article editorial

Objective. To perform multivariate comparison of two surgical strategies in the treatment of patients with severe Scheuermann’s disease.

Material and Methods. The search of sources (in Scopus and Web of Science databases) revealed  56 publications containing the required information. The literature data were analyzed in four directions: the results of one- and two-stage interventions are compared in terms of the magnitude of achieved correction and its preservation, the complication rate, the surgery duration and the volume of intraoperative blood loss, and the quality of life of patients in the postoperative period.

Results. The magnitude of the achieved correction of kyphotic deformity and postoperative loss of correction in patients after one- and two-stage operations are almost identical. Implant-associated complications are more often observed after one-stage operations, and purulent, neurological and other complications – after two-stage operations. Surgery duration and intraoperative blood loss volume are greater in two-stage operations. The quality of life assessed by various questionnaires is significantly improved, regardless of the type of surgery.

Conclusion. Two-stage surgical correction of Scheuermann’s kyphosis has no noticeable advantages over one-stage surgery, however, new studies with long (more than 15–18 years) postoperative follow-up are needed.

Objective. To describe the technique of  anterior scoliosis correction in patients with completed growth and to analyze immediate results of its application.

Material and Methods. Study design: retrospective clinical series. Level of evidence IV (D). A retrospective analysis of clinical and radiological data of 19 patients aged 13–44 years, who underwent anterior dynamic correction of typical idiopathic scoliosis, was performed.  Patients were divided into groups as follows: Group 1 (Lenke type 1 scoliosis) – 8 patients; Group 2 (Lenke 3) – 4 patients; and Group 3 (Lenke 5) – 7 patients. When analyzing clinical and radiological data, the age was taken into account; the deformity magnitude before and after surgery, and correction angle, were studied; and intraoperative blood loss, the number of fixed levels, duration of surgery and hospital stay length were evaluated. The functional status was assessed using the VAS and the SRS-22 questionnaire. Control examinations were carried out before and after surgery as well as at 4–6 weeks and 3, 6, and 12 months after surgery. The search for statistically significant differences was carried out between all groups in pairs: between groups 1 and 2, 2 and 3, and 1 and 3. Statistical analysis was conducted using Mann – Whitney U-test.  The SRS-22 and VAS data were processed using the Wilcoxon W-test.

Results. The number of dynamically fixed levels varied from 6 to 12. The most proximal level of fixation was T5, the most distal – L4. The average time of surgery was 181 ± 28 minutes for transthoracic access and 198 ± 34 minutes for thoracophrenolumbotomy. The average length of hospital stay was 7.2 ± 1.5 days. In the intergroup comparison of indicators of  age, mean angle of deformity before and after surgery, mean angle of  correction and blood loss between groups with Lenke 1 and 3 scoliosis, no statistically significant differences were found. Comparison of the same indicators for groups with Lenke 1 and 5 scoliosis showed significant differences in the angles of deformity after surgery and in the number of fixed levels (p = 0.024 and p = 0.006, respectively). There were also no statistical differences between types 1 and 5. At 3 months after surgery the average SRS-22 score for all patients was 4.0 ± 0.42 (from 3.00 to 4.95). The VAS score changed from 6.9 ± 1.5 (4.0–9.0) before surgery to 4.4 ± 1.6 (1.0–7.0) which indicates the effectiveness of the treatment in the short term.

Conclusion.  Analysis of the immediate results of  anterior dynamic correction of Lenke type 1, 3 and 5 scoliotic deformities in physically active young adults showed positive primary effectiveness in terms of VAS and SRS-22, which makes it possible to recommend this technique for use in the presented cohort of patients.  The method is effective for all studied types of scoliosis, with a greater efficiency in Lenke types 1 and 5. Further evaluation of long-term results on a larger clinical material will allow developing more precise indications and an algorithm for application of the method.

Objective. To carry out a comparative analysis of two methods of the posterior bone block formation (with autograft bone chips or with a whole vertebral arch) and to assess the rate of bone block formation, the degree of surgery invasiveness and the patient-reported cosmetic satisfaction with the results.

Material and Methods. The study involved 31 patients with kyphotic deformity of the thoracic spine, of which 15 patients underwent spinal fusion using autograft bone chips (control group), and 16 were operated on using a new technique with a whole vertebral arch. The results of treatment were assessed using a modified MacNab scale. During the follow-up period from 1.5 to 2 years, pain syndrome was assessed according to VAS, quality of life according the Oswestry Disability Index, and cosmetic satisfaction was assessed using the SRS-22 scale.

Results. In the course of the work, it was revealed that in patients who were operated on using new method, the time of bone block formation according to CT data was shorter, the overall satisfaction with surgery result was higher (mainly due to the absence of a cosmetic defect), and the indicators of the operation duration and blood loss did not differ compared to those in the control group.

Conclusion. Based on the results obtained, spinal fusion using a whole vertebral arch can be recommended in clinical practice for surgical interventions in patients with kyphotic deformities of the spine.

Objective. To analyze morphological and morphometric changes in the sciatic nerve of rats after the spinal cord injury.

Material and Methods. The Т9 moderately severe contusion injury of the spinal cord was simulated in 12 Wistar female rats. Functions of the pelvic limbs were assessed according to the standardized BBB scale. The animals were withdrawn from the experiment after nine and 13 weeks. Epoxy semi-thin (1 µm) sections were used to study sciatic nerve at the light-optical level.

Results. Significant recovery of pelvic limb functions was observed within four weeks after surgery, the plateau was achieved by Week 5 (9.5 ± 0.28 points according to the BBB scale), the deterioration in the motor activity was observed by Week 9 (8.67 ± 0.33), its recovery was achieved by Week 13 of the experiment (9.5 ± 0.87). After 9 and 13 weeks, reactive-destructive changes were detected in the sciatic nerve in 9 % and 8 % of nerve conductors, an increase in the number density of myelin fibers by 28 % and 27 % (p < 0.05) and myelin-free fibers by 20 % and 49 % (p < 0.05), and a decrease in axon diameters by 8 % and 10 % (p < 0.05), respectively.

Conclusions. The morphological and morphometric changes in the sciatic nerve revealed after the spinal cord injury in the form of destruction of a part of the fibers, axonal atrophy and a decrease in the proportion of large fibers negatively affect its conductive properties. The leveling of peripheral nerve damage, possibly, will accelerate the regression of the motor deficit caused by the spinal cord injury; therefore, it is necessary to develop a set of preventive measures aimed at preventing the reorganization of the peripheral nerve tissue.

Objective. To study the influence of thoracic inlet angle (TIA) and the fracture of the articular process on the initial strength of the fixation of the spinal segment during its anterior and circular instrumental surgical stabilization in an experiment on a model of the lower cervical spinal segment.

Material and Methods. The material of the study was assembled models of C6–C7 spinal segments made using addictive technologies by 3D printing. After preliminary instrumentation, spinal segments were installed on the stand testing machine using specially manufactured equipment. A metered axial load simulating the native one was applied along the axis of the parameters SVA COG–C7 and C2–C7 SVA, which values were close to the value of 20 mm, at a rate of 1 mm/min until the shear strain was reached. The system’s resistance to displacement was measured, and the resulting load was evaluated. Four study groups were formed depending on the modeling of the T1 slope parameter, the integrity of the facets, and the type of instrumentation. Three tests were conducted in each group. The graphical curves were analyzed, and the values of the parameters of the neutral and elastic zones, the yield point, time to yield point, and the value of the applied load for the implementation of shear displacement were recorded. The data were subjected to comparative analysis.

Results. In Group 1, anterior shear displacement of the C6 vertebra could not be induced in all series. In groups 2, 3, and 4 a shear displacement of ≥4 mm was noted in all series. In Group 3 where a fracture of the articular process was additionally modeled, the average value of the yield point was 423.5 ± 46.8 N. Elastic zone, the time to the onset of the yield point, the time at the end point or at a shear of C6 ≥4 mm did not differ significantly. In Group 4, a translational displacement of ≥4 mm was observed, though the average yield point was 1536.0 ± 40.0 N.

Conclusion. The direction of the load applied to the fixed spinal segment, as well as the presence of damage to the articular processes, play a crucial role in maintaining resistance to shear deformation of the spinal segment during its instrumental stabilization. At high values of TIA (T1 slope) and the presence of fractures of the articular processes, the isolated anterior stabilization is less effective, circular fixation of 360° under these conditions gives a high initial stability to the spinal segment.

Objective. To analyze the results of treatment of patients with implant-associated surgical site infection after decompression and stabilization surgery performed for lumbar spinal stenosis.

Material and Methods. Results of treatment of 43 patients with early (up to 90 days after the operation) suppuration of the surgical wound after decompression and stabilization operations for lumbar spinal stenosis were analyzed.

Results. A total of 4033 operations for lumbar spinal stenosis with implantation of stabilization systems were performed from 2015 to 2019. There were 43 (1.06 %) cases of early suppuration of the surgical wound with the installed instrumentation. Out of them seven (16.27 %) cases were superficial and 36 (83.78 %) – deep. In all cases, the wound revision, surgical debridement and installation of a vacuum assisted closure (VAC-dressing) were performed. The treatment of superficial suppuration was accompanied by a single installation of a VAC-dressing before wound closure, and in deep suppuration from 2 to 8 (on average 4.10 ± 1.73) VAC-dressings were changed. Wound healing was achieved in all patients within 14–55 (average 29.10 ± 10.06) days. Timely diagnosis of the complication and application of negative pressure therapy allowed arresting the inflammatory process and preserving the implants in all patients with a follow-up period of 12 months.

Conclusion. In the case of development of early suppuration of the surgical wound, the patient needs an urgent sanitizing operation. Negative pressure treatment with VAC-dressings is an effective and safe way to relieve this complication. This method combined with etiotropic antibiotic therapy makes it possible to quickly cleanse and heal the wound while preserving the implanted instrumentation.

Objective. To  evaluate the efficacy and safety of radiofrequency ablation of the basivertebral nerve in the treatment of chronic low back pain associated with Modic I and II changes according to MRI data.

Material and Methods. The results of treatment of 19 patients with chronic low back pain syndrome in the lower back lasting 6 months or more were analyzed. Patients were treated with radiofrequency ablation of basivertebral nerve.

Results. The duration of the manipulation averaged 28.0 ± 4.8 min. In all patients, a decrease in the Oswestry index by an average of 24.3 points (21.7 ± 5.2) was observed at 6 months after ablation of the basivertebral nerve. The intensity of the pain syndrome decreased immediately after the manipulation to 2.1 ± 1.1 cm on average, that is, by 71.2 %. According to the Beck Depression Scale, the patients showed signs of mild depression (subdepression) before the procedure (13.8 ± 3.6 points). When examined after 12 months, the patients showed an improvement in their psychoemotional state up to the normal values (3.4 ± 2.7 points). Subjective assessment of the condition of patients compared with the baseline showed that 16 (84.2 %) of them assessed their condition as a significant improvement with a significant regression of pain by more than 50 % at all stages of follow-up, and two patients (10.5 %) reported only a slight decrease in pain syndrome immediately after the procedure, followed by its resumption to the initial level.

Conclusion. Using clear criteria for selection of patients for radiofrequency ablation of the basivertebral nerve, it can be argued that this method is effective in the treatment of chronic low back pain associated with Modic I and II changes according to MRI data. With the help of radiofrequency ablation, it is possible to achieve long-term remission of pain syndrome up to 12 months and more.

Objective. To analyze the results of surgical treatment of chronic infectious cervical spondylitis and literature data.

Material and Methods. Design: retrospective monocentric cohort study for 2017–2020. The study included medical history and clinical and instrumental data of 25 patients who underwent 28 reconstructive surgeries on the suboccipital (n₁ = 3) and subaxial (n₂ = 25) spine. The average follow-up period was 1 year 2 months ± 4 months. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS), version 22.0.

Results. The effect of the duration of the therapeutic pause (p = 0.043) and the T1 slope (T1S) (p = 0.022) on the intensity of vertebrogenic pain syndrome was established. When assessing the parameters of the sagittal balance a direct relationship between the age of patients and the value of cervical sagittal vertical axis (CSVA) (p = 0.035) was revealed, while CSVA (p = 0.514) and neck tilt angle (NTA) (p = 0.617) did not significantly affect the intensity of vertebral pain syndrome. The extent of vertebral destruction did not affect either the intensity of vertebral pain (p = 0.872) or the indices of the sagittal balance: CSVA (p = 0.116), T1S (p = 0.154), and NTA (p = 0.562). A significant predictor of postoperative complications is the level of comorbidity with an index of 7 or more (p = 0.027) according to the Charlson scale.

Conclusion. The leading predictors of complications of surgical treatment of cervical infectious spondylitis are the Charlson comorbidity index (7 points or more) and the variant of anterior reconstruction (the use of a blocked extraspinal plate). The factors influencing the intensity of vertebrogenic pain syndrome in this pathology are the duration of the therapeutic pause and the magnitude of T1S compensation. Anterior reconstruction of the cervical spine in the presence of infectious spondylitis provides a correction of the sagittal balance parameters, with the possibility of long-term maintaining the achieved values.

Objective. To assess the effect of neodymium laser radiation on the recurrence rate and continued growth of primary extramedullary tumors on the basis of clinical data obtained in the long-term follow-up period in operated patients with extramedullary tumors.

Material and Methods. The long-term results of surgical treatment of two groups of patients (n = 412) with primary extramedullary tumors operated on from 1998 to 2014 were studied and systematized. Patients of comparison group (n = 277; 67.2 %) underwent removal of tumors using standard microsurgical techniques, and the neoplasms in patients of the study group (n = 135; 32.8 %) were removed with additionally used neodymium (Nd:YAG) laser.

Results. The use of the developed laser technologies for the resection of extramedullary intracanal primary tumors made it possible to reliably reduce the relative number of recurrence and continued growth from 11.1 % to 1.2% compared with patients treated with standard surgery methods. The proportion of recurrences was 3.5 %, all of them were detected only in the group with the classical technique of tumor resection (p <0.01).

Conclusion. The use of a neodymium laser as an additional technology to the classical microsurgical resection of extramedullary tumors is effective for the prevention of their recurrence and continued growth.

Objective. To analyze lethal outcomes in patients with hematogenous vertebral osteomyelitis.

Material and Methods. Study design: retrospective analysis of medical records. A total of 209 medical records of inpatients who underwent treatment for hematogenous vertebral osteomyelitis in 2006–2017 were analyzed. Out of them 68 patients (32.5 %) were treated conservatively, and 141 (67.5 %) – surgically. The risk factors for lethal outcomes were studied for various methods of treatment, and a statistical analysis was performed.

Results. Hospital mortality (n = 9) was 4.3 %. In patients who died in hospital, average time for diagnosis making was 4 times less (p = 0.092). The main factors affecting mortality were diabetes mellitus (p = 0.033), type C lesion according to the Pola classification (p = 0.014) and age over 70 years (p = 0.006). To assess the relationship between hospital mortality and the revealed differences between the groups, a regression analysis was performed, which showed that factors associated with mortality were Pola type C.4 lesions (OR 9.73; 95 % CI 1.75–54.20), diabetes mellitus (OR 5.86; 95 % CI 1.14–30.15) and age over 70 years (OR 12.58; 95 % CI 2.50–63.34). The combination of these factors increased the likelihood of hospital mortality (p = 0.001). Sensitivity (77.8 %) and specificity (84.2 %) were calculated using the ROC curve. In the group with mortality, the comorbidity index (CCI) was significantly higher (≥4) than in the group without mortality (p = 0.002). With a CCI of 4 or more, the probability of hospital death increases significantly (OR 10.23; 95 % CI 2.06–50.82), p = 0.005. Long-term mortality was 4.3 % (n = 9), in 77.8 % of cases the cause was acute cardiovascular pathology, and no recurrence of vertebral osteomyelitis was detected.

Conclusion. Hospital mortality was 4.3 %, and there was no mortality among patients treated conservatively. The main risk factors were diabetes mellitus, type C lesion according to Pola and age over 70 years. There was a significant mutual burdening of these factors (p = 0.001). With CCI ≥4, the probability of death is higher (p = 0.005).

Objective. To present a virtual three-dimensional model of pathologically altered segments of the patient’s spine and to analyze the results of its application when planning a surgical intervention in the smartphone-assisted augmented reality.

Material and Methods. A three-dimensional modeling of the target area of the intended surgical site was performed based on computed tomography data of five patients with various spinal deformities. A smartphone application has been developed that allows displaying a three-dimensional object of the intended surgical site in the form of augmented reality.

Results. The created virtual three-dimensional models were successfully used in five cases for preoperative planning and simulation training before surgery, which allowed to see in detail the anatomical features of the spine, the location of vascular structures when contrasting them, and to plan the direction of the screws. The potential of using augmented reality in clinical practice was demonstrated.

Conclusion. The advantages of the smartphone-assisted augmented reality technology for preoperative planning in spine surgery are the simplicity of creating a computer model, the possibility for a surgeon to use a three-dimensional model for orientation in complex anatomical zone at any time of surgery, and the reduction in the risk of technical errors.

A review of the literature on performing spinopelvic fixation for injuries and various pathologies of the spine and pelvis is presented. The review is analytical in nature and was carried out using databases of medical literature and search resources of PubMed and eLibrary. The following aspects are highlighted: the relevance and indications for performing spinopelvic fixation and its anatomical and biomechanical features. The historical aspects of the development of methods for performing spinopelvic fixation are considered and structured. The analysis of various methods of spinopelvic fixation (using hooks, screw insertion into the S2 sacral wings, L-shaped Luque rods, distractors, transiliac rods, Jackson, Harrington and Galveston techniques) was carried out.  The features of surgical techniques, their advantages, disadvantages and complications are considered.

Mikhail Vitalyevich Mikhaylovskiy

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