Objective. To analyze the number of patients with idiopathic scoliosis operated on using segmental instrumentation in a highly specialized clinic during the period of 20 years and the severity of their deformities.

Material and Methods. The study included patients over 10 years of age with idiopathic scoliosis operated on using segmental instrumentation (CDI, Horizon, M8, Legacy, Expedium, NITEK) in the Children and Adolescents Spine Surgery Clinic of Novosibirsk RITO n.a. Y.L. Tsivyan in 1996-2015. For each year within this period, the number of surgically treated patients, the average Cobb angle of the primary curve, and the number of patients with primary curve less than 90°, from 91° to 120°, and greater than 120° were specified.

Results. Analysis of the dynamics of annual surgical activity related to idiopathic scoliosis showed that number of cases has been growing for a number of years and then stabilized. The severity of spinal deformities in operated patients increased over the years, and for several years the most severe deformities (Cobb angle greater than 90°) exceeded 30 %. Later on, the average severity of deformities significantly decreased, which suggests that active surgical work allowed to operate on a significant portion of patients with advanced spinal deformities.

Conclusion. The presented data may be useful in the formation of a national registry of patients with scoliosis. 

The paper presents a review of 28 domestic and foreign publications with the level of evidence of not less than 2 reporting the treatment results in children with congenital monosegmental anomalies of the spine over the past 15 years. A total of 657 clinical cases were analyzed, including 593 literature cases and 64 cases from authors’ experience. Results of hemivertebra treatment in children using combined approach, extended posterior approach and local posterior approach with transpedicular excision of hemivertebra were analyzed. The following criteria were used for analysis: patient’s age at the time of treatment, magnitude of the local (segmental) curvature before and after surgery, percentage of correction, blood loss volume, duration of surgery, type and length of fixation, and nature and structure of complications. The advantages of transpedicular excision of abnormal vertebra through posterior approach were noted in terms of surgery duration, intraoperative blood loss, risk of neurological complications after comparable correction of deformity, and time required for patient activation and rehabilitation as compared with combined approach, as well as in terms of blood loss volume and correction of kyphotic component as compared with extended posterior approach.

Formulation of expanded diagnosis in spine surgery is of particular importance. This allows for most timely solving the issue of the treatment choice and determining the amount of intervention. A single technique for diagnosis formulation is one of the first steps to establish a national registry of patients with scoliosis, the significance of which needs no justification. The paper presents a methodology for the formulation of a clinical diagnosis in patients with spinal deformities of different etiologies: idiopathic scoliosis, congenital scoliosis and kyphosis, syndromic scoliosis, myopathic deformities of the spine, and Scheuermann’s disease. In authors’ view, diagnosis should include information on the following characteristics: etiology, side of convexity, localization, structurality and rigidity of the primary curve, degree of deformity compensation, nature of progression and magnitude, sagittal contour of the spine, location of secondary curve, peculiarities of the rib hump, neurological symptoms, pain, age group, comorbidities (vertebral and non-vertebral), and previous surgeries on the spine. In congenital deformities, the abnormalities, both vertebral (intra- and extracanal) and non-vertebral should be noted.

Objective. To evaluate the outcomes and methods of surgical treatment of patients with fractures of the cervical and thoracolumbar spine in ankylosing spondylitis.

Material and Methods. The study included 19 patients with ankylosing spondylitis, spinal fractures were diagnosed in seven of them. The average age of patients with fractures was 39 years (range: 32-58 years). Injuries to the cervical spine were observed in three patients, and to the lumbar - in four. Among patients with lumbar spine injuries, a clinical picture of profound inferior paresis was observed in one patient with previous kyphosis. Paraplegia was diagnosed in two patients with fractures at the C₅-C₆ level, and radicular pain - in one patient with injury at the C₅-C₆ level. The remaining patients had no neurological disorders. Patients were operated on in the period from three days to two weeks after the injury. CT study to confirm the diagnosis was performed in all patients. Injuries to the cervical spine were treated by anterior fixation, to the thoracolumbar spine - by transpedicular fixation.

Results. The results were evaluated according to X-ray and CT findings, as well as to a degree of neurological regression. Complications, instrumentation removal and increase in spinal deformity were not observed. In one patient with the cervical spine fracture, the pain caused by radicular irritation was eliminated. A regression of neurological complications from Frankel B to Frankel D was observed in one patient with the Th₁₂-L₁ fracture.

Conclusion. Surgical stabilization of the spine is the method of choice for the treatment of spinal fractures in ankylosing spondylitis. Graduated correction of kyphotic deformity in fractures may be one of the elements of surgical treatment. 

Objective. To analyze the characteristics of the stress-strain state of the cervical spine when replacing vertebral body with implants of different design.

Material and Methods. Mathematical modeling was performed by developing three finite element models of the cervical spine. The models simulated human cervical spine within C₃-C₇ spinal segment. The C₅ vertebra was replaced by three different systems: mesh cage, mesh cage combined with anterior plate, and telescopic vertebral body replacement implant fixed to the bodies. The stress-strain state of models was studied under four variants of loading: compression, flexion, extension, and rotary impact.

Results. Stress intensity values were obtained for the following structures: top of the vertebral body, bottom of the vertebral body, pedicle, lamina, joint masses, teeth and screws (if any) of instrumentation under different loading options.

Conclusion. The presence of an additional fixation to vertebral bodies allows reducing the level of maximum stress in the bone tissue of vertebrae contacting the implant. Telescopic cage shows the lowest level of stress in the model elements under compression and flexion. Stress indicators in extension and rotation have minor differences between different sites. 

Objective. To analyze the outcomes of early rehabilitation of patients with consequences of spinal cord injury using robotic technology.

Material and Methods. A total of 122 patients with consequences of spinal cord injury having movement disorders were examined and treated in the rehabilitation department of the Novosibirsk RITO. Group 1 included 59 patients treated with the standard version of rehabilitation program, while the program used in Group 2 (63 patients) involved longer and more careful preparation for sessions on the Lokomat machine and consisted of three stages of treatment - prehospital, preliminary and main ones.

Results. The course of rehabilitation therapy had positive effect on the dynamics of neurological symptoms. Indicators of positive dynamics were statistically significantly higher in patients of Group 2. Data of electrophysiological study also showed that the optimized treatment program was more effective in restoring lost functions of the spinal cord. Optimization of rehabilitation and preconditioning of patients to loads decreased frequency of adverse reactions (orthostatic and fever responses, increase in pyramidal muscle tone in lower extremities) in comparison with the standard approach.

Conclusion. Optimized course of rehabilitation therapy positively affected the dynamics of neurological symptoms. 

Objective. To analyze the reasons for and to evaluate the results of repeated surgery in patients with lumbar degenerative disc disease after the removal of herniated discs.

Material and Methods. The results of surgical treatment in 186 patients (mean age 48.7 years) treated between 2013 and 2014 at the Federal Center for Neurosurgery in Novosibirsk were analyzed. All patients previously underwent surgery for lumbar disc herniation in different hospitals. Primary intervention at one level was performed in 171 patients (92.0 %), and at two levels - in 15 patients (8.0 %).

Results. Progression of degeneration at the operated segment was detected in 155 patients (83.3 %). Out of them, recurrent disk herniation was diagnosed in 92 patients (49.5 %) and instability at the operated level was found in 63 patients (33.8 %). Adjacent segment degeneration was diagnosed in 31 patients (16.7 %). After surgery, positive results in pain regression were achieved in 87.1 % of cases, and unsatisfactory results with preserved pain intensity were observed in 12.9 %.

Conclusion: The main causes of reoperation after primary microdiscectomy were recurrent disc herniation and instability of the operated segment. In 16.7 % of cases, repeated surgery was performed for the adjacent segment degeneration, which must be regarded as a sequela of primary disease. The use of differential surgical treatment strategy based on the identification of the dominant clinical and neurological syndrome provides good and satisfactory results in patients undergoing reoperation after primary microdiscectomy. 

Objective - to study the role of different structures of the intervertebral disc in its degeneration, as well as the possibilities of tissue engineering in the treatment of this disease. The most common clinical manifestation of intervertebral disc degeneration is back pain, which is often associated with the early disability of patients. Histological examination of intervertebral disc remains the most reliable method for diagnosing and studying the processes of its degeneration. The review considers a violation of the disc metabolism due to morphological changes in its structural components as a trigger for this process. It is shown that disc microcirculation disorders cause a change in the structure of the nucleus pulposus (fibrotization) and its extracellular matrix, which results in the disc destruction. The use of autologous disc-derived cells cultured in vitro and stem cells with their subsequent implantation can replenish the cell deficit and restore the structure of the matrix.

Objective.To analyze the features of surgical treatment of children and adolescents with herniated discs and radicular compression symptoms.

Material and Methods. A retrospective multicenter study of 34 patients with juvenile osteochondrosis with mean age of 15.4 years was performed. Surgical treatment included disc puncture methods, microdiscectomy through posterior approach, anterior discectomy, dynamic and rigid stabilization, and replacement of the fibrous ring defect.

Results. Positive clinical effect with complete relief of pain was achieved in all cases. Paretic syndrome regressed completely in all patients. All patients regained the level of physical activity in the next 2-3 months. Long-term follow-up was on average 45.5 months. No recurrence of pain was noted during the follow-up period.

Conclusion. Surgical treatment of disc herniation in children results in the relief of pain and full functional recovery. Among surgical methods, a preference should be given to microdiscectomy through minimally invasive surgical approaches. In the presence of indications, both rigid stabilization of spinal motion segment at the level of decompression and dynamic stabilization can be performed, and the latter is more preferable. 

Objective. To analyze the first experience of negative pressure wound therapy in the treatment of patients with infectious complications after surgical interventions on the spine.

Material and Methods. Clinical cases of negative pressure wound therapy (NPWT) in patients with peri-implant infection developed after decompression and stabilization interventions for degenerative disease (n = 2), and injury (n = 1) of the spine are presented.

b. Good results were achieved in all three patients. Average length of hospital stay was 33 days. Implants were successfully preserved in two patients. The average time of wound closure before cutaneous suturing was 10.3 days.

Conclusions. The use of NPWT objectively reduces the number of surgical debridements and shortens drainage and healing of the wound. 

Objective. To test validity of formalized Analgesiс Assessment Scale (AAS) by examining the correlation of its parameters (gradations) with other parameters characterizing pain intensity during the treatment, and to assess the adequacy of conducted analgesia in patients with spinal tuberculosis by taking into account AAS gradations.

Material and Methods. The study was performed in a prospective cohort of 15 consecutive patients who underwent similar elective spine surgery for tuberculous spondylitis. Postoperatively, all patients received systemic analgesia with parenteral narcotic and non-narcotic analgesics, depending on pain intensity subjectively assessed by patients using VAS. The protocol for postoperative analgesia included records of pain intensity assessed by VAS, systolic and diastolic blood pressure (BPsist and BPdiast), heart rate, and the AAS gradations of analgesic consumption.

Results. An analysis of the correlation between AAS and other variables characterizing pain intensity in the postoperative period showed a strong positive association of AAS with VAS (r = 0,567; P < 0,05) and ADsist (r = 0,340; P < 0,05) variables, which confirms usability of each of these parameters in the assessment of pain intensity.

Conclusion. The AAS tested in a pilot study on the cohort of 15 consecutive patients operated for spinal disorders proved its effectiveness in pain intensity assessment, pain therapy, and convenience of analgesics accounting.

The lecture presents the evidence of priority of V.D. Chaklin, outstanding Russian orthopedic and trauma surgeon, in developing and applying the method of anterior spinal fusion. The method became widespread around the world over the past 85 years and is used to treat spondylolisthesis, spinal osteochondrosis, intervertebral disc herniaton, scoliosis, spinal and facet stenosis, injuries, benign and malignant tumors, and some other pathological conditions of the spine. Spine surgeons using this method are able to operate on vertebral bodies and intervertebral discs of any localization.