Objective. To determine the predictors of complications of surgical treatment of patients with spinal cord injury (SCI) in the lower thoracic and lumbar spine using various options for performing decompression and stabilization surgeries.

Material and Methods. A total of 240 patients with spinal cord injury in the lower thoracic and lumbar spine were operated on in 2010–2021. All patients were divided into 3 groups depending on the tactical option of surgical treatment performed. In Group 1, patients (n =  129) underwent two-stage surgical intervention through combined approach: the first stage included transpedicular fixation (TPF) supplemented with posterior decompression options and the second stage – fusion through anterior approach, in Group 2 (n = 36) – TPF and decompression through posterior approach, and in Group 3 (n = 75) – one-stage surgical intervention including TPF, decompression and fusion through extended posterior approach. An analysis of surgical complications was carried out, and factors that increase the likelihood of their development were identified. Comparison of groups according to quantitative indicators was carried out using single-factor analysis of variance (with normal distribution), and Kruskal-Wallis test (with distribution other than normal). Comparison of percentages in the analysis of multifield contingency tables was performed using Pearson’s χ² test.

Results. A total of 130 cases of postoperative complications were identified that corresponded to the grade 2 or 3 of the Clavien – Dindo classification, including respiratory, infectious processes in the surgical site, iatrogenic neurological complications, intraoperative damage to the dura mater, and instability of metal fixation. In two-stage surgery through combined approaches, the most common were respiratory complications (17.1 %), intraoperative damage to the dura mater (9.3 %) and surgical site infection (7.0 %). Predictors of these complications included the severity of preoperative neurological deficit of ASIA grade A or B, the patient’s preoperative condition corresponding to the average risk of death according to the modified SOFA score, and the performance of extended laminectomy. In isolated TPF with reposition and stabilization without fusion, the most common complication was instability of metal fixation in the long-term period (47.1 %), the predictors of which were incomplete reposition of the fractured vertebral body and performing two-segment TPF. In one-stage decompression and stabilization interventions with TPF and fusion through the extended posterior approach, the most common complications were intraoperative damage to the dura mater (26.7 %), respiratory complications (18.7 %), infectious processes in the surgical site (10.7 %), iatrogenic neurological complications (12.0 %), and instability of metal fixation (16.1 %). Predictors of these complications were the severity of the patient’s condition before surgery, corresponding to the average risk of death according to the modified SOFA score, neurological deficit of type D or rapidly regressing neurological deficit of type C, A or B according to ASIA scale, and bisegmental fusion when the injury was located at the lumbar level.

Conclusion. Analysis of the causes of complication development contributes to their prevention, and can also form the basis for algorithms to choose tactics and technology for performing decompression and stabilization operations.

The experience of treating a patient with a mine blast wound of the T11 vertebra with an anatomical disruption of the spinal cord, bilateral hemo- and pneumothorax is presented. As a result of the injury, the patient suffered massive destruction of soft tissues with the formation of a full-thickness defect up to the vertebral bodies. The tactics of staged surgical treatment of the patient are described: elimination of fracture dislocation, fixation of the spine and plastic surgery of the soft tissues of the wound defect using the VAC system.

A review of current publications devoted to the epidemiology and tactics of treatment of combat injuries of the spine and spinal cord is presented.

Objective. To analyze the current situation in the community of spine surgeons regarding the determination of the zone of posterior spinal fusion for double thoracic idiopathic scoliosis.

Material and Methods. The content of 16 publications containing the results of surgical correction of double thoracic scoliotic deformities was analyzed. The number of studied clinical cohorts was 25, of which in 13 groups only the right-sided main thoracic (MT) curve (MT group) was blocked, and in 12 – both MT and left-sided proximal upper thoracic (PT) curve (MT + PT group). Four parameters were analyzed in both groups: preoperative Cobb angle, preoperative curve mobility, deformity correction, and postoperative deformity progression.

Results. Significant differences were found in the MT and MT + PT groups only in two cases: for the initial Cobb angle of the PT curve and the magnitude of its correction (Cobb angle before surgery minus Cobb angle immediately after the intervention). When choosing the extent of the instrumental fusion zone, the authors of the publications included in the review were guided, first of all, by the initial magnitude of the Cobb angle of the proximal thoracic curve. In the MT + PT group, it averaged 37–40° and was 11–13° more than in the MT group. At the same time, PT curve mobility in both groups is not statistically different. The achieved correction was statistically significantly greater in the МT + РT group, despite a more severe proximal curvature as compared to the MT group. Postoperative dynamics of kyphosis (both T2–T5 and T5–T12) is insignificant. The length of the instrumental spinal fusion zone has virtually no effect on the parameters of the sagittal contour of the thoracic spine. A fairly high frequency of the adding-on phenomenon development (20.6 %) indicates the presence of a connection between this complication and the dynamics of PT curve, but the available data are not enough to formulate a final conclusion. Literature data regarding patients’ self-assessment of quality of life after surgical treatment of Lenke types 1 and 2 scoliosis are scarce, although the majority of those operated on assess the result of treatment as positive.

Conclusion. The problem of determining the extent of the instrumental fusion zone for double thoracic scoliosis remains unresolved. Most surgeons focus not so much on the mobility of the proximal curve, but on its magnitude. There is no consensus in predicting the development of the adding-on phenomenon; there is little information about changes in the quality of life of patients after surgery. New research is needed.

Objective. To analyze the results of surgical treatment of patients with rigid posttraumatic deformities of the thoracolumbar spine operated on using Schwab 5 osteotomy through combined and posterior approaches.

Material and Methods. A retrospective cohort study was conducted. Study group included 60 patients (m/f = 25/35). Median age was 48 (26–58) years, median time since injury was 11 (9–14) months, and minimum follow-up period was 2 years. A two-stage intervention with resection of the vertebral body, correction of the deformity, and placement of an interbody implant through the anterior approach followed by final fixation through the posterior approach (VCR_a+p group) was performed in 29 cases. Vertebral body resection through the posterior approach with correction of the deformity, installation of an interbody implant, and rigid transpedicular fixation (VCR_p group) was performed in 31 cases. In all patients, the magnitude of correction was assessed, as well as the following parameters: frontal balance, sagittal balance, thoracic kyphosis, lumbar lordosis, pelvic incidence, sacral slope and pelvic tilt. The results of treatment were evaluated in dynamics by the level of pain syndrome (VAS) and quality of life (ODI), as well as based on the analysis of postoperative complications.

Results. The groups were comparable in terms of gender, age, magnitude of the kyphotic component of the deformity, level of pain syndrome and degree of initial neurological deficit (p > 0.05). Correction of the deformity kyphotic component was significantly better in patients in the VCR_p group compared to those in the VCR_a+p group (p = 0.036). Both groups showed a significant decrease in the level of pain syndrome 3 months after surgery. However, further follow-up showed a tendency for back pain to increase on average one year after surgery in the VCR_a+p group. A total of 67 complications were revealed in 40 (66.7 %) patients. Herewith, in the early postoperative period there were 55 complications in 31 patients, and in the late period there were 12 complications in 9 patients. Analysis of early complications showed a higher incidence of anemia (p = 0.002) and liquorrhea (p = 0.017) in the VCR_p group compared to those in the VCR_a+p group. The incidence of long-term complications did not differ significantly between groups (p = 0.866). An increase in back pain in the long-term period was observed in 12 (41.4 %) patients of the VCR_a+p group and in 4 (12.9 %) patients of the VCR_p group. Analysis of risk factors for this condition showed a tendency for back pain to increase in the long-term period in patients with residual local deformity against the background of low pelvic index values.

Conclusion. Correction of the kyphotic component of deformity was significantly better in patients of the VCR_p group, which was accompanied by greater surgical trauma and incidence of early postoperative complications. The tendency of patients’ quality of life to deteriorate in the long-term follow-up period seems to be related to the occurrence of pain syndrome in the lumbar spine in patients with residual kyphotic deformity against the background of initially low compensatory capabilities.

Objective. To evaluate the long-term results of surgical treatment of patients with monosegmental stenosis of the lumbar spine after using minimally invasive and standard open techniques.

Material and Methods. The open cohort randomized prospective study included 132 patients. Long-term results were assessed in 110 patients, some patients discontinued participation in the study for natural reasons. Patients were operated on in 200–2011 in the volume of minimally invasive decompression and stabilization surgery (Group 1) and decompression and stabilization surgery through conventional posteromedial approach (Group 2). The following parameters were analyzed: Oswestry Disability Index and VAS pain intensity. Formation of an interbody block was assessed using the Tan scale, and the fatty degeneration of the paravertebral muscles – according to the Goutallier scale. Development or aggravation of the course of degeneration of the adjacent segment was also evaluated. Statistical analysis was performed using the R packages for data processing and plotting.

Results. At long-term follow-up (144 months), when assessing back pain according to VAS and ODI, a statistically significant difference p < 0.001 in favor of minimally invasive interventions was revealed. Both surgical methods resulted in high rates of fusion and low reoperation rates. In the group of minimally invasive surgical interventions, there is a lower incidence of fatty degeneration of the paravertebral muscles and damage to the adjacent segment.

Conclusions. Open and minimally invasive surgical interventions have comparable long-term clinical and morphological results. Open surgical interventions in the long term are fraught with aggravation of fatty degeneration of the paravertebral muscles and more frequent development of the adjacent level syndrome. Minimally invasive techniques are an effective and safe alternative to traditional open surgery and can reduce trauma, preserve the intact posterior support complex of the spine at adjacent levels, while performing adequate decompression and stabilization, followed by the formation of a bone block.

Objective. To analyze the results of the continuous monocentric 5-year microbiological monitoring of causative agents of surgical site infection (SSI) in patients who underwent primary surgery for chronic infectious spondylitis and required revision surgery.

Material and Methods. The study included patient data from 2018 to 2022. The primary cohort included 569 consecutively operated patients with chronic infectious spondylitis of nonspecific (n₁ = 214) and tuberculous (n₂ = 355) etiology. The analyzed sample was formed taking into according to inclusion and exclusion criteria. Thus, in 99 patients who required revision surgical interventions due to the development of SSI, a continuous microbiological monitoring of pathogens was performed, including the assessment of drug resistance and the timing of the development of infectious complications. Periodization of the time of SSI development was performed according to the accepted classification of Prinz et al. (2020), the assessment of drug resistance spectrum was performed according to the EUCAST recommendations (2020) and taking into account the approved methodological recommendations.

Results. In the general structure of surgical interventions for chronic infectious spondylitis, the share of revision interventions due to the development of SSI was 17.4 %. The highest incidence of complications was noted in the late postoperative period (χ² = 9.237; p = 0.009). Bacterial detection from the material of vertebral localization was noted in 43 cases (48.3 %), pathogen strains were isolated in urine in 28 (60.8 %), in decubital ulcers in 11 (23.9 %) and in hemoculture in 7 (15.2 %) patients. Culture negative SSI was detected in 10 cases (10.1 %) in the late period. Infectious complications in the setting of chronic non-specific spondylitis were detected more frequently than in spondylitis of tuberculous etiology (χ² = 21.345; p < 0.001). Gram-positive multidrug-resistant and Gram-negative bacteria with extreme resistance prevailed in the microbiological landscape of late SSI, and Gram-positive strains without drug resistance in that of early and delayed SSI (χ² = 17.516; p = 0.0032).

Conclusion. Drug-resistant Gram-positive bacteria predominate in the structure of SSI with a significantly higher frequency of complication development. Nonspecific etiology of spondylitis is associated with a significantly higher incidence of SSI. In the absence of a positive result of bacteriological examination of the material of vertebral localization, it is advisable to collect blood, decubital ulcer secretion and urine sampling.

Objective. To present a brief description of a series of clinical cases of infectious spondylodiscitis with an assessment of the used diagnostic criteria in terms of their influence on the choice of sanifying treatment tactics.

Material and Methods. A continuous retrospective study of 39 cases of spondylodiscitis was carried out. Level of evidence is IIIC. The level of ESR, serum C-reactive protein, the results of the study of biopsy materials, and CT and MRI data were evaluated. Criteria of neurological deficit, instability of the spinal motion segment, and recommendations for assessing the clinical and radiological severity of the disease were used to select the treatment tactics. Treatment success was defined as primary wound healing, absence of recurrent infection and/or death, and satisfaction with treatment according to the EQ-5D and EQ-VAS scales at a follow-up period of 22.5 months.

Results. The average age of patients was 57.4 years. Primary spondylodiscitis accounted for 82 %, the predominant localization of the pathological focus was the lumbar spine (56.4 %), and staphylococci were predominant etiologic agents (59.1 %). On average, the increase in ESR was 45 mm/h, C-reactive protein – 57 ng/l, and D-dimer – 1235 pg/ml. The level of pain before sanation according to the VAS scale was 6.79 points, after the operation it was 2.3 points (p < 0.05). Instability of the spinal motion segment according to the SINS scale was revealed in 36 cases, paravertebral abscess according to MRI – in 51.3 % of cases, and neurological deficit – in 38.5 % of cases. Severe spondylodiscitis according to the SponDT scale was noted in 53.8 %, moderate – in 43.6 %, and mild – in 2.6 % of patients. According to the clinical and radiological classification of infectious spondylodiscitis severity (SSC), grade I was present in 2 patients, grade II – in 21, and grade III – in 6. Compliance of the chosen treatment tactics with current recommendations was noted in 94,9 % of cases. Recurrence of infection was observed in 7.7 %; lethal outcome – in 5.1 %. Satisfaction with the quality of life according to EQ-5D was 0.74 points, and according to EQ-VAS – 73.88 points.

Conclusions. The integrated use of criteria for neurological deficit, instability of spinal motion segments, and severity of the disease according to the SponDT classification with the account of Pola’s recommendations on treatment tactics made it possible to choose the optimal treatment tactics and achieve satisfactory results in the sanation of patients with infectious spondylodiscitis.

Objective. To analyze the radiation doses to patients during spinal decompression and stabilization surgery under optical CT navigation and fluoroscopy.

Material and Methods. Study design: retrospective cohort study. The sample consisted of 164 patients who underwent transpedicular fixation of the spine performed by percutaneous or open techniques. In the O-arm group (n = 109), cone-beam CT combined with optical navigation was used; in the C-arm group, fluoroscopy (n = 55) was used. The effective dose equivalent (EDE) and the maximum absorbed dose (MAD) in the skin were evaluated.

Results. EDE in the O-arm group was Me 9.1 mSv, [IQR: 7.1–11.6], and in the C-arm group –Me 1.8 mSv [IQR: 1.8–5.6], p < 0.0001. Maximum absorbed dose in the skin in the O-arm group was Me 49.3 mGy [IQR: 27.0–96.9], and in the C-arm group – Me 36.1 mGy [IQR: 16.6–111.5], p = 0.424.

Conclusion. The use of CT navigation and fluoroscopy during pedicle screw fixation of the spine is not associated with the risk of developing deterministic effects. The use of intraoperative CT navigation during pedicle screw fixation is associated with a greater patient EDE compared with that of fluoroscopy (p < 0.05). Differences in EDE received by patients undergoing open and percutaneous techniques of pedicle screw fixation are statistically insignificant, regardless of the type of beam guidance and the number of fixation levels. The number of intraoperative CT scans is proportional to the patient EDE (p = 0.018).

An interdisciplinary consensus of experts has been formed in the area of medical activity such as tissue banking. An analysis and attempt was made to systematize some of the terms and definitions used by tissue bank specialists in the process of their work and presented in the Federal laws and orders of the Ministry of Health of the Russian Federation regulating medical activities in the field of tissue donation and their clinical use.

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