Degenerative disease of the intervertebral discs (DDD) is currently a serious problem facing the world community. The surgical methods and conservative therapy used today, unfortunately, do not stop the pathological process, but serve as a palliative method that temporarily relieves pain and improves the patient’s quality of life. Therefore, at present, there is an active search for new methods of treating DDD. Among new techniques of treatment, biological methods, and minimally invasive surgery, including the use of laser radiation, which, depending on the laser parameters, can cause ablative or modifying effects on the disc tissue, have acquired considerable interest. Here, we analyze a new approach to solving the DDD problem: laser tissue modification. This review of publications is focused on the studies of the physicochemical foundations and clinical applications of a new method of laser reconstruction of intervertebral discs. Thermomechanical action of laser radiation modifies tissue and leads to its regeneration as well as to a long-term restoration of disc functions, elimination of pain and the return of patients to normal life.

One of the main causes of the development of debilitating pain syndrome after surgical treatment of a herniated disc is herniation recurrence. This pathology dictates the need to perform reoperation on an already operated segment of the spinal column, which complicates the technique of surgical intervention and negatively affects the relief of pain syndrome. In the presented review of scientific publications selected from the medical literature databases PubMed, E-library and Cochrane, the current problems of the pathogenesis of recurrent herniated discs in the lumbar spine are considered. The concept of risk factors for the development of recurrent disc herniation is highlighted, their characteristics are given, and the significance of each of them in the development of recurrent disc herniation is analyzed.

Cervical myelopathy is a serious modern challenge that requires careful attention. Clinical manifestations of cervical myelopathy are variable, from mild neurological disorders to tetraplegia. This results in the decrease of accuracy and delayed diagnosis, and therefore, poor treatment results. Currently, magnetic resonance imaging is the main method for diagnosing cervical myelopathy. Diffusion tensor imaging tractography is the most appealing method because of the more detailed visualization of spinal cord structure. Together with MRI Diagnostic Center in Tushino, we studied patients with cervical myelopathy in NGHCI NCC OJSC RZhD. For the first time, such parameters as fractional anisotropy and apparent diffusion coefficient were used to evaluate tracts and perform their 3D reconstruction. Our research showed that these data correlated with the severity of clinical symptoms of myelopathy. This provided an opportunity for development of early and precise topical diagnosis of myelopathy, differential diagnosis with spinal cord demyelination, and could be used to improve the quality and results of patient management.

Morton’s neuroma is one of the most common entrapment mononeuropathies of peripheral nerves. The main clinical manifestation is neuropathic pain syndrome in the foot. Currently, many methods of treatment are proposed. Despite the advantages of each method, the main disadvantages are low effectiveness, aggravation of symptoms due to scar-related complications, or relatively high incidence of complications following surgical invasion. Objective. To evaluate the effectiveness of percutaneous ultrasound-guided neurolysis with local administration of betamethasone in patients with Morton’s neuroma. Material and methods. The study included 14 female patients aged 24-56 years (mean 44.7±6.4). We analyzed VAS scores of pain syndrome (mean 7.1±1.1) and DN4 scores of neuropathic pain (mean 4.9±0.9). Ultrasound imaging was performed to estimate localization and volume of neuroma. Mean volume of neuroma was 226±142 mm3. Results. Mean follow-up was 12 months. In 12 out of 14 patients, there was a significant decrease in pain intensity to VAS score 1.1±0.6 and regression of neuropathic pain to DN4 score 0.5±0.5. In 2 cases, neuropathic pain recurred after 6 months with enlargement of neuromas (to 429 and 452 mm3). There were no complications in any patient. Conclusion. Percutaneous ultrasound-guided neurolysis of Morton’s neuroma with local administration of betamethasone is an effective and promising minimally invasive method. Selection criterion for this procedure may be small volume of neuroma. Further research is required to clarify the indications for this procedure.

Purpose: a comparative analysis of long-term clinical and radiological outcomes of bilateral microsurgical decompression from unilateral approach and open fusion surgery in the treatment of patients with stable stage I lumbar degenerative spondylolisthesis complicated by spinal stenosis. Materials and methods: this study included 83 patients with degenerative stage I lumbar spondylolisthesis, combined with spinal stenosis at one/several levels. Bilateral microsurgical decompression from unilateral approach was performed in group A (n = 41), in group B (n = 42) we used transforaminal lumbar interbody fusion. Results: intraoperative blood loss and operation time significantly prevailed in group B (P < 0,05). Pain in the legs (VAS), Oswestry disability index significantly decreased in both groups in the long-term postoperative period. No statistical difference in these was found in groups A and B (P = 0,59; P = 0,10). Lower back pain in both groups at the follow-up period had a significant difference: in fusion group there was a significantly higher intensity, than in group А (P < 0,001). Assessment of radiological outcomes in group A at the level of spondylolisthesis showed a slight decrease in segment stability: an increase in anteroposterior displacement of the vertebrae by an average of 0,44 mm, the angular difference by 0,77°, an increase in displacement of the vertebral body by 1,30 % (P < 0,05). Conclusion: minimally bilateral microsurgical decompression from unilateral approach is an effective method for treatment of stable stage I degenerative lumbar spondylolisthesis, combined with spinal stenosis, allowing to achieve significant regression of leg pain and disability in the long-term postoperative period. And this method admits to significantly decrease of low back pain, then in fusion surgery, as well as a low risk of postoperative instability and reoperation with instrumentation.