article editorial

Objective. To analyze immediate results of meningomyelocele closure with simultaneous kyphectomy in newborns.
Material and Methods. In two newborns, correction of kyphosis by vertebrectomy and decancellation of the apical vertebral body was performed simultaneously during surgery for meningomyelocele
Results. In both cases, extensive mobilization of soft tissues to close the skin defect was not required, while a significant correction of kyphotic
deformity was noted. The postoperative wound healed by primary intention on days 9–11. The follow-up period was 11 and 8 months.
Only 34 such operations in newborns were reported in the literature. All the authors noted the absence of postoperative wound complications typical for meningomyelocele repair without an orthopedic stage. In small series with a long follow-up period there was a gradual loss of correction after such operations, but without the formation of angular kyphosis requiring repeated kyphectomy.
Conclusion. Kyphectomy in newborns with meningomyelocele provided the possibility of effective closure of the skin defect and uncomplicated healing of the postoperative wound.

Objective. To analyze intraoperative data and results of treatment of patients with idiopathic scoliosis with two options of the open insertion of pedicle screws using the free-hand technique.
Material and Methods. The data of 457 patients aged 16–35 years who underwent surgical treatment for idiopathic scoliosis by one surgeon were analyzed. In 236 patients (Group I), the screws were placed manually, and in 221 (Group II) – using power tool. The preparation of the canal for pedicle screws in both groups was performed using the free-hand technique. The correct position of the screws was
assessed intraoperatively using an image intensifier and neurophysiological monitoring. The duration of surgery and X-ray monitoring, blood loss, and the presence of intra- and postoperative complications were assessed.

Results. In Group I, 4243 screws were inserted, and in Group II – 3978. The correct position of pedicle screws was recorded in 89.1 % of cases in Group I, and in 89.6 % of cases in Goup II. In Group I, the incorrect position of anchor elements was detected in 10.9 % of cases, and in Group II – in 10.4 % of cases. The number of screws re-positioned intraoperatively corresponded to the number of incorrectly positioned screws. There was a statistically significant difference in the volume of intraoperative blood loss and duration of surgery between
patients of both groups (p < 0.05).

Conclusion. The development and active introduction of high-tech methods of surgical treatment of spinal deformities increase the number of interventions performed annually. The proposed combined method of surgical treatment seems to be optimal because manual formation of the canal reduces the risk of intraoperative complications, and the use of power tool during screw placement shortens duration of surgery and reduces blood loss.

Objective. To analyze the current literature dedicated to the etiopathogenesis and development of idiopathic scoliosis.

Material and Methods. The analysis includes studies on the etiological factors of idiopathic scoliosis. The search was carried out on eLibrary, PubMed and Google Scholar databases. The review includes research and experimental studies, as well as systematic reviews and meta-analyses. The exclusion criterion is a theoretical work without practical research/experiment to confirm the theory. The depth of analysis is 30 years.

Results. Out of 456 papers on the research topic, 153 were selected as meeting the inclusion/exclusion criteria. The main theories of the occurrence of idiopathic scoliosis are identified: genetic, neurogenic, theory of bone and muscle tissue defects, biomechanical, hormonal, evolutionary, and the theory of environmental and lifestyle influences.

Conclusions. The term “idiopathic scoliosis” combines a number of diseases with different etiopathogenetic mechanisms of development. Idiopathic scoliosis has a polygenic inheritance. Different genes are responsible for its occurrence in different populations, and the progression mechanisms are triggered by various epigenetic factors. Bone and muscle tissue defects, pathology of the central nervous system, biomechanical disturbances, hormonal and biochemical abnormalities may play a dominant role in some cases of idiopathic scoliosis.

Objective. To  study the associations of single-nucleotide polymorphisms: rs6570507 in GPR126 gene, rs1800795 in IL-6 gene, rs1800469 in TGFB1 gene, rs731236 in VDR gene, rs625039 and rs11598564 polymorphisms in LBX1 gene, and rs12946942 in SOX9 gene with congenital scoliosis.

Material and Methods. The study included 90 patients with verified congenital anomalies of the spine (single and multiple malformations of the spine, ICD-10 Code: Q76.3) and 157 clinically healthy volunteers without diagnosed spinal deformity and without family history of spinal malformations or osteoarticular system diseases. Molecular genetic testing was performed by PCR with real-time registration of a signal from the developed oligonucleotides used to determine rs6570507, rs1800795, rs1800469, rs625039, rs11598564, rs12946942, and rs731236 polymorphisms. Reference sequences were selected from the dbSNP database, and sequence design was performed on the BLAST platform. Data analysis was performed using the R free software computing environment. Data were compared using Pearson’s c² test, and 95 % confidence interval limits were calculated to assess the significance of OR.

Results. Statistically significant association of the G allele and GG genotype of the rs1800795 polymorphism in the interleukin-6 gene with congenital scoliosis was found in group of Russian patients (p < 0.001). No significant association of alleles and genotypes of polymorphic variants of rs6570507, rs1800469, rs625039, rs11598564, rs12946942, and rs731236 with congenital scoliosis was found.

Conclusion. The rs1800795 polymorphism can be considered as a promising marker for molecular genetic diagnostics of congenital scoliosis.

Objective. To analyze the role of the functional state of the diaphragm in patients with cervical spinal cord injury at the stages of respiratory support and to substantiate additional criteria for their readiness to transfer to spontaneous breathing.

Material and Methods. The state of the diaphragm was assessed by ultrasound in 24 patients with spinal cord injury. The excursion of the diaphragm during quiet breathing, the excursion and thickness of the diaphragm during forced breathing, and the change in forced expiratory volume from the moment of admission till the end of mechanical ventilation were analyzed.

Results. On the first day, on the background of mechanical ventilation, there was a significant decrease in the excursion and thickness of the diaphragm during forced breathing (p = 0.002; p = 0.008) which persisted up to 3 days (p < 0.001; p < 0.001); by the fifth day of mechanical ventilation, the indicators increased to the initial levels (p = 0.112; p = 0.433); and by the 10th day they exceeded the initial values (p < 0.001). When comparing the excursion and thickness of the diaphragm during the transfer of patients to spontaneous breathing with the data on their admission, a significant difference was obtained (p < 0.001; p < 0.001). The dynamics of forced expiratory volume indicators was similar to those of diaphragm excursion during forced breathing.

Conclusion. A peculiarity of the functional state of the diaphragm in patients with cervical spinal cord injury in the acute period was a significant decrease in diaphragm excursion and the development of ventilator-induced diaphragm dysfunction (VIDD) associated with mechanical ventilation in replacement modes. The tactics of early tracheostomy and the use of auxiliary ventilation modes determined the absence of progression of VIDD during prolonged mechanical ventilation. The presence of a strong correlation between the diaphragm excursion during forced breathing and the forced expiratory volume allows concluding that these indicators can be additional objective criteria for the  readiness of patients with cervical SC injury to transfer to spontaneous breathing, since they reflect not only the functional state of the diaphragm, but also the state of the lung tissue.

Objective. To analyze clinical and radiological results of corrective fusion in the lumbar spine in the treatment of patients with sagittal imbalance after previous surgical interventions.

Material and Methods. A retrospective monocentric study, clinical case series. The data of 18 patients operated on using a combination of surgical methods with obligatory anterior corrective  fusion at the L4–L5 and/or L5–S1 levels to achieve optimal parameters of the sagittal balance  disturbed or developed after previous interventions were analyzed. Clinical and radiological parameters were assessed during hospital stay and at least 10 months later.

Results. The study presents data from 3 (16.7 %) men and 15 (83.3 %) women with an average age of 57.5 ± 9.1 years. Average length of hospital stay was 26.9 ± 10.1 days. In 7 (38.9 %) cases, the deformity occurred at the previously operated level and in 11 (61.1 %) – at the adjacent one. The duration of surgery was 481.4 ± 101.7 minutes, and blood loss was 1028.9 ± 594.9 ml. Back and leg pain VAS scores decreased in 10–19 months after surgery from 6.4 ± 0.9 and 4.8 ± 1.3 to 3.2 ± 1.2 and 0.9 ± 0.8, respectively (p < 0.001). The ODI score decreased from 59.6 ± 5.9 to 39.9 ± 7.7 (p < 0.001). The ideal Roussouly type was restored in 11 (61.1 %) cases, below ideal – in 3 (16.7 %), and overcorrection – in 4 (22.2 %). LL increased from 48.1 ± 13.6 ° to 56.9 ± 11.6 ° (p < 0.001), and LDI – from 40.1 ± 16.9 to 58.8 ± 10.3 (p <0.001); SVA decreased from 5.1 ± 1.9 to 3.4 ± 2.1 cm (p < 0.001), PT – from 23.9° ± 7.2° to 19.1° ± 3.8° (p < 0.001). According to GAP score, the number of patients with severe and moderate disproportion was reduced (p < 0.001). Perioperative complications were observed in 12 (66.7 %) patients.

Conclusion. Multi-stage surgical correction of the residual and aggravated sagittal imbalance with obligatory anterior corrective interbody fusion after instrumental correction of degenerative spinal deformity through the posterior approach significantly improves clinical and radiological parameters and allows restoring a harmonious sagittal profile in 61.1 % of cases.

Objective. To analyze the known classifications of infectious and inflammatory lesions of the cervical spine using the example of the author’s clinical material.

Material and Methods. Data on the results of treatment of 24 patients with lesions of the cervical spine were analyzed. Classifications proposed by groups of authors led by L. Homagk (2016) E. Pola (2017), M. Akbar (2012) and H. Almansour (2020) were used for comparison.

Results. Out of 24 patients with osteomyelitis of the cervical spine, monosegmental lesions were observed in 15, polysegmental – in 5, multilevel – in 2, and multilevel polysegmental lesions – in 2 cases. The C5–C6 segment was affected in 70.8 % of cases. Sepsis was diagnosed in 2 (8.3 %) patients. One case was not classified, as there was a lesion of the C1–C2 segment. The total number of neurological deficit  was 16 (66.7 %). Twenty (83.3 %) patients were admitted with the acute form of the disease, and 4 (16.7 %) patients with the chronic form. Surgery was performed in 20 (83.3 %) patients. Hospital mortality was 8.3 % (n = 2), 91.7 % (n = 22) of patients recovered. The analysis of the classifications presented above was carried out, and proposals for their use were outlined.

Conclusion. «New Classification of Pyogenic Spondylodiscitis» by Pola et al., a modified classification with specification of instability criteria and adaptation of surgical methods of treatment for the cervical spine allows applying it as the main treatment and diagnostic algorithm.

A clinical case of surgical treatment of a female patient with dumbbell schwannoma growing from the T4 nerve root and aggressive hemangioma of the T4 vertebral body and arch is presented. The open kyphoplasty through posterior approach was performed and followed by T4 laminectomy, costotransversectomy at the T4–T5 level on the left, total microsurgical resection of the tumor through right extrapleural approach, and transpedicular fixation of the T3–T5 vertebrae. There were no postoperative complications. The control computer tomography confirmed the complete removal of the tumor and the spine stability at the level of surgery.

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