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Objective. To analyze characteristics, diagnostic features and results of surgical treatment of patients with traumatic spinal injuries associated with ankylosing spondylitis.

Material and Methods. A retrospective analysis of the results of surgical treatment of 32 patients (25 men and 7 women) operated on in 2019–2022 was performed. Results were followed-up during 12 months in all patients. Patient characteristics, diagnostic features,
clinical outcomes, and the range of postoperative complications were reviewed.
Results. The number of damaged levels in the cervical, thoracic and lumbar spine was 39. Low-energy injury (fall from a height and from a sitting position) was observed in 20 patients (62.5 %), and high-energy injury (fall from a height of more than 1 m and a road traffic
accident) – in 12 patients (37.5 %). Type B3 fractures according to the AOSpine classification were present in 23 patients (71.8 %), and type C translational fractures – in 9 (28.2 %). CT of the spine and verification of the diagnosis were performed within 24 hours after the injury in 24 patients (75 %). The remaining 8 (25 %) patients underwent primary diagnosis later – in 19.8 ± 24.4 days (range 5–46 days). All patients underwent posterior fixation with or without decompression. The time of surgical intervention depended on the presence of neurological symptoms. Twenty one (65.6 %) patients with complicated injury underwent surgical intervention within 8 hours after admission to the hospital. In the remaining 11 (34.4 %) neurologically uncomplicated patients, operations were performed within 3.2 ± 1.4 days. In-hospital mortality was 6.25 % (n = 2), and 1-year mortality was 28 % (n = 9). There were no neurological symptoms before or after surgery in 11 patients (36.7 %). In the group of patients with initial neurological complications (n = 21), 3 (14.3 %) patients
had complete regression of neurological symptoms (from AIS D to AIS E), 4 (19 %) - incomplete regression of symptoms (from AIS C to AIS D), and 14 (66.7 %) patients did not show significant positive dynamics. Pulmonary embolism (PE) and pneumonia were observed in 5 (15.6 %) and 6 (18.75 %) patients, respectively. In the postoperative period, the deep vein thrombosis of the lower extremities was most frequent (n = 9; 28.1%), and in 5 cases it was complicated by PE.
Conclusion. The basis for diagnosing fractures in patients with ankylosing spondylitis is clinical data (increased pain after a fall and/or the appearance of neurological deficit) and radiological data (CT scan of the whole spine). Fractures in ankylosing spondylitis are characterized by absolute instability with a high risk of developing secondary neurological deficits in the case of conservative treatment or delayed surgical intervention. The essence of the surgery is the use of extended fixation with 8 screws in the cervical spine and more than 10 screws in the thoracic and lumbar spine. The most common complications of the early postoperative period include liquorrhea, surgical wound suppuration, pulmonary embolism, pneumonia, and loosening of transpedicular screws.

Objective. To determine the influence of the urgency of performing surgical decompression of the spinal cord (SC) on the course of acute and early periods of complicated injury of the lower cervical spine.
Material and Methods. The results of treatment of 75 patients with acute complicated injury of the lower cervical spine with ASIA A and ASIA B severity of spinal cord injuries were retrospectively analyzed. Two groups were formed, depending on the timing of surgical decompression of the spinal cord after injury. Group I included 33 patients in whom the SC decompression was performed within the first eight hours after the injury, and Group II included 42 patients in whom the SC decompression was performed in more than eight hours
after the injury.
Results. The mean age of patients in Group I was 29 [25; 39] years, in Group II – 35 [30; 42] years (p = 0.129). There were 31 (94.0 %) male patients in Group I and 38 (90.5 %; p > 0.999) in Group II. The time from the moment of injury to decompression of the spinal cord
was 6.1 [5.0; 7.5] hours in Group I and 16.9 [11.8; 39.6] hours in Group II (p < 0.001). Pneumonia developed in 55 % [38 %; 70 %] of patients in Group I and in 86 % [72 %; 93 %] of patients in Group II (p = 0.004). The duration of pneumonia in Group I was 18 [8; 20] days, and in Group II – 28 [20; 39] days (p < 0.001). It was shown that the risk ratio for developing pneumonia in patients with delayed decompression of the spinal cord was 2.08 [1.17; 3.67] times higher (p = 0.01). The duration of mechanical ventilation in Group I was 12 [7; 17] days versus 19 [11; 26] days in Group II (p = 0.001). Maintaining the target blood pressure levels ≥ 85 mm Hg was required in 73 (97.3 %) patients with a duration of hemodynamic support of 6 [3; 10] days in Group I versus 10 [5; 15] days in Group II (p = 0.019). It was shown that SC decompression within the first eight hours after injury reduced the proportion of patients with a SOFA score of 4 points or more by 20 % in the acute period and by 42 % by the fifth day of the early period of injury. Positive dynamic in neurological
status was recorded in 30.0 % [17.0 %; 47.0 %] of patients in Group I and only in 2.0 % [0.0 %; 12.0 %] of patients in Group II (p < 0.001). The duration of treatment in the ICU was 20 [16; 25] days in Group I and 29 [23.5; 41.75] days in Group II (p = 0.001).
The total length of hospital stay was 38 [27; 46] days in Group I versus 57 [45.75; 67.50] days in Group II (p < 0.001). Mortality was recorded
only in Group II and amounted to 5.3 %.
Conclusion. Decompression and stabilization surgery within the first eight hours after the injury, together with a complex of intensive care measures for acute complicated injury of the lower cervical spine have a significant positive effect on the course of the acute and early periods of traumatic SC disease.

Objective. To conduct a meta-analysis of studies focused on the conservative treatment of thoracolumbar burst fractures, and to determine the efficacy and safety of this method in the observed group of patients.
Material and Methods. The study was performed following PRISMA guidelines. Inclusion criteria for meta-analysis were as follows: availability of full-text version of the article in English or Russian; A3 or A4 type fractures according to the AOSpine classification, or burst fractures of types IIA, IIB or IIC according to the Denis classification, or a direct indication of the presence of a burst fracture without its classification; absence of neurological deficit; age over 18 years; detailed description of treatment outcomes or complications; and a follow-up for at least one year.
Results. The meta-analysis included 29 articles describing the results of treatment of 1107 patients. At the time of admission, the following radiographic parameters were calculated for patients: mean kyphotic angle, 13.6 (95 % CI, 10.8–16.5), degree of vertebral body compression, 39.9 % (95 % CI, 27.7–52.0), and the degree of compression of the spinal canal lumen, 41.7 % (95 % CI, 29.2–54.2). A follow-up examination revealed a significant increase in segmental kyphosis by 3%, in vertebral body compression by 3.7 %, and lysis of bone fragments with a decrease in the degree of spinal canal stenosis by 2 times. The incidence of neurological deficit and progression of thoracic and lumbar spine instability was 5.8 % (95 % CI, 4.1–8.1) and 6.5 % (95 % CI, 4.5–9.3), respectively. Recovery of work ability according to Denis scale was as follows: W1 and W2 – 74.7 % (95 % CI, 63.9–83.1); W3 – 14.1 % (95 % CI, 10.2–19.3); and W4 and W5 – 14.8 % (95 % CI, 8.8–23.9).
Conclusion. Conservative treatment of neurologically intact thoracolumbar burst fractures can be an effective and safe option if the angular deformity does not exceed 16 degrees and the anterior vertebral body compression rate is up to 52 %. With conservative therapy, a twofold reduction in spinal canal stenosis was observed due to the lysis of bone fragments. The pooled prevalence of radiculopathy or myelopathy with conservative therapy was 5.8 %. Orthopedic intervention due to the progression of instability of the damaged segment may be required in 6.5 % of patients. More than 90 % of patients returned to full-time work following conservative therapy. Comparative studies
on the effectiveness of conservative therapy versus surgical treatment should be continued to form clear recommendations for the choice of treatment tactics for patients with uncomplicated fractures of the thoracic and lumbar spine.

Objective. To analyze the results of surgical treatment of patients with fixed spinal deformity due to osteonecrosis of the vertebral bodies of the thoracic and lumbar spine.

Material and Methods. The data obtained from the case histories of 40 patients operated on for kyphosis due to osteonecrosis of the vertebral bodies were studied. The patients underwent staged surgical interventions in one surgical session. Demographic data and radiological results of surgical treatment before surgery, after surgery and up to 1 year after surgery were assessed.

Results. As a result of surgical interventions, local kyphosis was corrected on average from 30° to -0.25°. After correction of kyphosis, statistically significant changes in the sagittal curves of the spine were revealed: an increase in thoracic kyphosis and a decrease in lumbar lordosis. There was an improvement in sagittal balance indicators in the form of a regression in the number of imbalanced patients – 17 (42.5 %) patients improved balance indicators. During the follow-up period, a statistically significant improvement in VAS and ODI scores was noted. Intra- and postoperative complications accounted for 35 %, and 8 (20 %) mechanical complications were identified during dynamic observation. Predictors of mechanical complications were the presence of imbalance: 2 and 3 points according to the balance modifier of the Formica classification and the GT index (global angle) > 7°, and insufficient correction of kyphosis (LK postOp > 4°), T-score index < -3.35.

Conclusion. Simultaneous staged surgical interventions allow for complete correction of the deformity, restoration of the sagittal profile, thereby improvement of the patient’s quality of life. To reduce mechanical complications when planning and performing surgical intervention, it is necessary to take into account the identified predictors.

Objective. To present a literature review assessing the effectiveness of surgical treatment methods for tethered spinal cord syndrome of  secondary origin in spina bifida.

Material and Methods. The Pubmed, EMBASE, eLibrary, and Cochrane Library databases were searched for prospective cohort clinical studies published from 2009 to 2024 and evaluating the effectiveness of methods for correcting tethered spinal cord syndrome in spina bifida. The study was carried out in accordance with the guidelines for Preferred Reporting Items for writing Systematic Reviews and Meta-Analyses (PRISMA).

Results. During this period, 20 articles were published assessing the effectiveness of surgical methods for correcting tethered spinal cord syndrome. Of these, 15 are pragmatic clinical trials and 5 are randomized clinical trials. The average level of evidence is III.

Conclusion. Currently, it can be stated that there is an intra-expert consensus regarding functional radiological criteria for tethered spinal cord syndrome of secondary origin in spina bifida. However, the issue of the effectiveness of surgical intervention directly depends on the availability of objective methods for clinical assessment of the severity of functional deficit and the reversibility of morphofunctional changes in the nervous tissue. Despite the variety of clinical scales and questionnaires, there is no unified assessment system for neurological, urological and orthopedic deficits in patients with tethered spinal cord syndrome. In this context, functional MRI (spinal MR tractography) can be considered a promising method for objectifying the pathological process. However, the phenomena revealed during the examination are not fully studied and require further research.

Objective. To perform clinical testing of a pediatric modification of the 18-point Japanese Orthopedic Association (mJOA) scale for assessing pathology of the spine and spinal cord in children.
Material and Methods. Functional and neurological status was assessed in 143 pediatric patients with pathology of the spine and spinal cord using the mJOA scale with three age versions (0.5–1.5 years, 1.5–4 years and 4–18 years). The control group included 10 adult patients with a similar pathology profile, who were assessed using the mJOA scale as modified by Benzel.
Results. An initial analysis of mJOA scores across five age groups (0.5–1.5, 1.5–4, 4–8, 8–18, and over 18 years) did not reveal significant differences in final scores. Repeat assessment (mean 3.1 years, range 1–10 years) also showed no significant differences either within
or between groups. A secondary analysis was performed in patients with pathology at the cervical, thoracic and lumbar levels of the spinal cord: no significant changes in scale scores were found within the groups over time. At the same time, patients with pathology at the
cervical level demonstrated a significantly higher score; they were less likely to have deformity of the lower extremities and dependence on a wheelchair, while sensitivity and movements in the upper extremities were significantly worse than in other groups.
Conclusion. The proposed pediatric mJOA scale demonstrated age consistency and utility. The results of assessing the functional and neurological state of patients using this scale, in addition to being comparable with each other, are comparable with the results of the Benzel mJOA scale in adults.

Objective. To evaluate early and medium-term results of surgical treatment of early-onset scoliosis using the principle of growth-friendly systems.

Material and Methods. A retrospective analysis of the medical records of 54 patients treated using surgical distractible metal implants was carried out. Patients were divided into 4 etiological groups: congenital (n = 17), systemic (n = 12), idiopathic (n = 16) and neurogenic scoliosis (9). The boy/girl ratio was 11/43. The average age at which patients started treatment was 9.6 years, and at the end of treatment – 13.2 years.

Results. Radiometric parameters were assessed during and after completion of treatment. The Cobb angle of the main curve of deformity before treatment averaged 56.1°, after the primary operation – 31.8°, and after completion of treatment – 23.2°. Correction of the main deformity curve for the entire period of multi-stage surgical treatment was 57.8 %. The highest initial magnitude of deformity was noted in the group of neuromuscular scoliosis (67.6°), and the lowest in the group of congenital pathology (50.4°). In the groups of systemic and idiopathic scoliosis, the preoperative values were very close: 53.4° for systemic scoliosis and 57.6° for idiopathic scoliosis. According to the results of staged treatment in the neuromuscular scoliosis group, the residual curvature of the main curve was the lowest, and the percentage of its correction was the highest – 18.9° and 73.6 %, respectively, versus 24.5° and 49.7 % in the congenital scoliosis group. The effectiveness of treatment with an assessment of the percentage of correction after final instrumentation in groups of idiopathic and systemic scoliosis was close: 23,0° and 62.3 %, and 28.5° and 51.5 %, respectively. Identical average values of the main curve angle after
final instrumentation were noted in all four etiological groups (on average, 23.2°). Changes in thoracic kyphosis and lumbar lordosis were insignificant. During the treatment, 22 unplanned surgical interventions were performed in 15 patients.

Conclusion. This study revealed a number of key points that in the future may help in the formation of clearer algorithms of selecting the most optimal technique: neurogenic scoliosis is most successfully corrected by growing systems, and congenital scoliosis shows less pronounced correction of deformity and a greater relative number of complications per patient with a single use of growing systems, which requires caution during staged surgical treatment.

Classical concepts of embryogenesis of the spine, supplemented by modern data on the role of extracellular matrix factors, specific cell adhesion
molecules, signaling molecules, and Hox and Pax genes are presented. They allow us to get closer to understanding the molecular genetic cascades possibly regulating the development of the axial skeleton. Particular attention is paid to the data on the influence of these factors on the morphogenesis of the craniovertebral zone and its defects, primarily associated with segmentation disorders.

The history of medicine is interesting and instructive. In each of the many branches of medical science, the specificity of pathology determines diagnosis and treatment. These processes inevitably continue in time and space in accordance with the conditions existing
in a given place and in a given period of time. Spine injury is one of the most striking examples of the longevity and duration of this process.
Humanity relatively recently discovered what diabetes is and how it should be treated, but this branch of medicine also has its own history, although not a very long one. Spinal injuries have accompanied man and his predecessors almost always, disrupting the usual rhythm
of life, and therefore they have been required to be treated since time immemorial. A true professional is always interested in the history of his specialty. Spine surgeons are no exception. What we managed to collect bit by bit, of course, is not everything, but it is impossible to grasp the immense, and it is necessary to know the past in order to better understand the present and the future.

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