The overall incidence of symptomatic lumbar spinal stenosis is about 1015% among persons aged 5070 years. Due to the aging of the population, the incidence of this pathology is constantly growing. The desire of older patients to preserve their quality of life and their functional abilities, along with the improvement of surgical techniques, leads to an increase in the number of surgical interventions for lumbar stenosis. This publication describes the classification of spinal canal stenosis. The clinical picture of this disease has been studied in detail. A special attention is paid to such diagnostic methods as computed tomography (CT), radiography, CT-myelography, magnetic resonance imaging (MRI). Various methods of surgical treatment decompression and decompression-stabilization are described in detail.. The efficiency of various types of decompression operations are 7280%, the results of surgery not differing statistically between the types of decompression (hemilaminectomy, interlaminectomy). Decompression-stabilization operations are used for progressive degenerative spinal deformity, destabilization after the surgical treatment, and disruption of the vertebral-pelvic relations. Currently, the following types of stabilization are used in the lumbar stenosis surgery: ALIF, PLIF, PLF, TLIF, XLIF, OLIF, and transpedicular fixation. The rate of complications in the stabilizing interventions is 27.6%; after decompression operations 9.7%. The frequency of revision operations is also higher after stabilization 10.3%, while after decompression it is 6.5%, which makes us cautious about these types of interventions. Systems of interosseous fixation are also used in the treatment of lumbar stenosis. In the 14 years of followup after interosseous fixation and decompression in 142 patients, 30 (21.1%) patients underwent revision interventions, with chronic pain (38.5%) and disc herniation (42.3%) being the main indication for repeated surgery in 26 of them.

8590% of the elderly people are diagnosed with spondyloarthrosis There are various synonyms for this disease in the literature: facet syndrome, facet pain syndrome, arthrosis of the intervertebral joints, zygapophysial joint arthrosis and spondyloarthropathy. The article analyzes the pathogenesis, clinical picture and methods of diagnosis of this disease. Modern types of conservative and surgical treatment are presented. The advantages and disadvantages of the surgical methods for the facet syndrome treatment are analyzed: instrumental denervation (radio frequency, laser, etc.), chemical denervaion and intraarticular administration of drugs. The results of our own clinical work are presented. The facet joint denervation appears to be a productive minimally invasive method of treatment of the reflex forms of spondyloarthrosis. In the early and long-term postoperative period, it leads to a persistent decrease in the intensity of pain and improvement of the quality of life with a low risk of perioperative complications.

Pain is one of the most important problems of modern medicine. The high prevalence of pain causes significant material and social losses. As an effective measure to solve this problem, the idea of organizing a network of pain treatment centers and clinics was put forward. The purpose of the work is to describe the structure of the organization of multidisciplinary clinics and pain treatment centers. The article discusses the basic principles of the organization of pain treatment centers and the system of analgesic care. An example of the work of the pain center on the basis of a multidisciplinary hospital (Volga District Medical Center of the FMBA of Russia) is given. The authors shared the structure and organization of the work of this pain treatment center. They also presented the results of his work. Currently, there are no specialized pain centers in Russia. Now in many cities of Russia there is a process of formation of analgesic care. However, this process faces a number of difficulties.

Malignant neoplasms remain the leading cause of death worldwide. The spine is a target for metastasis more often than other skeletal bones. This article details the principles of diagnosis, treatment, and the clinical picture of secondarylesions of the spinal column. The causes of pain syndrome in cancerous lesions of the spine are reviewed: compression of nerve structures, pathological fractures, spinal instability, lytic foci and paraneoplastic pain syndrome. The causes and patterns of each type of pain syndrome are described in detail. The article presents the scales used to predict the life expectancy of these patients: Tokuhashi, Tomita and Bauer. The effectiveness of these scales is compared. The selection criteria for surgical treatment of patients with metastatic lesions of the spine are described in detail. Modern methods of surgical treatment of secondary lesions of the spinal column are presented: palliative, subtotal, total (enblock resections). The indications and contraindications for each type of surgical treatment are described. Methods of intraoperative hemostasis are described, with the special attention given to preoperative tumor embolization. The errors and complications of this technique are described in detail. The correlation dependence of intraoperative blood loss volume on the embolization terms is presented. Modern trends in the development of surgical methods in metastatic spinal tumors are described in conclusion.