Cheshuk Y. Surgical treatment of the consequences of damage to the spinal cord using the technique of epidural electrical stimulation

One of the main consequences of spinal cord injuries (SCI) is the loss of neurological functions, the recovery of which is actually a big problem. The frequency of SCI is constantly increasing due to the intensification of industrial development, the growth of traffic accidents and military conflicts [1,2]. Treatment of patients with SCI involves performing decompressive-stabilizing operations and methods of restorative treatment. Spine injuries belong to the most difficult diagnostic category and make up from 3% to 6% of all injuries of the musculoskeletal system [55]. The issue of spinal cord injuries as a result of trauma and its consequences is an acutely relevant problem in the world today, and especially in Ukraine. In the world, up to 750,000 people suffer spinal cord injury annually, in the USA – 18,000 and in Ukraine from 2 to 3,000 people, and approximately 1,300,000 people live with neurological deficits associated with the consequences of SCI [55-60]. These are mostly men, more often younger people as a result of traffic accidents, mine-explosive injuries and other injury mechanisms [61-68]. During SCI, primary and secondary processes occur, which lead to the consequences of trauma, initially there is mechanical damage and vascular damage with the consequences of hemorrhage. In the future, the injury leads to hypoxia of the brain, electrolyte disturbances and loss of membrane potential. Epidural stimulation creates electrical fields localized to the dorsal surface of the spinal cord using electrodes implanted on the back of the dura mater, usually via cylindrical linear multicontact electrodes implanted percutaneously or multicolumn arrays of plates implanted via laminotomy. Each contact provides an individually programmable conductive surface, resulting in flexible combinations of mono-, bi- or multipolar stimulation. Lead wires are tunneled to a remote, subcutaneously implanted pulse generator that can be modulated electronically and recharged frequently. For the first time, the greater efficiency of installing two systems for EES on cervical and lumbar spinal cord thickening in patients with damage to the cervical segments of the spinal cord, simultaneously with surgical treatment of the consequences (decompression, stabilization) or in a delayed period, has been shown. In case of long-standing injuries and repeated surgical interventions, it is effective to perform myeloradiculolysis and install a system for EES at the site of the injury.