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BACKGROUND: One of the causes of pain in the lumbar spine may be congenital spinal column malformations. Bertolotti syndrome is a clinical and radiological symptom complex associated with sacralization of the LV vertebra, leading to disruption of the biomechanics of the lumbosacral spine and accelerated degeneration of facet joints and intervertebral discs, followed by foraminal and central stenosis of the spinal canal. The clinical manifestations of the disease can be polymorphic, and their cause is multifactorial. Thus, along with pain in the lumbar spine, patients with sacralization of the LV vertebra suffer from numbness and paresthesia in the lower extremities. The incidence of pathology ranges from 4% to 8%, mainly affecting elderly and mature people. СLINICAL CASE DESCRIPTION: Patient S was born in 1982 with long-term nonspecific pain in the back and lower limb; she presented to the Neurosurgical Department of the Irkutsk Scientific Center for Surgery and Traumatology. During a clinical neurological examination and additional introscopic studies of the lumbar spine, dorsopathy diagnosed. Degenerative spondyloarthrosis LIV–LV grade III according to D. Weishaupt. Sacralization of the LV vertebra type IIa according to Castellvi A.E. Syndrome of lumbar ischialgia on the right. Persistent pain and muscle-tonic syndrome. Minimally invasive interventional treatment was performed: pulsed radiofrequency ablation of the dorsal ganglion and radicular nerve at the level of the foraminal openings LIV–LV on the right and thermal radiofrequency ablation of the recurrent nerve of Luschka at the level of LIV–LV and LV–SI on the right. In the postoperative period, the intensity of the pain syndrome decreased, and the patient was discharged to work. CONCLUSION: A promising method of minimally invasive surgery is radiofrequency ablation in the area of neoarthrosis for denervation and relief of pathological pain impulses. Assessing the patient’s complaints, carefully collecting anamnesis, interpreting data from a clinical and neurological examination, and introscopic methods of examining the lumbar spine enables establishing an accurate diagnosis and selecting the most effective treatment method.

Background: A prolonged course of the autoimmune inflammatory process in Bekhterev's disease is accompanied by calcification of the vertebral column’s ligaments, damage to the costovertebral and true joints of the spine, and their ankylosis, that ultimately leads to a decrease in the support capacity of the spine, so that even a minor injury can lead to a fracture. Spinal fractures in ankylosing spondylitis often have an unstable character and a high risk of the spinal cord injury. The main methods for diagnosing the spinal instability in Bekhterev's disease are multispiral computed tomography and magnetic resonance imaging, since the informative significance of survey radiography is not high. An early surgical treatment is the method of choice for unstable fractures in ankylosing spondylitis, despite the comorbid pathology and age, which significantly burden the prognosis. Сlinical case description: Patient K., born in 1969, injured on October 07, 2021 as a result of falling on his back from a height of 2 meters. An MSCT study of the thoracolumbar spine revealed a fracture of the ThXII–LI vertebrae, rupture of the anterior longitudinal ligament, and instability of the ThXII–LI vertebral-motor segment. The following diagnosis was established: closed uncomplicated injury of the thoracolumbar spine; grade I unstable compression fracture of the ThXII, LI vertebrae with a damage to the posterior support complex against the background of ankylosing spondylitis; grade I kyphotic deformity of the thoracolumbar spine; bilateral vertebrogenic lumboishialgia syndrome; pronounced persistent pain and muscle-tonic syndromes. A surgical treatment was applied which included correction of the spinal deformity and stabilization of the thoracolumbar spine using a transpedicular fixation system. The pain vertebrogenic syndrome and clinical neurological disorders regressed. The MSCT control was carried out in 6 months with the detected completed fusion at the ThXII–LI level. Conclusion: A timely diagnosis using multispiral computed tomography and magnetic resonance imaging data allows us to assess the full picture of traumatic changes in the spinal column and choose the most effective type of surgical intervention, using, if necessary, stabilizing systems.

Background: Among the modern methods of surgical treatment of the lumbar spines degenerative stenoses, decompressive-stabilizing surgical interventions using transpedicular screw-rod structures occupy an important place. The use of metal structures is justified not so much by the degenerative process specifics, degree or length of stenosis, but by the presence of instability in the spinal motion segments. In turn, the widespread use of fixing structures has naturally led to an increase in the specific complications, reaching 1020 per cent of the total number of operated patients. One of the threatening complications of decompressive-stabilizing operations is the fracture of structural elements, often with the formation of pathology at the adjacent levels. The reasons for these complications are associated with both an erroneous choice of the construct parameters and a violation of the technique for installing the transpedicular fixation system (TPS). Clinical case description: The article presents an analysis of the clinical symptoms appearing with the formation of the adjacent level syndrome due to a fracture of the TPS system screws used to treat central stenosis of the spinal canal at the LIV -LV level. The correction of the pathology was carried out with a repeated surgical intervention. Conclusion: This clinical example draws attention to the combination of the adjacent level syndrome with a fracture of the metal structure in a patient after a decompressive-stabilizing operation using screw-rod fixation. An early diagnosis and adequate correction of the pathology helps to avoid the aggravation of symptoms and disability of patients.