixation and TLIF technology, MSCT in 2-energy mode and morphological investigation of the intraoperative material were performed. Results In Pfirrmann grade 2, an increase in the volumetric content of chondrocytes, Hounsfield density of the cartilage plate, and the level of Ca in the facet joints was visualized. They indicate that the joint remains functional. In Pfirrmann grade 5, deep pathological changes occurred with violation of the architectonics of the cartilage formations of the facet joints, formation of bone elements and connective tissue growth into the cartilage and bone structures of the joint, which correlated with the results of MSCT. Conclusion The data obtained show that there is a close relationship between morphological and radiological changes in the facet joints. Modulating the data obtained allows us to obtain objective criteria for evaluating the grade of pathological processes in facet joints and use them as a diagnostic component when planning decompression and stabilizing operations in patients with degenerative diseases of the lumbar spine.

Standard treatment for lower back pain (LBP) includes the use of nonsteroidal anti-inflammatory drugs (NSAIDs).Objective: to determine the magnitude of the effect of injectable chondroitin sulfate (CS) as part of combination therapy for LBP on the intensity of pain syndrome.Patients and methods. The investigation was conducted in August 2019 to February 2020. A total of 60 patients (23 men and 37 women) aged 36 to 66 years (mean age, 48.65±8.72 years) with non-specific LBP were followed up. The patients were divided into two equal groups. A study group (n=30) took a NSAID (meloxicam) 7.5 mg twice daily for 7—10 days and intramuscular (i.m.) CS every other day in accordance with the scheme: the first three injections at a dose of 1 ml (100 mg) on days 1, 3, and 5; if this was well tolerable, a dose of 2 ml (200 mg) from the 4th injection (on day 7). A control group (n=30) used meloxicam 7.5 mg twice daily for 7—10 days. Changes in the patients' status were evaluated at baseline and 10, 20, and 50 days after therapy. The authors used a numerical rating scale (NRS) to determine the intensity of pain (at rest, during walking, during palpation), as well as the Oswestry functional status scale (OFSS). Adverse events (AEs) were evaluated.Results and discussion. In the study group, there was a decreased need for NSAIDs on day 7 of therapy, whereas in the control group, there were no dosage regimen changes through the treatment cycle. The intensity of pain syndrome according to the NRS decreased by 89.8% in the study group and by 68.3% in the control group; that according to OFSS reduced by 95.5% in the study group and by 86.6% in the control group (p

Pain in the spine is one of the most common pathological conditions and holds the second place in terms of disability throughout the world. Pain syndrome has a great influence on the functional capabilities of the spine and the professional activity of a person, and that carries a serious social and economic problem. The main causes of pain in the spine are: pathology of the intervertebral discs and the zygapophysial joints; dynamic instability of the spinal motor segment; spondylosis; stenosis of the spinal canal and dural sac with compression of the neurovascular structures; spondylolisthesis; osteoporotic compression fractures of the vertebrae; infectious diseases of the spine, etc. In connection with the aforementioned, of particular interest to clinicians is the pathology of the zygapophysial joints (spondylarthrosis), its diagnosis, and targeted ethiopathogenetic treatment using puncture surgical technology in the treatment of facet syndrome. This paper presents the results and features of puncture surgical technology in the treatment of facet syndrome in degenerative-dystrophic lesions of the zygapophysial joints of the lumbar spine. The analysis is based on 55 sources of literature of domestic and foreign authors. The article presents data on the anatomical and topographic features of the zygapophysial joints, their biomechanics, innervation and their function. The ethiopathogenetic features of pain during degeneration of facet joints are considered. The effectiveness of the use of methods of using radio and laser denervation of the zygapophysial joints in the treatment of facet syndrome is analyzed. The materials of the article describe the methods of using chemodeception, cryodestruction, and intra-articular administration of hyaluronic acid preparations.

Background. Periarticular cysts of the facet joint, due to their rare occurrence, often slip away from the attention of clinicians. However their formation and progression may cause compression of vascular-neural structures with subsequent manifestations of severe neurological disorders. Description of the clinical case. We present a rare clinical case of surgical treatment of a periarticular cyst of the facet joint. A comprehensive examination of the patient S. revealed: Dorsopathy with degenerative spinal canal stenosis at LV-SI level; spondyloarthrosis; periarticular facet cyst at LV-SI level on the left; radiculopathy LV on the left, in the acute stage; pronounced pain and musculo-tonic syndrome. Complaints of the patient: constant pain in the lumbar spine, extending to the left lower extremity and aggravating when walking at a distance of 50-100 meters; feeling numb when walking on the plantar surface of the left foot. When examining the local status, a forced posture with a bowed head and torso forward was noted; smooth lumbar lordosis and antalgic right-sided scoliosis; tension of paravertebral muscles. Neurological examination revealed LVradiculopathy on the left with moderate paresis of the extensor muscles of the left foot and ipsilateral Lasgue's positive test. MRI examination revealed spinal canal stenosis, facet joint cyst at the level of LV-SI with dimensions of 1488.5 mm. An operative intervention was performed: reconstructive decompressive-stabilizing spinal surgery with a single block removing the articular facet with a periarticular cyst at the left LV-SI level with subsequent posterior transpedicular fixation of the vertebral motor segment. Two months after the operation, complete medical and social rehabilitation of the patient was achieved. No complaints. Conclusion. In case of compression of a periarticular cyst of vascular-neural structures with severe neurological disorders, surgical treatment with the cyst removal is recommended.

Objective. To clarify indications for dynamic and rigid stabilization based on the analysis of correlation between neuroimaging parameters of facet joints (FJ) and clinical outcomes of surgical treatment of patients with degenerative diseases of the lumbar spine. Material and Methods. A total of 141 patients with degenerative diseases of the lumbar spine were surgically treated. Patients were divided into three groups: patients of Group I (n = 48) underwent surgical intervention with artificial intervertebral disc prosthesis; those of Group II (n = 42) – with interbody fusion and combined transpedicular and transfacetal stabilization; and those of Group III (n = 51) – with interbody fusion and bilateral transpedicular stabilization. The correlation between long-term clinical outcomes (pain syndrome according to VAS, functional state according to ODI, and satisfaction with surgical result according to MacNab scale) and preoperative neuroim- aging parameters of FJ (degenerative changes according to Fujiwara, facet angle magnitudes, and the presence of tropism) was analyzed. Results. A direct significant nonparametric correlation of neuroimaging parameters of facet angles and FJ tropism with long-term clini- cal outcomes of surgical treatment according to VAS and ODI was revealed. It was established that good clinical outcomes were achieved with the following preoperative parameters: in Group I, the facet angle was less than 60°, while the presence of tropism had no correlation dependence; in Group II, the facet angle – more than 60°, in the absence of FJ tropism; and in Group III, the facet angle – more than 60°, in the presence of FJ tropism. Conclusion. Objective neuroimaging parameters of the facet angle magnitude of less than 60°, regardless of the presence of tropism, allow performing total arthroplasty. If the facet angle is more than 60°, the rigid stabilization of the operated segment is indicated; in the ab- sence of tropism, a contralateral transfacetal fixation is possible, and in its presence – a bilateral transpedicular stabilization is reasonable.

Objective. To evaluate the relationship between the radiological and neuroimaging parameters of the spinal motion segment and the clini- cal outcome of surgical treatment of patients with degenerative diseases of the lumbosacral junction to clarify the indications for dynamic and rigid stabilization. Material and Methods. The study included 267 patients with degenerative diseases of the lumbosacral spine. Depending on the stabiliza- tion method, patients were divided into two groups: Group I (n = 83) with dynamic intervertebral disc (IVD) prosthesis; and Group II (n = 184) with interbody fusion and transpedicular fixation. Long-term clinical parameters and biomechanical characteristics before and after surgery were analyzed. Results. A significant nonparametric correlation of the long-term result of surgical treatment assessed by VAS and Oswestry Disability Index with radiological parameters and results of neuroimaging was revealed. It was determined that the use of artificial IVD allows achiev- ing a minimum level of pain syndrome and good functional recovery with effective preservation of the volume of physiological movements in the operated segment and restoration of the total angle of lumbar lordosis. Conclusion. Objective neuroimaging data (grade II–IV of degeneration according to the measured diffusion coefficient) and radiological parameters (linear displacement of vertebrae not more than 4 mm, sagittal volume of movements in the spinal motion segment less than 6°, decrease in the height of intervertebral disc space no more than 2/3 of the superjacent one) make possible using total arthroplasty. It is advisable to perform interbody fusion and rigid stabilization in grade IV–V of degeneration, linear displacement of vertebrae more than 4 mm, sagittal volume of movements of at least 6°, and decrease in the interbody space height over 2/3 of the superjacent one.

Background. Periarticular cysts (PC) of facet joints is a rare pathology in neurosurgical practice. The concept of PC is applicable for all cysts that are located either pararticularly in the region of facet joints, or start from them.Material and methods. A systematic search was performed in medical databases: Medline, RINC, EMedicine, UMKB, Pubmed on the relevant topic in Russian and English. The search query includes words: arcuate joint, periarticular cyst, clinic, diagnosis, surgical treatment. One of the significant factors of PC development is the instability of the vertebralmotor segment of both degenerative and post-traumatic character.Results. The result of the literature review was the writing of a clinical lecture, the current state of the issue of etiopathogenesis, diagnosis and management of patients with periarticular cysts of facet joints was studied. The article gives a clinical example of surgical treatment of a patient with a periarticular cyst at the level of LIV-LV on the right.Conclusion. Periarticular cysts of facet joints are one of the factors of compression of cauda equina roots, with surgical treatment being a radical and effective way of treatment. A detailed study of this pathology is a promising direction in spinal neurosurgery. Further research is required on comparative analysis of clinical and instrumental efficacy of various methods of surgical treatment of periarticular cysts of facet joints.

Objective: The purpose of the study was to analyze the relationship of long-term clinical results with the preoperative clinical and instrumental parameters of the facet joints in the treatment of patients with degenerative diseases of the lumbar spine. Methods: The retrospective study included 171 patients who were treated at the Neurosurgery Center of the Road Clinical Hospital at st. Irkutsk-Passenger and which in the period from January 2014 to January 2017. A comprehensive preoperative clinical and neurological examination was performed with neuroimaging verification of changes in the facet joints of the lumbar spine. Taking into account the surgery performed, the patients are divided into three groups: I (n=58) – using an artificial disc prosthesis; II (n=52) – with the use of interbody fusion, combined transpedicular and transfacet stabilization; III (n=61) – using interbody spinal fusion and bilateral transpedicular stabilization. A correlation analysis of long-term clinical outcomes (level of pain syndrome in VAS, functional status in ODI, satisfaction with the result of surgical treatment on the Macnab scale) and pre-operative neuroimaging parameters of the facet joints (degree of degenerative changes in Fujiwara, facet angle, presence of tropism). Conclusion: As a result, a direct correlation was found between the clinical symptoms of the pathology of the facet joints and the degree of their structural and functional changes. It has also been established that the use of individual parameters of the facet joints in preoperative planning determines the possible surgical tactics. [ABSTRACT FROM AUTHOR]