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Objective. To analyze the dynamics of pain syndrome, quality of life and functional status of patients with unstable atlas fractures after C1-ring osteosynthesis.

Material and Methods. Study design: observational retrospective case series study (n = 15). The intensity of pain syndrome was assessed using the VAS scale before surgery, 3 days, and 3 and 6 months after surgery. The quality of life was assessed using the Neck Disability Index (NDI) before surgery, and 3 and 6 months after surgery. Functional status, as well as cervical spine range of motion (head turn left/right, flexion/extension) was assessed 3 and 6 months after surgery. The integrity of the atlas bone ring and the degree of fusion after fixation were assessed using axial CT scans; and the lateral mass separation was assessed using frontal CT scans. The criterion for transverse ligament injury was a separation of lateral masses of more than 8.1 mm.      

Results. All patients had C1 fractures type 3B according to Gehweiler, out of them 7 patients (46.7 %) had traumatic injury to the atlas transverse ligament according to Dickman type 1, and 8 patients (53.3 according to Dickman  type 2. The average age of patients was 40 years (12; 71), the male/female ratio was 2/1. In 7 patients (46.7 %), the cause of injury was diving, in 6 (40.0 %) it was a traffic accident, and in 2 (13.3  %) – a fall from a standing height. Observation of patients revealed a positive dynamics in the form of statistically significant regression of pain according to VAS before and 6 months after surgery from 6.8 (6.0; 8.0) to 1.0 (1.0; 0.0) points (Z = -3.434; p = 0.001). A positive trend was also noted in the form of a decrease in NDI scores and an improvement in the quality of life after 3 (Z = -3.411; p = 0.001) and 6 months after surgery (Z = -3.410; p = 0.001). The range of motion (turn left/right, flexion/extension) increased statistically significantly by the 6th month after C1-ring osteosynthesis, and its indicators were close to physiological ones. Postoperative CT scans showed positive dynamics in the form of statistically significant regression of the  lateral mass separation from 10.4 mm (8.9; 11.4) to 2.2 mm (1.8; 2.6); Z = -3.408; p = 0.001. Complete fusion of the atlas fracture was observed after 12.5 months (8.5; 16.5).

Conclusion. Isolated posterior osteosynthesis of the atlas ring for Gehweiler type 3B injury using a repositioning compression maneuver under distraction conditions is physiologically justified. It is a reliable method of stabilization, ensures the restoration of congruence and the entire range of motion in the atlanto-occipital and atlantoaxial joints and stability of the occipital-atlantoaxial complex. This operation contributes to a considerable and long-term reduction in the intensity of pain syndrome and a significant improvement in the quality of life.

Objective. To conduct a systematic review and meta-analysis of studies on the surgical treatment of patients with uncomplicated burst fractures of the lower thoracic and lumbar spine and to determine the effectiveness and safety of short transpedicular fixation (TPF) in this patient group.

Material and Methods. The study included articles with the following criteria: publication date from January 1, 2004, to December 31, 2023; patient sample descriptions involving uncomplicated burst fractures from T10 to L5; TPF involving one segment adjacent to the fractured vertebra in both cranial and caudal directions without spinal fusion; descriptions of treatment outcomes or complications; and an average follow-up period of at least 12 months. Meta-analysis was conducted using the Comprehensive Meta-Analysis software, version 2.2.064. Depending on the level of heterogeneity (I² test), either a fixed-effects or random-effects model was applied. Begg’s or Egger’s test was used to assess publication bias, and any bias present was corrected using the trim-and-fill method.

Results. The application of TPF resulted in a significant reduction in the overall Cobb angle by 5.9 degrees in the percutaneous group and by 7.6 degrees when using a midline approach. Regarding AVBCR (anterior vertebral body compression ratio), a reduction of 24.0 % and 24.8 % was observed in both groups, respectively. The overall complication rates were as follows: superficial infection, 2.2 %; deep infection, 2.0 %; and implant-associated complications, 5.6 %. No patient developed a neurological deficit. The levels of work adaptation W1 and W2 on the Denis scale were achieved in 70.9 % of patients. The overall quality of life, as measured by the Oswestry Disability Index, averaged 13.4 %.

Conclusions. Short transpedicular fixation without additional spinal fusion or laminectomy appears to be an effective and safe method for treating burst fractures of the lower thoracic and lumbar spine without neurological deficits. This method allows for regression of kyphotic deformity in the long-term post-injury period by at least 5.9 degrees and restoration of anterior vertebral height by 24 %. The approach demonstrated relatively low overall postoperative complication rates. More than 90 % of patients were able to return to full-time work, either in their previous position or with reduced physical demands.

Objective. To analyze the mechanisms of the blood-spinal cord barrier permeability violation after spinal cord injury and to assess its impact on the development of secondary injuries, including those in the areas significantly remote from the epicenter of injury.

Material and Methods. The article is an analysis of 45 publications supplemented by our own experimental data. The search for articles was conducted in databases such as PubMed, Scopus and Web of Science on the topic under study. Experimental data were obtained using confocal microscopy and bioluminescence detection on a rat spinal cord contusion injury model.

Results. The problem of barrier disintegration in a region remote from the injury epicenter is considered. It is shown that spinal cord injury significantly increases the permeability of the blood-spinal cord barrier, which promotes enhanced transmigration of immune cells and release of cytotoxic molecules. The results of our own studies on a model of dosed contusion injury in the thoracic spinal cord of a rat show that the permeability of the barrier increases not only in the injury epicenter, but also along the entire length of the organ. This circumstance is especially significant for the lumbar spinal cord, where neural networks that are critical for the maintenance and restoration of motor function are localized.

Conclusion. Potential causes of remote barrier disruption have been discussed, including the possible influence of damage biomarker molecules that travel from the injury epicenter to remote regions of the spinal cord via the bloodstream or cerebrospinal fluid. The promising clinical application of effective experimental approaches to contain barrier disruption and restore the blood-spinal cord barrier and the lack of translational research in this direction are highlighted.

Objective. To analyze complications of extended posterior instrumental fixation for spinal deformity in children in accordance with the Clavien – Dindo classification and to assess its information content and limitations.

Material and Methods. A retrospective single-center cohort study included 136 patients aged from 1 year to 17 years 11 months consecutively operated in 2020–2023 for thoracic and lumbar spine deformities associated with congenital, neuromuscular, syndromic, idiopathic scoliosis and Scheuermann’s kyphosis. At least four spinal motion segments were included in the zone of posterior instrumental fixation. All perioperative events and postoperative complications noted in the medical records were registered in accordance with the Clavien – Dindo classification. An analysis of factors influencing the development of complications of grade IIIB and higher was carried out.

Results. With a total apparent high number of complications/events (55 or 40.4 % of the number of operations), the vast majority of them correspond to grade I–II (41; 30.1 %) and do not affect the tactics and outcome of treatment. Complications of grade III and IV were noted in 13 (9.6 %) cases, and of grade V – in 1 (0.7 %) case. The influence of deformity etiology, gender, age or underweight on the risk of grade IIIB and IVA complications was not revealed, which may be due to the limited number of observations. The installation of more than 18 transpedicular screws, which correlated with surgery duration and blood loss volume, was significant for the development of such complications. The results obtained were compared with those presented in the literature, the information content and limitations of the use of the Clavien – Dindo classification in spine surgery were discussed.

Conclusion. A significant part of the complications of spinal deformity correction in children is conventionally not taken into account in domestic practice and, accordingly, cannot be prevented. The use of the Clavien – Dindo classification allows estimating the frequency of complications that potentially do not affect (grade I–II) and affect (grade III–IV) the tactics of postoperative treatment and outcomes. The installation of 18 or more supporting elements of instrumentation is directly related to surgery duration, intraoperative blood loss volume and the risk of developing grade IIIB and IVA complications. Larger data sets are needed for a more objective analysis of the risk of severe complications for each nosology.

Objective. To create a multifactorial model for predicting the risks of developing clinically significant frontal imbalance in surgical treatment of severe idiopathic scoliosis based on the identification of predictors influencing the main clinical parameters of trunk asymmetry.

Material and Methods. The results of surgical treatment of 288 patients with severe forms of idiopathic scoliosis with a primary thoracic scoliotic curve of types 1, 2, 3 according to Lenke (mean 97.6° ± 15.5° according to Cobb) who underwent surgery in 1999–2019
using posterior segmental instrumentation with hook, hybrid and transpedicular fixation, were analyzed. There were 243 female (84.4 %) and 45 male patients (15.6 %). The average age of patients at the time of surgery was 15.3 [10–39] years. The average postoperative follow-up period was 3.5 [2.0–19.5] years. The analysis included clinical and radiological data obtained in the preoperative, postoperative and late postoperative periods. Predictors of the occurrence of frontal imbalance (the distance from the plumb line to the navel and intergluteal fold more than 15 mm, the tilt of the shoulder girdles more than 5° and the tilt of the scapula more than 15°) were identified by building single- and multivariate logistic regression models.

Results. In the total cohort, 41 (14.2 %) patients with clinically significant frontal imbalance were identified, including 10 (3,0 %) – with an increase in the distance from the plumb line to the umbilicus of more than 15 mm, 12 (4.2 %) – with an increase in the distance from the plumb line to the intergluteal fold of more than 15 mm, 8 (2.8 %) – with a shoulder girdle tilt of more than 5°, and 11 (3.8 %) – with a scapular tilt of more than 15°. A significant predictor of the risk of developing frontal imbalance was determined as postoperative thoracic scoliotic curve of more than 63°. Multiplicative predictors of the risk of frontal imbalance were identified: postoperative increase in the distance from the plumb line to the umbilicus by more than 15 mm and a tilt of the shoulder girdles by more than 5° with a sensitivity of 88.9 % and 100.0 %, and a specificity of 89.5 % and 100.0 %, respectively (p < 0.001).

Conclusion. Identification of multiplicative predictors of the risk of frontal imbalance allows predicting the risk of increasing the distance from the plumb line to the navel by more than 15 mm and the risk of shoulder girdle tilt by more than 5°. To eliminate the risk of frontal imbalance, it is necessary to strive for maximum correction of the thoracic scoliotic curve. When planning surgical treatment using transpedicular fixation for the correction of severe thoracic scoliosis, it is necessary to take into account the patient’s gender and the presence of concomitant neurosurgical, cardiological and pulmonological pathology to prevent shoulder girdle imbalance.

Objective. To perform comparative analysis of the results of endoscopic and microsurgical decompression for lumbar spinal stenosis.

Material and Methods. Design: Retrospective monocentric intra-cohort comparison of two groups of patients. The study included 99 patients aged 51–88 years with clinically significant lumbar spinal stenosis manifested by neurogenic intermittent claudication syndrome. Endoscopic decompression was performed in 51 patients, and microsurgical decompression – in 48 patients. To objectify and standardize clinical symptoms, walking distance in meters, pain syndrome and quality of life were assessed before and after surgery using standard scales and questionnaires (VAS, ODI). On the first day after surgery, back and lower limb pain were assessed, and during the observation period back and lower limb pain, quality of life and walking distance were assessed. Functional lumbar radiography was performed to exclude instability of the spinal motion segment. Using MRI, the cross-sectional area of the dural sac at the level of stenosis was measured before and after surgery. Clinical efficacy was assessed using the MCID (Minimal Clinical Important Difference) criterion. The results of the operation were followed-up for 12 months after the operation.

Results. Blood loss in the endoscopic intervention group was less than in the microsurgical group. Pain in the lumbar spine and in the lower extremities decreased, and the cross-sectional area of the dural sac increased. In the first days after surgery, patients after endoscopic decompression had less severe back and lower extremity pain than patients after microsurgical decompression due to less soft tissue trauma. Pain syndrome in back 10–12 months after surgery was without statistically significant difference between the groups. Patients after endoscopic decompression had statistically significantly better quality of life according to ODI, lesser pain in the lower extremities according to VAS and longer walking distance than those in the microsurgical decompression group. Surgical treatment in both groups turned out to be effective, which is confirmed by MCID. The time of endoscopic intervention is significantly longer than that of microsurgical intervention. The length of the incision during endoscopic decompression is shorter than that of microsurgical decompression.

Conclusion. A comparative analysis of the results of endoscopic and microsurgical decompression for degenerative central lumbar stenosis showed comparable effectiveness of both methods, including an increase in the spinal canal dimension and ensuring regression of clinical symptoms. The results of the comparison do not allow making a sufficiently substantiated judgment on the advantages of one of the methods, which dictates the need for further research.

Objective. To analyze the structure of complications and follow-up results of revision surgeries in patients operated on for chronic nonspecific spondylitis (CNS).

Material and Methods. Revision interventions due to the development of complications corresponding to type IIIB according to Clavien – Dindo classification were performed in 78 patients (mean age 58 years 6 months ± 11 years 2 months) with CNS who had previously undergone reconstructive surgery on the spine. The timing of complications was analyzed according to Prinz classification. The structure of complications and factors potentially influencing their development were evaluated. Predictors of infectious and orthopedic complications were differentiated.  Follow-up period was at least 1 year (M ± m = 3 years 3 months ± 1 year 2 months). Statistical analysis was performed using SPSS, version 22.0.

Results. The estimated frequency of Clavien – Dindo grade IIIB complications after surgical treatment of CNS was 11.3 %. In 44 (56.4 %) of 78 cases, indications for revision surgery were due to infectious complications, and in 34 (43.6 %) – to orthopedic complications. The Charlson comorbidity index was 4.5 ± 1.8 with no intergroup differences between infectious and orthopedic complications (p = 0.052). The duration of primary interventions (p < 0.001) and blood loss (p = 0.010) were higher in patients with infectious complications. The average preoperative ODI was 48.3 ± 13, with a higher value in the infectious complications group (F = 5.146, p = 0.026). The timing of complications and the location of primary reconstruction influenced both the ODI score (F = 6.622, p < 0.001) and the type of complications (Pearson’s χ² = 14.224, p = 0.014). The patient age had no effect on the location of complications (p = 0.349, F value = 1.137). Preoperative neurologic deficit was noted in 23 patients, regression was recorded in 11 cases, including complete in 6 and within the same functional class in 5 cases. The complication rate in the long-term period after revision surgery was 14.1 %.

Conclusion. Infectious complications of primary interventions in patients with chronic nonspecific spondylitis prevail over orthopedic ones. Significant predictors of the development of complications are the patient age > 55 years, the Charlson comorbidity index > 3, duration of surgery > 2 hours 30 minutes, and blood loss volume > 250 ml.

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.

The very first issue of the Russian Journal of Spine Surgery (2004;(1):39–46) published an article entitled “Surgical Treatment for L5 Spondylolisthesis with Transpedicular Fixators”. Twenty years later, the authors analyzed changes in approaches to surgical treatment of spondylolisthesis, taking into account the experience in surgical treatment of this pathology gained at the N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics. The issues of classification, fixation methods, reduction, changes in sagittal balance, the possibility of using additive technologies and possible complications of surgical treatment are considered.

In conclusion, it is noted that the development of surgical treatment methods, the study of biomechanical features, the introduction of additive technologies and much more enable improving the outcomes of spondylolisthesis treatment.

Meeting for spine specialists

Resolution of the VII Congress of Orthopedic Traumatologists of the Siberian Federal District

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