Objective. To analyze the causes of subsidence of modern support cages for vertebral body replacement in the early postoperative period after surgical treatment of thoracolumbar spine injuries.

Materials and Methods. A retrospective analysis of the data of 46 patients operated on in a single surgical session for unstable injuries of the thoracolumbar spine using a telescopic extendable vertebral body cage was performed. The degree of cage subsidence was assessed according to the criteria of Marchi et al.:  penetration of the implant into the body of the adjacent cranial or caudal vertebral by 25% – grade 1,
25–50% – grade 2, 50–70% – grade 3, 75–100% – grade 4. A comparative assessment of demographic, clinical, and radiographic parameters was performed in patients with and without cage subsidence within one year after surgery.

Results. Implant subsidence was detected in 76.5% (n = 13) of patients intraoperatively and in 23.5% (n = 4) after 4 months during an outpatient appointment. Subsidence into the cranial body prevailed (76%, n = 13). The anterior/posterior sequence of surgery stages combined with osteopenia and osteoporosis dominated in the study group (83.3%, n = 10). Quantitative parameters such as age, segmental angle, ROI in HU, surface contact area index, as well as qualitative parameters such as female gender, period of injury, and its low-energy nature had statistically significant differences between the study and control groups (p < 0,05). The augmentation of the screws and the length of fixation did not affect the formation of subsidence, but were associated with its magnitude.

Conclusion. The use of modern expandable body replacement cages for reconstruction of the anterior spinal column leads to their subsidence in some cases. Patient age, female gender, reduced bone density, the area of the bone-implant contact, anterior/posterior stabilization, and the late period of injury significantly affect the formation of subsidence when using expandable vertebral body replacement cages. A mean implant-to-vertebral endplate contact area ratio of less than 0.4 is a promising predictor of subsidence which requires further study.

Objective. To evaluate the effectiveness of transpedicular reposition planning in patients with single-level injuries of the thoracic and lumbar vertebrae, depending on the target parameters.

Material and Methods. The study included two representative groups, retrospective and prospective, each of 80 patients with thoracic and lumbar fractures with an average age of 39.2 ± 2.2 years. In the prospective group, morphometry of the spine was performed using CT data, to plan the restoration of the vertical dimensions of the vertebral body and closed decompression of the contents of the spinal canal using a transpedicular repositioning system within up to a month from the moment of injury. Based on the results of morphometry, the main target parameters were calculated, which were aimed at being achieved during the operation.

Results. In the main group, the lumen deficit significantly decreased (from 39.5 ± 4.1% to 14.2 ± 3.1%) versus that in the control group (from 39.3 ± 4.6 to 22.1 ± 5.1%; p = 0.01), as well as the cross-sectional area of the spinal canal (from 37.4 ± 5.1% to 14.2 ± 3.1%) versus that in the control group (from 39.6±5.3% to 24.1 ± 5.5%; p = 0.01). The anterior vertebral body height was maximally restored, and the magnitude of bone fragment displacement into the spinal canal decreased (t < 0.05). A direct correlation was found between the size of the interbody spaces and the height of the vertebral body: between the anterior interbody space and the anterior height of the vertebral body in the main group – r = 0.485, in the control group – r = 0.594; and between the posterior interbody space and the posterior height of the vertebral body in the main group – r = 0.309, in the control group – r = 0.252. A strong correlation was obtained between the posterior height of the vertebral body and the spinal canal: r = 0.625 in the main group, r = 0.461 in the control group. The difference between the initial and calculated angle after surgery was 3.1° ± 0.5° in the main group and 5.6° ± 1.2° in the control group (p = 0.01).

Conclusion. Preoperative planning which includes the use of calculated target parameters such as interbody spaces and segmental angles during surgery, allows for the maximum restoration of the vertical dimensions of the injured vertebral body and the performance of closed decompression of the spinal canal contents.

Objective. To perform a systematic analysis of contemporary scientific data characterizing the clinical effectiveness of expandable implants for vertebral body replacement in the complex surgical treatment of patients with thoracic and lumbar spine injuries.

Material and Methods. The search for scientific sources was carried out in accordance with the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA principles in the Cochrane Library, PubMed and Medline databases for  the period 2015–2025 A total of 19 studies on the radiological and functional outcomes of the surgeries involving implantation of expandable spinal cages for thoracic and lumbar spine injuries were analyzed.

Results. The technologies for spinal surgery have been developing rapidly over the recent decades. The improvements in minimally invasive techniques have required modifications to implants including those for anterior support spinal fusion. The implants of transformable geometry which allow the replacement of spinal defects that significantly exceed their original dimensions are of particular interest. The contemporary expandable spinal cages vary in the material they are made from and their transformation mechanisms. The literature describes successful cases of their use in thoracic and lumbar spine injuries. The authors demonstrate favorable surgical outcomes using combinations of screw-assisted fusion and interbody implants.

Conclusion. Expandable spinal cages feature a wide range of applications in the treatment of spinal injuries. The advent of vertical lift mechanisms in intervertebral implants has led to a trend towards modifying surgical techniques, particularly the sequence of intervention stages. Despite differences in approaches, specialists favor minimally invasive implant placement, with radiographic and functional results showing no significant differences.

Objective. To establish the types of autonomic regulation in patients with adolescent idiopathic scoliosis based on the analysis of heart rate variability at the preoperative stage.

Material and Methods. The study included 69 adolescents with idiopathic scoliosis, who underwent cardiointervalogram recording with subsequent spectral analysis at rest and during an active orthostatic test in order to assess the reserves of autonomic regulation. Very low frequency oscillations of the spectrogram, stress index of regulatory systems, and the total power of the spectrum were analyzed. Four types of autonomic regulation were determined: type I with moderate predominance of sympathetic and central regulation, type II with pronounced predominance of sympathetic and central regulation, type III with moderate predominance of parasympathetic regulation, and type IV with pronounced predominance of parasympathetic regulation.

Results. At rest, a moderate predominance of sympathetic activity and central regulation with moderate stress of regulatory systems, or type I regulation was observed in 15 (22%) patients; a sharp increase in the activity of central regulation with the development of a state of vegetative dysfunction, or type II regulation – in two (3%) patients; a moderate predominance of parasympathetic activity, or type III regulation – in 39 (56%) examined patients; and a pronounced predominance of parasympathetic regulation with overstrain of the regulatory systems, or type IV regulation – in 13 (19%) patients. After the orthostatic test, most of the examined patients, 44 (64%), had type I regulation, while type II was registered in seven (10%) patients, type III – in 14 (20%), and type IV – in four (6%) patients.

Conclusion. The background state of autonomic regulation of the heart rate in most adolescents with idiopathic scoliosis reflects the stability of adaptation mechanisms. Orthostatic testing allows identifying cases of instability of regulatory system associated with the risk of hemodynamic instability due to the moderate predominance of sympathetic autonomic regulation observed in most patients.

Objective. To determine the impact of isolated decompression of intracanal neurovascular structures of the spine on sagittal balance in patients with degenerative lumbar stenosis. Study registration number: NCT07139938, clinicaltrials.gov.

Material and Methods. Adult patients with neurological and/or pain syndromes caused by degenerative lumbar stenosis confirmed by MRI will be enrolled in research centers across Russia. All patients will undergo isolated decompression of neurovascular structures without the use of any implants. The dynamics of sagittal balance parameters will be assessed at 3 and 12 months after surgery by comparing with preoperative data. The sample size was calculated in accordance with the hypothesis of non-inferiority. The study aims to enroll 165 patients. Patient recruitment will take 12 months, and the total duration of the study will be approximately 2 years.

Anticipated results. This study will provide valuable information on the potential for spontaneous correction of sagittal spinal parameters following isolated decompression without the use of implants.

** Dear colleagues! We invite you to participate in a multicenter prospective study of spontaneous correction of spinal sagittal balance in patients with degenerative spinal pathology after isolated decompression. The person responsible for inclusion in the multicenter study is Alexandr Vladimirovich Krutko, MD, PhD (National Medical Research Center of Traumatology and Orthopedics n.a. N.N. Priorov, Moscow), e-mail: KrutkoAV@cito-priorov.ru.

Objective. To identify predictors of indirect decompression of spinal nerve roots in patients with degenerative monosegmental central spinal canal stenosis in the lumbar spine after isolated direct lateral interbody fusion (XLIF).

Material and Methods. This prospective study analyzes the treatment outcomes of 80 patients with multisegmental central degenerative spinal stenosis associated with instability of the spinal motion segment. All patients underwent single-level XLIF without additional posterior fixation. Based on early postoperative data, patients were divided into groups with no positive dynamics in neurological status (n = 58) and with positive dynamics in the form of a decrease in the lower extremity pain to 1 point on the VAS (n = 22). All patients underwent preoperative MRI, MSCT, lumbar spine radiography, and VAS questionnaire survey. Postoperatively, they underwent MRI and MSCT of the lumbar spine, and VAS questionnaire survey. The prognostic significance of the studied factors for treatment outcomes was determined using logistic regression analysis.

Results. Factor analysis revealed significant prognostic factors for the effectiveness of indirect decompression of spinal nerve roots in the spinal canal after XLIF: lateral recess depth greater than 3.75 mm and body mass index greater than 35.97 kg/m². According to a single-
factor model, it was revealed that the higher Hounsfield (HU) values in the bodies of adjacent vertebrae, a lower intervertebral disc, the presence of laterospondylolisthesis, intervertebral disc degeneration (Pfirrmann grades 4, 5), endplate changes of grades 4, 5, 6 according to Toshiba Endplate Scoring (TEPS) and the clinical picture of dynamic compression are moderate prognostic factors for successful indirect decompression of the nerve roots in the spinal canal after XLIF for degenerative central stenosis associated with instability of the spinal motion segment.

Conclusion. Further studies are required to validate the identified prognostic criteria, as well as other possible prognostic indicators - the timing of bone block formation in the surgical area, the frequency of implant subsidence and its clinical significance in the long-term period, the long-term effect of indirect decompression, and the results of the ODI and SF-12 survey in the late postoperative period.

Objective. To evaluate the ability of the Index of Neurological and Degenerative Impairments (INDI) to reliably stratify patients with single-level cervical spinal stenosis depending on treatment tactics, through a retrospective analysis of clinical, neurological, and neuroimaging data.

Material and Methods. A total of 176 patients with single-level cervical spinal stenosis treated in a neurosurgical hospital were screened. Of these, 77 patients were included in the study based on predefined criteria: Group 1 – conservative treatment (n = 22), Group 2 – surgical treatment (n = 41), and Group 3 – patients who received conservative treatment but were discharged without improvement and placed under observation (n = 14). Patients were treated strictly in accordance with the current Russian Clinical Guidelines for Degenerative Spinal Diseases. A statistical analysis of differences between the groups was performed using the INDI scale, and its prognostic significance was assessed. The INDI scale was used retrospectively, and the scale data did not influence treatment decisions.

Results. Group 1 had an average INDI score of 2.58 ± 1.46, Group 2 – 6.30 ± 1.36, and Group 3 – 2.90 ± 0.36. Patients in Group 2 were younger (46.12 ± 10.65 vs. 53.90 ± 10.66 years in Group 1; p < 0.05), had more pronounced paresis (2.92 ± 0.46 vs. 1.63 ± 1.50; p < 0.05) and more severe degenerative changes (p = 0). Discriminant analysis confirmed significant differences between the groups (Wilks’ lambda = 0.279; p = 0), with INDI score and total neurological impairment score being the most discriminating factors (F = 92.78 and 92.47, respectively). The stratification accuracy was 93.5%.

Conclusion. The INDI scale allows for a unified assessment of the severity of neurological disorders and degenerative changes of the spinal motion segment based on neuroimaging data. It demonstrated a good ability to differentiate between groups in a retrospective sample, however, further prospective studies are required to validate the method.

The results of surgical treatment of a 14-year-old female patient with a rare vertebrological disorder, multiple exostotic chondrodysplasia with spinal column involvement, are presented. Clinical, radiographic, MRI, histological and laboratory examinations were carried out. The observation revealed a massive space-occupying lesion in the spinal column with projected dimensions of 97 × 70 × 72 mm. The patient had narrowing of the intervertebral foramina with signs of compression of the L1–L2 and L2–L3 nerve roots on the left, secondary deformity and cranial displacement of the 12th rib on the left.