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Background: Microsurgical decompression of the spinal root in patients with herniated intervertebral discs is the most common spinal surgery. However, most national and foreign studies devoted to assessment of postoperative outcomes contain no consensus on the timing of radicular pain syndrome relief after decompression and predictors of unfavorable outcomes., Objective: To determine the period of radicular pain syndrome relief after microsurgical decompression and to identify clinical and neuroimaging predictors of unfavorable postoperative outcomes., Material and Methods: The study included 58 patients aged 26-73 years with clinical manifestations of L5 radiculopathy following compression by L4-L5 herniated disc. We assessed neurological status, functional state (Oswestry Disability Index) and fatty infiltration of paravertebral muscles. Results. Isolated radicular pain was observed in 31% of patients, combination of pain syndrome and sensory disorders - 17%, pain syndrome and motor disorders - 24%, pain syndrome, sensory and motor disorders - 28% of patients. Duration of disease until surgery was significantly longer in women ( p =0.030). Complete relief of radicular pain immediately after surgery was observed in 24 (48%) patients. Sixteen (32%) patients had persistent pain syndrome for up to 1 month. Relief of radicular pain on the first postoperative day was significantly more common in patients without motor disorders ( p <0.014). The outcomes of microsurgical decompression did not depend on duration of disease ( p =0.551), sex ( p =0.794), age ( p =0.491) and degree of fatty infiltration of paravertebral muscles ( p =0.686)., Conclusion: Radicular pain regresses within 4 weeks after microsurgical decompression. The predictor of unfavorable postoperative outcomes (long-standing pain syndrome and no functional improvement) is any preoperative motor impairment.

One of the most common causes of radiculopathy requiring neurosurgical treatment is a herniated disc. Magnetic resonance imaging (MRI) is still the main diagnostic approach for this lesion. However, MRI does not allow assessing the functional state of the root. Neurophysiological examination assesses the function of peripheral nervous system. These methods are used for differential diagnosis of causes of neurological symptoms and determine the level of the nerve root injury., Objective: To assess the role of electromyography including paraspinal muscle mapping in diagnosis of radiculopathies following spine diseases., Material and Methods: We have analyzed literature data in the Scopus, Pubmed, and RSCI databases and selected 93 references for primary reviewing. Final analysis enrolled the manuscripts with a detailed description of neurophysiological examinations and data on sensitivity/specificity of these methods., Results: Needle electromyography (EMG) is the most informative neurophysiological method for diagnosis of radicular damage. Sensitivity of EMG is up to 90% for lumbosacral radiculopathy. Electromyography of the paraspinal muscles can be used in case of of cervical, thoracic and lumbar radiculopathy in addition to EMG of limb muscles. Therefore sensitivity increases to 100%. Diagnostic value of nerve conduction study (NCS) is low, and performing NCS without EMG is not useful., Conclusion: In neurosurgical practice electrodiagnostic (EDX) should be performed for differential diagnosis of radiculopathy and peripheral nervous system lesions, to determine the level of radicular compression, and when physical examination does not correspond with neuroimaging or MRI is not possible to perform.

Objective: To evaluate the correlation of trigeminal radiculopathy with anatomical relationships of trigeminal nerve root, brainstem, tumors and vessels in patients with vestibular schwannomas., Material and Methods: A retrospective analysis included 153 patients (106 females and 47 males aged 22-82 years) with vestibular schwannomas who underwent surgery via retromastoid approach. Preoperative trigeminal radiculopathy (facial pain and sensory disturbances) was examined after microsurgical resection. Brainstem compression was analyzed by comparison of transverse size of contralateral to vestibular schwannoma half of brainstem and ipsilateral side., Results: Tumor-induced brainstem and trigeminal nerve compression was found in 115 cases. Sixty-four of these patients had trigeminal radiculopathy symptoms. Degree of brainstem compression was significantly higher in trigeminal radiculopathy group. Facial hypoesthesia was found in 61patients, trigeminal neuralgia - in 5 cases, neuropathic pain - in 3 patients. Thirty-seven patients without brainstem compression had no trigeminal nerve involvement. One patient had trigeminal neuralgia following compression by superior cerebellar artery. Total resection with brainstem and trigeminal nerve decompression were performed in all cases. Isolated or combined compression of trigeminal nerve root was noted in 9 patients with trigeminal neuralgia and neuropathic pain, in 2 with facial numbness and in 2 patients without trigeminal symptoms. In case of trigeminal neuralgia following compression by superior cerebellar artery, vascular decompression was performed only in patients with facial pain and numbness. Facial pain completely resolved in all patients. Complete or partial sensory restoration was noted in 25 cases. No facial sensory disorders were noted in 26 cases, transient sensory deterioration - in 10 patients., Conclusion: Trigeminal radiculopathy is caused by severe brainstem compression following vestibular schwannomas and usually results sensory disturbances and rarely facial pain. The impact of tumor on trigeminal nerve root and brainstem trigeminal pathways can be accompanied by vascular compression by superior cerebellar artery. Regression of trigeminal radiculopathy symptoms after resection of vestibular schwannoma is caused by decompression of trigeminal nerve root and brainstem. In case of concomitant neurovascular syndrome, vascular decompression is indicated.

The algorithm for cervical interbody stabilization with the use of vertical cylindrical mesh implant was improvement. Implementation of the developed method allows to reduce the load per unit area of bone bodies of recorded vertebrae in contact with the terminal part of the implant, which reduces the risk of loss of correction of the deformity after surgery. Results of surgical treatment of 5 patients for diseases and injuries of the cervical spine show the effectiveness of the method and the possibility of its application in clinical practice.

The study was performed for development of more precise criteria for assessment of pain using five-component visual analogue scale. Pain status was studied in 493 patients who underwent lumbar spinal nerve root decompression. Pain scale included the following parameters: pain at the moment, usual pain, maximal pain, minimal pain and overall pain score which was calculated as an average quantity of the previous four parameters. Overall pain score is a more precise criterion for evaluation of postoperative pain status in patients with degenerative lumbar spine disease.

The article presents an example of endoscopically assisted neurosurgical removal of petrous apex meningioma associated with trigeminal neuralgia. Endoscopy was used during the operation for control of completeness of tumor removal and for identification of offending vessel and control of position of protector. Total resection of the tumor was achieved, complete regression of trigeminal pain was observed in early postoperative period.

In the article authors describe application of expanders for effective closure of skin defect after surgical removal of large myelomeningoradiculocele in an infant.

A study of 80 patients after the surgery for compressive lumbosacral radiculopathy revealed that myogenic trigger zones and skin zones of hyperalgesia in lumbar and low extremities on the side of radicular compression and the contralateral side were formed before the surgery. Trigger zones remained in the latent state after the surgery in 33 patients who had no anxiety and depressive symptoms before the operation. These zones were treated with exercises (a fitness program). Symptoms of anxiety and depression that predict the relapse of pain in the post-surgery period were noted in 47 patients. The relapse of pain followed the <> in these patients but it was caused by the pain conditioned by trigger zones formed before the surgery in the insufficiency of the antinociceptive system. Moreover, an iatrogenic zone emerged in the post-surgery scar. Treatment of this group of patients should include antidepressants (velaxin), local anesthetics (novocaine, plasters with 5% lidocaine gel) and later - a fitness program.

The authors present the results of microsurgical anterior cervical foraminotomy used in unilateral cervical radiculopathy caused by lateral disc herniation or foraminal stenosis. In 2000 to 2006, anterior cervical foraminotomy was performed at one or two adjacent levels in 44 patients (27 males and 17 females aged 18 to 64 years (mean age 43 years)) with cervical radiculopathy and myelopathy. All the patients underwent pre- and postoperative computed tomography, magnetic resonance imaging, and functional X-ray study. The surgical technique permitted anterior decompression of the affected nerve root from the site of its formation to the vertebral artery, by maintaining the stability and mobility of the involved vertebral segments. The immediate postoperative period was marked by excellent results with regression of radicular syndrome in 84% of the patients and by good results in 16%. A late (6-month-to-6-year) follow-up showed excellent (78%) and good (22%) results without additional surgery. The findings indicate that anterior cervical foraminotomy is an effective technique of nerve root decompression in patients with lateral disc herniation or foraminal stenosis.

The paper presents the results of percutaneous lumbar endoscopic diskectomy in 96 patients with discogenic lumbosacral radiculitis. Indications, contraindications, and surgical techniques are discussed. The intervention is shown to be highly effective (91.1%) in young patients with a relatively short history of the disease and hernias measuring as large as 8 mm. The paper analyzes complications and poor results of treatment using percutaneous lumbar endoscopic diskectomy.

On the basis of a complex analysis of surgical treatment of 52 patients with degenerative diseases of the lumbosacral part of the spine complicated by the formation of compressive reticulopathies main states were established responsible for the worse quality of life of this category of patients. Different forms of vertebrogenic radiculopathies were determined according to the morphological substrate of compression. The methods of diagnosing the spinal diseases at the lumbosacral level were estimated and the diagnostic algorithms for different variants of degenerative lesions were developed. Rational schemes of surgical correction are proposed according to the established groups of vertebrogenic lumbosacral radiculopathies. Special attention is given to prophylactics of recurrences of the pain syndrome and postoperative instability of the spine.

Percutaneous laser discectomy (PLD) was performed in 273 patients with herniated disc-induced lumbosacral radiculitis. Indications for PLD were based on clinical and neurological findings and results of MR tomography: no benefit from conservative treatment, pain syndrome in the lumbago stage and sciatica not presenting with severe paresis and with herniated intervertebral discs down to 6 mm in size across.

The puncture laser discectomy was conducted in 273 patients with discogenic lumbosacral radiculitis while the conservative therapy inefficacy, pain syndrome in a lumbago stage present and lumboischialgia with absent prominent locomotive disorders and if the intervertebral disc hernia has the size up to 0.6 cm.

A classification of changes in the inferior lumbar portion of the spine that cause radicular pain and symptoms not amenable to concervative therapy is given. In most cases the said changes can be educed through a clinico-roentgenological investigation. Anatomical data bear proof to the presence of structural variants in which, in case of an intercurrent osteochondrosis without hernia of the disc, the compression of the root becomes quite probable. The classification lists changes that should be looked for when no hernia of the disc could be detected and lays emphasis on the multiplicity of causes accounting for the emergence of vertebrogenic radiculitis.

The author has analyzed 65 observations of patients with purulent spinal epiduritis resulting mostly from purulent diseases of the skin and subcutaneous fat. A period of pyo-resorptive fever was established which in most cases preceded the appearance of local symptoms of the disease. The purulent process is more frequently accompanied with fever, more rarely it turns into sepsis. The most rational method of treatment of the disease is early operation followed by irrigative drainage of the wound in complex with antibacterial and symptomatic therapy. A classification of purulent spinal epidurites is proposed.