Design: non-systematic literature review. The aim of the study was to analyze the current state of the problem of treating patients with hip-spine syndrome. Diagnosis and treatment of a combination of degenerative pathologies in the hip joints and spine are complicated due to the significant coincidence of the symptoms of the diseases. Loosening of hip endoprosthesis components remains the second most common cause of revision surgery after infection. Increasing awareness of the mobility of the spinopelvic complex, as well as taking into account the sagittal alignment of the trunk, are important for improving the quality of surgical treatment of patients with hip-spine syndrome. Currently, there is no established tactical surgical algorithm for treating patients with hip-spine syndrome: there is no consensus on which pathological condition should be treated first, and algorithms for the sequence of surgical treatment of the spinopelvic complex require supplementation and consolidation by prospective studies. 

Objective. To analyze the correlation of the acetabular component (AC) position criteria with the sagittal balance criteria in pelvic translation associated with body posture change from a standing to a sitting position and vice versa.

Material and Methods. A prospective study of 20 patients who underwent hip arthroplasty for unilateral coxarthrosis, in the absence of signs of arthrosis and dysfunction of the contralateral joint was conducted. A the 20th week after surgery, an X-ray examination of the spine and hip joints was performed with an analysis of anteversion, inclination, AC anteversion, PT, SS, PTsit. A search for correlations between the indicators was carried out using the Spearman correlation method. Numerical associations were identified by calculating the Pearson correlation coefficients. Statistical hypotheses were tested at a critical significance level of 0.05, i.e. the difference was considered statistically significant when the level of p <0.05 was achieved.

Results. A direct correlation was found between the changes in the sagittal balance parameters (SS, PT) and the AC position. Comparison of the mean values and medians of the studied parameters measured in the standing and sitting positions showed the high correlation between them. The same dynamics of changes in the values between the AC anteversion and pelvic PT parameters was noted. A high direct correlation of the difference (Δ) in the AC anteversion values with PT in standing position, and a strong correlation of Δ in the AC anteversion values with PT in sitting position indicates an indirect relationship between the sagittal balance parameters and the AC position parameters through the AC anteversion parameter. This is confirmed by the strong direct correlation of Δ (sitting/standing) PT with Δ (sitting/standing) AC inclination (0.67) and Δ (sitting/standing) AC anteversion (0.82), and by an inverse correlation of Δ (sitting/standing) SS with Δ (sitting/standing) AC inclination and Δ (sitting/standing) AC anteversion (–0.7).

Conclusion. Comparison of sagittal balance parameters (SS, PT) measured in standing and sitting positions with the position of the AC showed their direct high correlation with each other.  Acetabular anteversion serves as a connecting criterion between sagittal balance parameters and the spatial position of the acetabular cup.

Objective. To determine the most valid biomechanical indicators of the stability of spinal motion segments in the lumbar spine, their normal values, and reproducibility for use in clinical practice of surgical treatment of degenerative diseases.

Material and Methods. To identify the most significant and sensitive criteria for assessing the biomechanics of the spinal motion segments in the lumbar spine, 4784 publications were selected using the PubMed and eLibrary search systems, of which 16 articles were selected after evaluation according to the established inclusion and exclusion criteria and served as the basis for further analysis.

Result. All segmental stability indices are divided into 3 groups: clinical, radiological and experimental. The rather subjective nature of clinical criteria is noted, including mainly either pain assessment during palpation or assessment of motor activity. At the same time, pain did not show a reliable connection with the presence of instability and can also be associated with radicular syndrome. Radiological instability criteria (static and functional radiography, CT) are in error against the background of severe pain syndrome due to reflex muscle spasm or due to limitations of the studies themselves. Based on preoperative examination data, it is quite difficult to predict the possible magnitude of instability after decompression during surgery. Biomechanical indices that are established under experimental conditions include the volume of angular motion, elasticity of the spinal motion segment, the size of the neutral zone and intradiscal pressure.

Conclusion. An obvious limitation is the current lack of technical capability for intraoperative measurement of experimental load indices in vivo. Development of technologies in this direction with accumulation of data and analysis of specificity and reproducibility of criteria will improve diagnostic protocols, and planning the volume and options of surgical treatment.

Objective. To determine experimentally the mechanical conditions required for decompression of the dural sac and spinal nerve roots during pedicle-lengthening osteotomy (PLO) with elongation of pedicles at the lumbar level.

Material and Methods. The experiments were conducted on three cadaver specimens of L1–L5 vertebral motor segments obtained at the forensic section from individuals aged 45–60 within two days after death in compliance with the standards for preparing human tissue for biomechanical studies. The contents of the vertebral and root canals were removed from the specimens of the lumbar spine, leaving all elements of the osteoligamentary support complex intact. Three experiments were conducted on each specimen. In the first experiment, bilateral pedicle lengthening osteotomy imitating PLO was performed on the L4 vertebra of the anatomical specimen. In the second experiment, osteotomies of the inferior articular processes of L3 at the level of their base were performed on the same specimen in order to mobilize the posterior support complex. In the third experiment, bilateral pedicle osteotomy was additionally performed on the L3 vertebra. The described experiments were repeated three times on three anatomical specimens. The obtained data were recorded in protocols, and then statistical processing was performed using descriptive statistics methods. The sets of study results measured on a quantitative scale for normality were checked using the Kolmogorov–Smirnov Z-criterion. To prove the statistical significance (or lack thereof) of the values of the compared parameters, the Mann–Whitney U-test was used. Results were considered significant if the level of statistical significance p was less than or equal to 0.05.

Results. The increase in the sagittal spinal canal size after PLO due to the elongation of the L4 pedicles by 4 mm is achieved with a traction force of 97 N, by 5 mm – with 162 N, by 6 mm – with 240 N, and by 7 mm – with 306 N. Mobilizing osteotomy of the inferior articular processes of the L3 reduces the traction forces necessary for decompression to 30 N, 73 N, 125.5 N, and 182 N, respectively, which is 1.7–3.2  times less than the PLO values without mobilization. Additional bilateral pedicle osteotomy on the overlying L3 vertebra does not provide further decrease in the traction forces necessary to increase the sagittal size of the spinal canal.

Conclusion. The technique of decompression of the dural sac and nerve roots in the lumbar spine by means of pedicle-lengthening osteotomy with elongation of pedicles is a promising option for surgical treatment of lumbar spinal stenosis. The data obtained in this study may be of interest, especially with the possible development of another technical solution and instrumentation for implementing PLO.

Objective. To analyze the correlations and dependencies of parameters of the cervical sagittal balance, as well as the corresponding compensatory mechanisms on the example of children without orthopedic pathology and children with Down syndrome.

Material and Methods. Digital radiographs of 110 children were used to evaluate the mutual influence of cervical sagittal balance parameters. The age range was 4-17 years. Group 1 included 60 children without identified orthopedic pathology: 26 boys and 34 girls, with an average age 11 years (7.0–14.0 years). Group 2 included 50 children with Down syndrome: 24 boys and 26 girls, with an average age 9 years
(7.0–12.0 years). Based on the digital radiographs, eight key angular parameters of cervical sagittal balance were assessed: O–C2,
O–C7, C1–C2, C2–C7, C7S, T1S, TIA, NT. Statistical analysis of the data was performed using rank correlation analysis and multivariate regression.

Results. In the assessment of rank correlations, the leading positive correlation between the cervical lordosis and thoracic inlet angle (TIA) values was determined. Based on the results of multivariate regression, the main trends in the change in key angles of the cervical sagittal balance in children were determined. An increase in TIA by 1° leads to increase in the C2–C7 angle by an average of 0.6° (p = 0.004) and the C1–C2 angle by 0.4° (p = 0.028) for both girls and boys without identified orthopedic pathology. This rule is also equivalent when the TIA angle decreases with age. At the same time, girls have C2–C7 angle on average 2.9° (p = 0.021) larger and C1–C2 angle 1.2° (p = 0.112) larger than boys. Similar trends are true for children with Down syndrome, but with a less pronounced regression effect of factors. Thus, in children with Down syndrome, an increase in TIA by 1° is associated with a mean increase in the C2–C7 angle by 0.5° (p = 0.004) and  the C1–C2 angle by 0.2° (p = 0.035). Girls have C2–C7 angle on average by 3.1° (p = 0.018) larger than boys. A similar dependence could not be determined for the C1–C2 angle.

Conclusion. The cervical spine, despite its high mobility, has a clear connection with the underlying spine departments. In our work, we succeeded in proving that the thoracic input angle (TIA) having small variability for each specific child, is the basis for the formation of cervical lordosis C2–C7 and local lordosis at the level of C1–C2. The formulas obtained as a result of building the regression models allow, knowing the TIA value, the age and gender of the child, to calculate the theoretical value of C2–C7 and C1–C2 values. This may help to identify signs of both sagittal imbalance and atlantoaxial instability in different groups of children, including those with Down syndrome. At the moment, the obtained formulas are theoretical and need further validation.

Objective. To analyze dynamics of changes in the parameters of the sagittal balance of the cervical spine against the background of surgical treatment of destructive tumor and infectious inflammatory pathology of the cervical vertebrae in children.

Material and Methods. Design: retrospective-prospective monocentric cohort. A total of 81 radiographs of the cervical spine in a standing position before and after surgery in children operated on for vertebral tumors and cervical spondylitis were selected. The 10 most common parameters were measured: angular values of Oc–C2, C2–C7, C7S, T1S, TIA, NT, CeT, CrT, SCA, as well as the cSVA distance measured in mm. The material was statistically processed using nonparametric analysis methods.

Results. In case of suboccipital lesions, the most significant changes were in the Oc–C2 and CrT parameters, in case of subaxial lesions — Oc–C2, C2–C7, and in case of cervicothoracic junction lesions — C2–C7, C7S, T1S, TIA, NT, CeT, and CrT. Significant difference  between the groups was noted only for NT parameter between the norm and the group of cervicothoracic junction pathology after surgery (p = 0.0190). In case of tuberculous spondylitis, the greatest changes were noted in TIA, NT, CeT, SCA and cSVA parameters. Significant differences were also revealed only for NT parameter between the postoperative groups of tuberculous spondylitis and tumors (p = 0.0016), as well as between the group of tuberculous spondylitis after surgery and the norm group (p = 0.0013). In case of extensive (3 or more vertebrae) destruction, the NT parameter differed from the norm both before (p = 0.0174) and after (p = 0.0059) surgical treatment. The cSVA parameter differed from the norm in case of short destructions only before surgical correction (p = 0.0195), while in case of extensive destructions it differed from the norm only after surgical reconstruction (p = 0.0212).

Conclusion. Studying the issues of spine biomechanics in pathological conditions allows for better understanding the changes that occur and propose effective methods for correcting and restoring the normal anatomy of the segment.

Objective. To perform comparative analysis of the components of dynamic somatosensory evoked potentials (DSSEP) from the upper and lower extremities with varying grades of central cervical spinal stenosis (CSS) in patients with mildly symptomatic and asymptomatic course of the disease.

Material and Methods. The retrospective monocentric study included 56 patients (29 men and 27 women; age 54.8 ± 9.6 years) with CSS examined in 2019–2024. In accordance with the grading system of Kang et al., patients were divided into three groups: Group 1 included 25 patients with grade 1, Group 2 – 23 people with grade 2, and Group 3 – 8 patients with grade 3. All patients underwent DSSEP examination from the upper and lower extremities in the neutral position and in flexion and extension positions of the neck at an angle of 45 Changes in the amplitude of the cortical peak N20, the spinal peak N13 and the interpeak interval N9–N20 were assessed when recording dynamic DSSEPs from the upper extremities. The changes in the amplitude of the cortical peak P38 were assessed when recording DSSEPs from the lower extremities. In addition to assessing the absolute values of the indicators, the index of change in the indicators was calculated.

Results. In the neutral position, statistically significant differences were found between groups 1 and 3 in the amplitude of the N20, N13 and P38 components and the N9–N20 interpeak interval. Statistically significant differences were also found between groups 2 and 3 in N20, N13, P38 peaks and the N9–N20 interval. At the same time, statistically significant differences were not found between Groups 1 and 2. When assessing the dynamic SSEPs, patients in Group 1 showed a statistically significant decrease in the N20 amplitude in the extension position and an increase in the N9–N20 latency in the flexion position. In Group 2, in addition to a statistically significant decrease in the N20 amplitude in the extension position and an increase in N9–N20 latency in the flexion position, a statistically significant decrease in the N13 amplitude was noted both in the flexion position and during extension. In Group 3, a statistically significant decrease in the amplitude of N13 during extension and of P38 during flexion was revealed. When analyzing the index of change in the indicators, no significant differences were found between the groups, however, statistically significant differences were recorded for the N9–N20 interval between Group 1 and Group 3, as well as between Group 2 and Group 3 without statistically significant differences between Group 1 and Group 2.

Conclusion. The use of dynamic SSEPs allows for an objective assessment of the degree of damage to the cervical spinal cord in patients with asymptomatic central stenosis of the cervical spinal canal of varying grades. Further multicenter studies are needed to clarify the reference values of dynamic SSEP parameters and, taking them into account, to develop clear criteria for selecting candidates for surgical treatment.

Objective. To study the epidemiology and clinical features of spinal injuries and wounds in combat situations.

Material and Methods. A systematic literature review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using PubMed and Cochrane Library databases. Statistical analysis of the data was performed using the R statistical programming language in the RStudio integrated development environment. The meta and metafor libraries were used for meta-analysis. The Knapp-Hartung correction was used to calculate the confidence intervals of the pooled effects.

Results. Of the 30 full-text articles, 11 met the required criteria and were included in this review with STROBE assessment. The mean age of the injured was 26.58 years (95 % CI: 25.8–27.4 years; I² = 0 %; p = 0.65), males accounted for 98 % (95 % CI: 98–99; I² = 37 %; p = 0.1), closed spinal cord injury was diagnosed in 47.11 % of cases (95 % CI: 28.83–66.19 %; I² = 99 %; p < 0,01), and gunshot wounds – in 43.64 % (95 % CI: 23.94–65.59 %; I² = 99 %; p < 0.01). Cervical injures were recorded in 32.13 % of cases (95 % CI: 17.75–50.94 %; I²  = 95.1 %; p < 0.01), thoracic injuries – in 34.28 % (95 % CI: 22.58–48.27 %; I² = 88 %; p < 0.01), lumbar injuries – in 57.16 % (95 % CI: 44.52–68.92 %; I² = 97.5 %; p < 0.01), and sacral – in 21.23 % of cases (95 % CI: 16.99–26.21 %; I² = 76 %; p < 0.01).

Conclusion. The results emphasize the peculiarities of the modern epidemiology of combat related spine and spinal cord injuries and wounds. Conflicts of the 21st century are characterized by the predominance of mine and explosive action; as a rule, young people suffer, the overwhelming majority of them are men; at least 30 % of wounded with gunshot injuries to the spine require surgical treatment. The vast majority of authors choose isolated posterior fixation. The most common complications include thromboembolic complications, urinary tract infections, pneumonia and bedsores.

Objective. To assess the inter- and intra-expert reliability of measurements of spinopelvic parameters using the SmartPlan Balance mobile application.

Material and Methods. The following spinopelvic parameters were measured on postural radiographs of patients with degenerative spine diseases: pelvic index (PI), pelvic tilt (PT), sacral slope (SS), total lumbar lordosis (LL), and lower lordosis L4–S1 (LowLL). The measurements were performed by three experts using the SmartPlan Balance mobile application and the Radiant DICOM Viewer desktop program. The values obtained by the mobile application and by the computer program were compared. The inter-rater reliability of the measurements obtained using SmartPlan Balance was calculated. After repeated measurements of parameters using the SmartPlan Balance, the intra-rater reliability was calculated for each expert.

Results. No statistically significant differences were found when comparing consecutive measurements of all experts for each parameter with each tool (Radiant DICOM Viewer and SmartPlan Balance); p > 0.05. The Pearson correlation coefficient ranged from 0.83 to 0.95 (PI: r = 0.956; PT: r = 0.912; SS: r = 0.865; GLL: r = 0.943; LowLL: r = 0.839) regardless of the specific expert or method. The inter- and intra-rater reliability of measurements by the SmartPlan Balance application had excellent or good reliability: the most stable and highest value of the intra- and interclass correlation index (ICC) was determined for the LowLL parameter (0.85–0.92), and the lowest ICC consistency values were found for the PT parameter (0.75–0.81).

Conclusion. Measurements of spinopelvic parameters using SmartPlan Balance demonstrate high reliability and reproducibility, comparable to the standard desktop program. The use of the SmartPlan Balance mobile application is recommended in the daily practice of each spine surgeon, particularly in surgical planning, intraoperative parameter measurements, and analysis of non-digital radiographs.

* The application is available on the Android platform via the QR code provided at the end of the article.

Objective. To prove the possibility of using a domestic computer program in clinical practice to determine Cobb angle by means of comparative analysis of the obtained automated data with the data of manual measurement by specialists.

Material and Methods. A total of 411 digital x-rays of the spine of children and adolescents were selected from the medical database of Prosthetic and Orthopedic Center «Scоliologic.ru». They were measured by a radiologist with significant experience in vertebrology
(VR-standard), by a radiologist without experience in vertebrology (R-beginner) and a computer program (CP). The CP data were compared with the standard twice – initially (CP1) and after fine-tuning (CP2). The mean absolute error and mean absolute deviation of the standard data of Cobb angle measurements were analyzed when compared with the indicators obtained by R-beginner, CP1 and CP2 for different types of scoliosis according to the Rigo classification, and in determining the main curve of different magnitude from 20° to 41° and more. The Pearson coefficient (R) and the intraclass correlation coefficient (ICC) were calculated.

Results. After fine-tuning, the domestic computer program improved the accuracy of measurement in general for curves and types of  scoliosis, exceeding the R-beginner indicators almost twice in mean absolute error. The previously identified program drawback in measuring the magnitude of the lumbar (lumbosacral) curve was eliminated. The CP2 data have the highest correlation with the standard (R = 0.94). The excellent level of reliability of the program (ICC = 0.95 when counting on the main curve and 0.97 when counting on all curves) comparable with foreign analogues was proved. It was also confirmed that the average absolute deviation of ±3.2° and ±4.0° for the main curve corresponds to foreign data.

Conclusion. It is possible to conclude that the domestic computer program may be validated, since it has been proven that when compared with a reference measurement, its current algorithm provides accuracy higher than that of a radiologist with no experience in vertebrology, and is comparable with foreign analogues.