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The literature review considers the pathophysiology of autofusion, its frequency, and the consequences of the spontaneous bone block development in growing children, as well as the necessity of final fusion using segmental instrumentation and bone grafting in surgery
for early onset scoliosis. The article presents the authors’ own material on the surgical treatment of 131 patients with early onset scoliosis of various etiologies using VEPTR instrumentation, of which 84 patients completed the cycle of multi-stage treatment. During stage
distractions and final fusion, the presence of spontaneous bone blocks of various localizations was ascertained. At the points of distraction rod fixation, the signs of autofusion were noted in 100 % of cases. There was not a single case of posterior vertebral autofusion along the apical and periapical zones of the main curve. In 21 patients, 22 complications were detected that required repeated intervention after the final fusion. The presented experience shows that the final stage of surgical treatment of patients with early onset scoliosis should include removal of VEPTR rods, correction of the deformity with segmental instrumentation and spinal fusion with local autobone along the entire length of the curvature.

Objective. To analyze the literature data on treatment tactics for patients with spondylolysis of the lumbar vertebrae, and to determine indications for surgical treatment, types of surgical interventions, criteria for assessing treatment results, complications and rehabilitation after treatment.

Material and Methods. Full text articles were selected from the Pubmed, EMBASE, eLibrary, Google and Yandex databases. The type of articles was a systematic review and meta-analysis, and the search period was 10 years. The literature search was carried out by three researchers. The study was conducted in accordance with the international PRISMA guidelines for writing systematic reviews and meta-analyses. The levels of evidence reliability and gradation of strength of recommendations were assessed according to the ASCO protocol.

Results. A total of 6812 articles on the topic under consideration were found, of them 4922 articles with full text, 2155 over the past 10 years, 115 systematic reviews and meta-analyses. Fourteen articles met the inclusion criteria.

Conclusion. Indications for surgical treatment of spondylolysis are the failure of conservative treatment for 6 months, worsening of clinical symptoms, and development of spondylolisthesis. The goal of the surgery is bone fusion formation at the level of the defect, restoration of  spinal stability and preservation of mobility of the corresponding segment. Surgical treatment methods for spondylolysis using transpedicular screws and a beam (Gillet) showed a higher fusion result than the Scott and Morscher methods. Minimally invasive methods (Buck method and its modifications) provide better functional results. The highest complication rate is observed in surgical interventions using the Scott method (wire rupture, transverse process fracture, lack of fusion) and those using the Morscher method (superficial infection, instability of implants and persistent back pain). The choice of surgical method should be based on the surgeon’s preferences and experience.

Objective. To explore results of transpedicular screws insertion in extremely small pedicles using two-part navigation template.

Material and Methods. Eleven consecutive patients with spinal deformities were included in the study. During surgery pedicle screws were implanted using two-part navigation templates with metallic adapter that allow to guide screw insertion as well as pedicle drilling (total of 98 screws including 60 screws in pedicle width lesser than 3.5 mm). Retrospective control group consisted of 46 patients treated using common design navigation templates that guide pedicle drilling only (total of 294 screws including 106 screws in pedicle width lesser than 3.5 mm). Malpositions with “empty” correct transpedicular channel and without one were reported separately.

Results. In extremely small pedicles malposition without “empty” transpedicular channel (due to navigation template misplacement) rates were similar in both groups (8.3 % vs. 8.5 %; p > 0.05). Meanwhile malposition with “empty” transpedicular channel (because of secondary screw deviation) rate was significantly less in two-part template group than in common design template group (3.6 % vs. 17.5 %; p < 0.05).

Conclusion. In pedicle width less than 3.5 mm application of two-part navigation template guiding transpedicular channel drilling and screw insertion allows to reduce the rate of malposition due to secondary screw deviation significantly, while the difference in malposition rate because of template misplacement is insignificant as compared with navigation template of common design.

Objective. To analyze clinical and radiological results of staged surgical interventions in the treatment of patients with posttraumatic kyphosis of the lumbar spine and to identify a mechanism of deformity compensation.
Material and Methods. The data obtained from the case histories of 42 patients operated on for clinically significant posttraumatic kyphosis at the L3 and L4 vertebral levels were studied. Patients underwent staged surgical interventions in one surgical session. Demographic data and radiological results of surgical treatment were evaluated.
Results. As a result of surgical interventions, local kyphosis was corrected on average by 29.66° ± 13.83° from 15.48° ± 13.04° to
-14.19° ± 8.85°. After correction of posttraumatic kyphosis, statistically significant changes in the parameters of sagittal curvatures of the spine were revealed: an increase in thoracic kyphosis (TK) and lumbar lordosis (LL), changes in the parameters of the spinopelvic balance PT and SS with a p-level < 0.05, as well as in the global angle (p < 0.001) were noted. According to the GAP scale, 26 (61.9 %) patients
moved to a more balanced category. A correlation (r = 0.45; p < 0.05) was found between the indices of local kyphosis and the GAP scores before surgery. The total duration of all surgical stages was 318 [150; 600] minutes, and blood loss was 677 [150; 1800] ml. In 9 (21.4 %) patients, 12 intra- and postoperative complications were noted.

Conclusion. The main compensatory mechanisms of posttraumatic deformities with the apex at L3 and L4 vertebrae are a decrease in thoracic kyphosis, the thoracolumbar lordosis and pelvic retroversion. Staged surgical treatment for posttraumatic spinal deformities significantly improves the parameters of the spinopelvic and global sagittal balance. It ameliorated the sagittal profile of patients in 61.9 % of cases and was accompanied by moderate duration of surgery and intraoperative blood loss and an acceptable number of complications.

Objective. To evaluate the effect of systemic application of cryopreserved human umbilical cord blood mononuclear cells (hUCB-MNCs) in the acute period of spinal cord contusion injury (SCI) on the volume of zone of the spinal cord damage using high-field MRI.

Material and Methods. This study was performed on adult female Sprague-Dowley rats. Severe contusion SCI was modeled using the weight-drop method. Cryopreserved hUCB-MNC concentrate, stored in a cryobank for 3–4 years at –196º°C, was administered intravenously 1 day after injury. Locomotor behavior was assessed when animals moved in an open field using the BBB (Basso – Beatty – Bresnahan) scale for rats. MRI examination of the spinal cord was performed using a Clin Scan 7.0 T device.

Results. At week 6 after injury, a significant increase in the level of restoration of the motor function of the hind limbs (~10 %) was observed in the cell therapy group using hUCB-MNCs relative to the level of the self-healing group (p < 0.05). At the same time, the area of the posttraumatic cystic cavity decreased significantly (~45 %) and statistically significantly (p < 0.05), as well as its transverse (~38%) and longitudinal (~41 %) dimensions.

Conclusion. Cryopreserved hUCB-MNCs may be an effective and affordable means of cell therapy for contusion SCI when used in the acute period of injury.

Objective. To assess trends in the management of patients after surgical treatment for degenerative diseases of the spine and to analyze literature data on perioperative management of this category of patients.

Material and Methods. An anonymous online survey of 55 spine surgeons was conducted   on the specifics of management of patients operated on for spinal stenosis and intervertebral disc herniation using microsurgical and endoscopic methods. The results of the survey were analyzed along with relevant literature data to provide a comprehensive understanding of the current practices in this field.

Results. The analysis of questionnaires showed that there are significant differences and contradictions among surgeons regarding the use of antibiotics, restrictions on sitting after surgery, length of hospital stay, and use of a lumbar orthosis. A review of the world and domestic literature revealed a sufficient evidence of some studies to support their use as recommendations, while there is still a lack of evidence for most of the issues raised.

Conclusion. Existing statements and protocols for the treatment of patients undergoing spine surgery need to be improved; randomized studies are required to establish the optimal approach for perioperative management of this group of patients.

Objective. To determine the timing and to identify predictive factors of resorption of lumbar intervertebral disc herniation.

Material and Methods. This study is retrospective cohort and is devoted to the study of two groups of patients: Group 1 with herniated disc resorption and Group 2 with no resorption. All patients underwent MRI of the lumbar spine at the onset of initial symptoms, and the second study was conducted during the second visit. Based on the MRI results, the following parameters were assessed: the degree of intervertebral disc degeneration according to the Pfirrmann classification, the degree of facet joint degeneration according to the Grogan classification, the type of hernia, the degree of migration of the hernial fragment according to the Komori classification, Modic changes, the state of the endplates according to the Rajasekaran classification, the presence of retrolisthesis and the presence of resorption of the hernial fragment in dynamics. The Syngo.via workstation was used to measure the volume of the hernial fragment. Resorption of a disc herniation was considered to be a decrease in its volume by more than 50 % of the initial value with mandatory relief of radicular pain syndrome. The identification of resorption predictors was performed by building logistic regression models. Single-factor models were used to identify individual predictors associated with the target event. For continuous indicators, the ROC analysis identified the maximum cut-point values according to the Youden’s index.

Results. Group 1 included 141 patients, and Group 2 (comparison) – 93. Statistically significant differences between groups were found in several parameters. The average age of patients was 6 years younger; the interval between MRI studies was on average 2 months longer; and the protrusive type hernias were more in Group 2 than in Group 1. Gender, body mass index, the presence of retrolisthesis and smoking habit did not differ significantly between the groups. In Group 2, there were more cases of hernia at the L5–S1 level, which is associated with a higher incidence of hernia at this level. Using logistic regression models, it was revealed that hernia volume, hernia type according to the Komori classification, body mass index and Modic changes are significant factors for hernia resorption. A hernia volume of more than 1.1 cm³, no Modic change, hernia types II and III according to Komori, and body mass index of less than 30.24 increase the chances of disc herniation resorption.

Conclusion. The average time to resorption of herniated lumbar disc is 5.5 months. Factors that predict the resorption include types II and III of hernia according to the Komori classification (correspond to sequestered herniation), the absence of Modic changes, hernial fragment volume larger than 1.1 cm³, and body mass index less than 30.24.

Objective. To analyze the features of zonal localization of osteoid osteoma and osteoblastoma and the results of their surgical treatment in pediatric patients.

Material and Methods. The data of 41 children aged 4 to 17 years who underwent surgery for osteoid osteoma (29) and osteoblastoma (12) of the vertebrae were compared retrospectively within a monocentric cohort. The features of the tumor zonal location and the results of surgical treatment were assessed taking into account the risk of relapse and the need for instrumental stabilization.

Results. Osteoid osteoma and osteoblastoma are localized in the posterior structures of the vertebrae (sectors 2–4 and 9–11 according to the Weinstein – Boriani – Biagini classification) in 93 and 75 %, respectively, with a predominance of right-sided localization of osteoid osteoma (sector 9–11). Osteoid osteomas are predominantly located in zones B and C, while the spread of osteoblastomas to zone D indicates a more aggressive course with the possibility of developing neurological symptoms in 50 % of cases. Complete removal of tumors in the volume of marginal resection due to unilateral localization in the posterior elements of the vertebra is safe and allows, in the absence of intraoperative destabilization, to complete the operation without additional instrumental fixation; local bone fusion is sufficient to prevent local instability.

Conclusion. Osteoid osteoma and osteoblastoma of the vertebrae in children differ in localization, zoning according to the Weinstein – Boriani – Biagini classification, and clinical aggressiveness of the course. Features of intraorgan zoning of tumors with proximity to nerve structures limit the use of ablation technologies, while wide marginal resection provides a full-fledged cure. The need for instrumental stabilization of the spine depends on the volume of resection.

Objective. To evaluate the effectiveness of surgical treatment of nonspecific spondylitis in the area of craniovertebral junction taking into account the clinical and pathomorphological features of the disease.

Material and Methods. The study included 11 patients with nonspecific craniovertebral spondylitis: 4 women and 7 men aged 31 to 75 years. In 8 patients, the clinical picture was represented by neurological symptoms, and in 3 – by pain syndrome. Combined interventions were performed in 7 patients who had compression of the spinal cord and medulla oblongata. Of these, 5 patients first underwent transoral decompression, and then occipitospondylodesis. In the rest patients, the sequence of surgical treatment had the reverse order. In 6 cases, combined operations were performed simultaneously, and in one case — with an interval of 7 days. In one patient, the first stage was external ventricular drainage of hydrocephalus due to occlusion of the cerebrospinal fluid pathways by a displaced odontoid process, and the second stage was transoral decompression. Patients with pain syndrome underwent occipitospondylodesis. In one case, after combined surgery, ventriculoperitoneal shunting was performed for aresorptive hydrocephalus that developed after meningitis.

Results. In 10 patients, the pain intensity according to VAS decreased by 5–7 points (6.3 on average) in the postoperative period. Out  of 8 patients with conductor symptoms, regression of neurological disorders after surgery was achieved in 3, complete recovery (Frankel E) in 4, and one patient died of purulent ventriculitis. Control examination of 10 patients confirmed the relief of the inflammatory process and the absence of compression of the spinal cord and medulla oblongata. Among the early postoperative complications, one case of  postoperative liquorrhea and the divergence of the edges of the wound of the posterior pharyngeal wall were recorded. Fracture of metal structure elements was observed in one patient 3 years after surgery.

Conclusion. In nonspecific craniovertebral spondylitis, an active surgical tactic is justified. Occipitospondylodesis at an early stage of the disease allows to eliminate atlantoaxial instability and prevent the associated risk of neurological complications. In conduction disorders, if the patient’s condition allows, simultaneous transoral decompression and craniocervical fixation is the best option for surgical treatment of nonspecific spondylitis of the craniovertebral region. Preservation of mobility in the cervical spine facilitates the transoral stage, therefore occipitospondylodesis is advisable to be performed at the second stage.

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