The article reviews the dissertation work of M.M. Usmanov, “Changes in the Intervertebral Disc with Limited Damage to its Elements and Implantation of Various Materials: an Experimental Study”, defended in 1991. This study is of great interest to us in the light of the development and advancement of anterior dynamic correction of scoliosis in patients with completed and close to complete growth, where we believe the partial nucleotomy to be a key moment for ensuring optimal results. The dissertation describes an experimental morphological study on rabbits and convincingly proves that limited damage to the intervertebral disc elements can affect the strength properties of the spinal motion segment. A direct correlation between the morphological state of the intervertebral disc and the strength characteristics of the spine is shown. It was established that changes in the strength characteristics of spinal segments depend on the nature and amount of regenerating tissue in the intervertebral disc. This information can confirm and explain the effectiveness of the new approach to treating scoliosis. 

Objective. Analysis of the results of surgical correction of neuromuscular scoliosis in order to optimize indications for performing spinal and pelvic fixation.

Material and Methods. A total of 45 patients aged 10 to 17 years were operated on for neurogenic scoliosis in the period of 2012–2024. Thirty patients without pelvic fixation were divided into two groups: Group I included 15 patients with pelvic tilt of less than 15°, and Group II – 15 patients with pelvic tilt of more than 15°. Group III consisted of 15 patients with pelvic tilt of more than 15° who underwent pelvic fixation. All patients underwent postural radiographs before and after surgery. The treatment results were assessed according to the following criteria: the frontal pelvic tilt angle according to Maloney, the tilt of the L5 vertebra, and the magnitude of scoliotic curve angle according to Cobb. A search for possible relationships between various radiographic parameters was also performed.

Results. The average value of pelvic tilt before surgery in Group I was 7.9° ± 5.1°, in Group II – 36.3° ± 14.7°, and in Group III – 37.9° ± 14.2°; after surgery in Group I – 5.9° ± 4.5°, in Group II – 13.6° ± 10.4°, and in Group III – 12.8° ± 4.0°. The average degree of correction in groups was 36.8 ± 32.0 %, 61.2 ± 26.8 % and 62.9 ± 8.9 %, respectively. No significant loss of correction was found during long-term follow-up in all groups. The preoperative Cobb angle of the primary curve was 73.3° ± 20.2° in Group I, 99.9° ± 31.0° in Group II, and 96.7° ± 17.5° in Group III. In the postoperative period, the average Cobb angle was 29.4° ± 9.7° in Group I, 40.2° ± 24.9° in Group II, and 41.6° ± 19.5° in Group III. In Group II, a direct relationship was found between the correction of the primary curve and the correction of pelvic tilt. When assessing the relationship between the L5 inclination and the correction of pelvic tilt in Group II, an inverse relationship was found. No reliable relationship was found between the initial angle of pelvic tilt and the correction of pelvic tilt in Group II.

Conclusion. Correction of pronounced pelvic tilt in patients with neuromuscular scoliosis is possible without pelvic fixation and without significant loss of correction, provided that the degree of correction of the primary curve is satisfactory (more than 50 %). A possible parameter determining the need for spinopelvic fixation may be the angle of L5 inclination. Narrowing the indications for inclusion of the pelvis in the fusion zone during surgical correction of neurogenic spinal deformities helps to reduce the frequency of implant-associated complications that are typical for spinopelvic fixation, which in general will lead to a significant increase in the effectiveness of surgical treatment of this category of patients.

Objective. To present two clinical cases of successful surgical treatment of atlantoaxial instability in Down syndrome patients with os odontoideum.

Material and Methods. The results of surgical treatment of atlantoaxial instability in two Down syndrome patients with os odontoideum were analyzed. The neuroorthopedic status of the craniovertebral junction was evaluated perioperatively according to CT and MRI (ADI, Swischuk test, Power’s ratio). The assessment of the patients’ quality of life was carried out using the Y.A. Orlov scales.

Results. The presented clinical cases demonstrate the results of reconstructive and stabilizing correction of C1–C2 instability using the Goel – Shah method combined with original patented technique.

Conclusion. The use of the Goel – Shah method in combination with remodeling of the C1–C2 articular facets (original patented technique) provides optimal correction of instability in C2 anomalies in patients with Down syndrome.

Objective. To present modern scientific information on the problem of venous thromboembolic complications (VTECs) following scoliosis surgery in children and adolescents.
Material and Methods. The search for scientific sources was carried out in the PubMed, GoogleScholar and eLibrary databases for the period of 2012–2024. The content of 57 articles covering the issues of frequency, etiology, risk factors for the development of venous thromboembolic complications and thromboprophylaxis in the pediatric cohort as a whole and in the cohort of children and adolescents operated on for scoliosis was analyzed.
Results. The incidence of VTECs during surgical correction of scoliosis is insignificant and does not exceed 1.0 %. Etiology of VTEC is multifactorial, since there is both genetic predisposition and acquired risk factors. For children and adolescents, the most important factors are patient age, family or personal thrombotic history, surgical site, duration of surgical intervention more than 120 minutes, repeated and complicated surgeries, blood loss, anemia, infections, immobilization for more than 48 hours, long hospital stay, and the presence of chronic diseases or concomitant hemostatic disorder in the form of hypercoagulation. In adolescence, smoking, use of oral contraceptives and obesity are acquiring particular importance. It is recognized that the presence of four of these factors requires classifying the patient to a group with a high risk of developing venous thrombosis and embolic complications.
Conclusion. Given the low incidence of VTECs in scoliosis surgery, potential risks of using anticoagulant drugs, as well as effective postoperative patient care through early activation and use of external compression devices, the drug prophylaxis in scoliosis surgery is not recommended. At the same time, the lack of regulatory documents on screening and prevention of VTECs for this category of patients is associated with difficulties in identifying those clinical cases where drug prophylaxis is absolutely indicated.

Objective. To analyze incidence rates and prevalence of unstable and complicated spinal injuries in pediatric patients and the results of their surgical treatment using different models of medical care.
Material and Methods. A total of 117 patients under 18 years of age with high-energy traumatic injuries of the spinal column were treated in the period from 2010 to 2023. The entire 14-year period was divided into 2 stages, taking into account the model of care provided to these patients. Stage 1 (2010–2016) included supervision of patients with spinal injuries by pediatric traumatologists-orthopedists and neurosurgeons with a decision on the advisability and timing of specialized treatment with involvement of a spine surgeon from the adult regional hospital to perform the operation. Stage 2 (2017–2023) included total supervision of patients with spinal injuries by specialists from the adult vertebrology department with a decision on the advisability, timing and scope of surgical intervention that would be performed in an adult hospital. The analysis included the number of patients, their epidemiological characteristics, types and location of spinal injury, timing of surgical care, as well as the tactics of surgical treatment taking into account two time stages of care.
Results. In 2010–2016, 22 children and adolescents with spinal injuries were operated on, of which 15 (68.2 %) suffered from neurological deficit. In 2017–2023, 95 victims underwent surgical treatment, of which 28 (29.4 %) had neurological deficit. After changing the concept of determining the grounds for surgical treatment and routing of victims (2017), a disproportionate increase in their total number (22 versus 95) and the number of victims with complicated spinal fractures (15 versus 28) was noted. In total, the number of children and adolescents hospitalized for surgical treatment in the periods under review increased more than 4-fold (by 332.0 %), and the number of complicated spinal injuries increased less than 2-fold (86.7 %).
Conclusion. Centralization of specialized medical care for children with spinal injuries in a functioning spinal surgery department of an adult hospital with the appropriate material and technical base, including instrumentation for children of all age groups, and the routine use of various surgical techniques ensures a unified approach to the principles of diagnosis and treatment of this category of patients with the achievement of good results.

Objective. To evaluate the effectiveness of the original technique of surgical treatment of unstable fractures of the atlas.
Material and Methods. The study included 8 patients with isolated unstable Gehweiler type III B atlas fractures (Jefferson fracture) operated on using original surgical technique of osteosynthesis. Two-part fractures were present in five patients, and three-part fractures – in three patients. Dickman’s type I transverse ligament injury was observed in 2 cases, and that of type II – in 6. All patients underwent osteosynthesis through the posterior approach using the developed method for eliminating atlantoaxial instability.
Results. In the postoperative period, a decrease in the VAS pain intensity by 5–7 points (on average 6.6) was noted. Control examination confirmed consolidation of the atlas fractures in all patients. The average value of the anterior atlantodental interval after surgery did not exceed 3.10 ± 0.54 mm. The amplitude of head rotation reached 145.00° ± 8.29°. Complications included surgical site infection in one case and cerebrospinal fluid leakage in another.
Conclusion. The described original surgical technique of reconstructing the transverse ligament function during osteosynthesis makes it possible to eliminate instability, while avoiding the rotation block in the atlantoaxial joint, which improves the functional outcomes of surgical treatment. The presented results indicate the effectiveness of the method and allow considering the proposed new technique of atlas osteosynthesis as a method of choice in the surgical treatment of unstable C1 fractures with Dickman’s type I and II transverse ligament injury. Further studies on sufficient clinical material are necessary for a reliable assessment of the method. 

Objective. A systematic review of the outcomes of surgical treatment of patients with spinal pathology in obesity.
Material and Methods. A search was conducted in the Pubmed, EMBASE, ELibrary and Google databases for studies assessing the impact of obesity on the results and outcomes of spinal surgeries, the frequency and type of complications, and clinical and functional outcomes. The type of articles of interest was a systematic review and meta-analysis; the search period was 10 years. The literature search was performed by three researchers. The study was conducted in accordance with the international PRISMA guidelines for writing systematic reviews and meta-analyses. The levels of evidence reliability and recommendation strength gradations were assessed according to the ASCO guidelines.
Results. A total of 1,695 articles were found in the databases using keywords, of which 1,618 were with full-texts, 1,161 — over the last 10 years, and 62 — systematic reviews and meta-analyses. The inclusion criteria were met by 17 articles. One article by domestic authors was additionally included in the sample by agreement of the authors of this publication. Thus, the study included 18 articles. Risk factors in obese patients undergoing spinal surgery include insulin resistance, arterial hypertension, atherogenic dyslipidemia, prooxidant and inflammatory activity, and muscle oxidative stress. Comparative analysis of surgical interventions in obese patients showed significantly higher duration of surgery, volume of blood loss, infectious and thromboembolic complications, and frequency of repeated interventions. According to all studies, the functional outcome of treatment in the long-term follow-up period does not differ in groups of obese and nonobese patients. Minimally invasive surgical interventions in obese patients showed advantages in terms of lower blood loss and shorter length of hospital stay without significant differences in functional outcomes. Technical difficulties in surgical interventions in obese patients are associated with surgical access, requiring additional traction of soft tissues and special instruments, which affects the duration of surgery, the volume of blood loss and, possibly, infectious complications.
Conclusion. Obesity is a significant risk factor for perioperative complications in elective spinal surgery, the most important of which are blood loss, duration of surgery, surgical site infection, thromboembolism and repeated interventions. It is the operating surgeon who, based on all the initial data, determines the possibility of performing the intervention during the period of the patient’s visit, taking into account the risk factors, technical capabilities and features of surgical manipulations.

Objective. To evaluate the influence of the grade and extent of lumbar spinal stenosis on the severity of clinical symptoms before surgical treatment and the functional status of patients after surgery.
Material and Methods. A retrospective monocentric study was conducted including 380 patients with clinically significant degenerative central lumbar stenosis. The grade of spinal canal stenosis was determined using MRI data (according to the Schizas and Lee – Guen classifications). The number of affected spinal segments was also studied. The functional status before and after surgery was assessed using the ODI questionnaire, and pain – using the VAS. The dynamics of clinical changes after surgery was followed-up in 76 patients from the general cohort who agreed to participate in a survey or came for a follow-up examination.
Results. After comparing the Oswestry and VAS scores in groups of patients with different grades of Schizas and Lee – Guen stenosis severity, no statistically significant differences were noted (p = 0.325, p = 0.498, and p = 0.634, respectively). Statistically significant differences in the number of affected segments were also not revealed (p = 0.281 for Oswestry and p = 0.664 for VAS). When assessing the correlation between the extent of stenosis and questionnaire scores, a weak direct relationship was found between Oswestry scores after surgery and the number of affected segments (rho = 0.357, p = 0.015). Construction of linear regression revealed that patients with one and two affected segments vary significantly in outcomes (p = 0.039, 95 % CI [0.734; 2.65]), while other cases showed no statistically significant difference.
Conclusion. The conducted study showed no statistically significant relationship between the severity of lumbar stenosis, as assessed according to the Schizas and Lee – Guen classifications, the number of affected segments and clinical symptoms in patients. It was also found that the severity of the stenosis does not affect the outcome of surgery, while the functional outcomes after surgery for patients with one or two affected segments may differ significantly in terms of statistics.  

Objective. To analyze short- and long-term results of surgical treatment of children with tumor and infectious destruction of the cervical vertebrae.

Material and Methods. The study included data from 94 children. The following parameters were evaluated: the effectiveness of perioperative use of halo-fixation, surgical approaches, methods of reconstruction and stabilization of the spine, dynamics of pain syndrome and neurological disorders, and the structure of postoperative complications. The material was statistically processed using nonparametric analysis methods. Statistical analysis and visualization of the obtained results were carried out using the R programming language.

Results. A halo-fixation was used in 12.8 % of cases due to significant deformations and stenosis of the spinal canal. Of the 34 resections that required combined approach, 30 were performed in a single surgical session. The median duration of the surgical stage was 162.5 minutes, the median blood loss volume – 100 ml. Reconstruction of the anterior column of the spine was required in 62.8 % of cases, and posterior instrumental fixation – in 42.6 %. Local pain syndrome was eliminated in all cases. Four patients with neurological disorders showed an improvement in neurological status by one or more levels according to the Frankel scale, two patients – worsening by one level, and no significant change in the neurological picture was observed in nine cases. Complications were revealed in 26.6 % of cases, while only five patients required repeated surgery. The outcome of surgical treatment is affected by the destruction of three or more vertebrae (p = 0.0298).

Conclusion. In the treatment of children with cervical vertebrae destruction, a unified syndromic approach is justified and associated with a minimal frequency of clinically significant perioperative complications.