The objective of the review is a multi-aspect study of the problem of neurological complications in scoliosis surgery, based on large arrays of literary data (eLibrary, Pubmed). The following aspects of the problem were studied: the incidence of neurological complications in scoliosis surgery, the incidence of neurological complications in scoliosis of various etiologies, the incidence of neurological complications in different age groups, the incidence of neurological complications following various surgical approaches, the frequency of functional recovery after the development of neurological deficit, the causes of neurological complications, risk factors for the development of neurological symptoms, damage to the peripheral nervous system, late development of neurological complications (delayed deficit), and rare complications (casuistry). Neurological complications of surgical interventions for spinal deformities of various etiologies develop relatively infrequently, but this circumstance in no way simplifies the problem, since these complications are sometimes catastrophically severe and require long-term and complex treatment, the success of which is not guaranteed. Surgical treatment of patients with spinal pathology (not just deformities) should be performed in highly specialized centers equipped with the most modern equipment and staffed by highly trained specialists.

Objective. To evaluate the effectiveness of uniplanar pedicle screws in combination with direct vertebral rotation (DVR) and their impact on the choice of the lower instrumented vertebra in the correction of idiopathic scoliosis with a primary lumbar curve.

Material and Methods. A retrospective cohort study of 33 patients divided into two groups was conducted. Patients in Group 1 (n = 17) underwent correction using uniplanar screws and DVR, and those in Group 2 (n = 16) underwent correction using multiaxial pedicle screws according to the standard technique. Radiographic parameters (Cobb angle) and CT data (translation, axial rotation of the spine) and the SRS-22 questionnaire were used for the analysis.

Results. A clinically significant threshold for the initial Cobb angle of 60° was identified. For deformities ≤60°, the use of uniplanar pedicle screws with DVR provided statistically significantly better correction of the deformity (p = 0.037) and axial rotation (p < 0.001) with a shorter construct length. For deformities >60°, no significant differences in Cobb angle correction and translation between the groups were found, with the exception of better derotation achieved in Group 1. According to the SRS-22 questionnaire results, there were no significant differences in the patients’ subjective assessment of their condition, except for the “self-image” domain, where the score was higher in Group 1.

Conclusion. The use of uniplanar screws in combination with direct vertebral rotation (DVR) technique is effective for the correction of moderate lumbar scoliotic deformities (≤60° Cobb angle). This approach allows for three-dimensional correction and preserves motion segments due to a shorter construct (fixation up to L3). The 60° threshold serves as a practical guide for choosing the fixation type: for smaller angles, uniplanar pedicle screws with DVR are preferable, while for larger angles, the screw type does not have a decisive influence on the correction.

Objective. To assess the hemostasis system status in adolescents with idiopathic scoliosis before surgical correction of spinal deformity and at the peak of intraoperative blood loss.

Material and Methods. The study is based on an analysis of hemostasis system functional parameters in 80 adolescents with idiopathic scoliosis who underwent primary surgical correction of spinal deformity. Hemostasis system parameters were assessed before elective surgery and at the peak of intraoperative blood loss. Standard laboratory diagnostic methods and low-frequency piezoelectric thromboelastography (LPTEG) were used.

Results. No abnormal preoperative laboratory parameters were recorded. Analysis of preoperative LPTEG parameters revealed a decrease in the total coagulation index (TCI) against the background of structural and chronometric hypocoagulation, as well as increased clot retraction and lysis. Comparison of initial LPTEG parameters with those measured at the peak of blood loss revealed an adequate hemostasis system response to surgical trauma: a normalization of the TCI was observed, while deviations in other LPTEG parameters became less pronounced as compared to reference values. The observed dynamics of LPTEG parameters led to the conclusion that the hemostasis system in the vast majority of patients with idiopathic scoliosis is effectively self-regulated. This is confirmed by the fact that in 90% of patients, blood loss did not exceed 30% of the total blood volume and did not require the use of donor blood components.

Conclusion. The established background abnormality in the coagulation profile in adolescents with idiopathic scoliosis is the presence of structural and chronometric hypocoagulation. Low-frequency piezoelectric thromboelastography can be used to assess the functional state of the hemostasis system, though only from the standpoint of personalized recording and analysis.

Objective. To systematically review current publications on surgical correction of neuromuscular scoliosis in children and its relationship with lung function.

Material and Methods. A search of scientific sources was conducted in accordance with PRISMA standard. The protocol was developed a priori and was not included in international registries of systematic reviews. The search included PubMed/Medline, Scopus, the Cochrane Library, Google Scholar, eLibrary.ru, CyberLeninka, and Rucont. Of the 938 database entries, 69 studies were included in the review.

Results. The most important positive effect of surgical correction of spinal deformity associated with neuromuscular scoliosis on pulmonary function is considered to be stabilization or slowing of the progression rather than regression of respiratory impairment. The main controversy lies in the fact that the method that provides maximum correction and stability (posterior instrumentation and fusion) irreversibly halts the growth of the spine and thorax in growing children, potentially limiting lung development. At the same time, growth-friendly technologies are associated with an expectedly smaller immediate deformity correction and with a higher incidence of planned postoperative complications, which, however, are incomparably less severe than with final fusion. Data on the effectiveness of many growth-preserving systems (Shilla, Luque trolley) in neuromuscular scoliosis remain fragmentary.

Conclusion. The analysis of surgical correction techniques in neuromuscular scoliosis and their impact on patients’ respiratory function demonstrates a lack and inconsistence of data; there are no uniform criteria for assessing respiratory function; patient cohorts differ in the nosology and prognosis of the underlying disease, severity of functional status, age, and magnitude of deformity.

Objective. To analyze current literature data on the relationship between sports and physical activity and the development and course of spinal deformity in adolescents with idiopathic scoliosis.

Material and Methods. A narrative review of 20 publications selected from the PubMed, ScienceDirect, Google Scholar, and eLibrary databases without restrictions on language or publication year was performed. The analysis included studies related to the epidemiology of adolescent idiopathic scoliosis, the prevalence of spinal deformity among adolescents engaged in various sports, and the effects of physical activity on disease course, functional status, and quality of life of patients. Studies focusing on postoperative management and specific methods of scoliosis correction were excluded.

Results. The analysis did not reveal convincing evidence of a causal relationship between sports activities and the development of adolescent idiopathic scoliosis. The increased incidence of idiopathic scoliosis observed in certain aesthetic sports is likely due to biological and anthropometric factors, as well as a selection effect, rather than the impact of sports activities. Most studies demonstrate no negative
effect of physical activity on the spinal deformity progression. Regular sports activities are associated with improved physical performance, psycho-emotional state, and quality of life in adolescents with idiopathic scoliosis.

Conclusion. Current data demonstrate the safety of physical activity in adolescent idiopathic scoliosis. Routine restrictions on exercise lack sufficient evidence and may negatively impact patients’ overall well-being and quality of life.

Objective. To analyze the immediate and long-term results of surgical treatment of recurrent single-level herniated L5–S1 intervertebral disc using the methods of total removal of the affected disc through anterior approach with spondylodesis (ALIF) and discectomy from the posterior approach with transforaminal spondylodesis (TLIF).

Material and Methods. A total of 180 patients (ALIF group – 87, TLIF group – 93) were operated on for recurrent single-level lumbosacral L5–S1 intervertebral disc disease. The average time to recurrence was 3 years ± 5 months.

Results. The average duration of surgery for ALIF was 92±14 min, for TLIF – 120 ± 18 min (p < 0.05). Сomparison of preoperative and postoperative VAS scores showed that pain syndrome reliably regressed almost completely in patients of the ALIF group. In the TLIF group (n = 93), pain syndrome also regressed, but to a lesser extent. Functional assessment according to ODI revealed positive dynamics after surgery in all patients. Despite the positive dynamics in both groups, the difference in the degree of improvement was statistically significant in favor of ALIF (p < 0.05). In accordance with the modified MacNab scale, the overwhelming majority of patients in the ALIF group rated the outcome as excellent, while in the TLIF group – as good. In the ALIF and TLIF groups, a comparable high percentage of a complete bone block formation was recorded. Insufficient fusion was recorded in four patients. Better restoration of lumbar lordosis was noted in the ALIF group. The average increase in the lordosis angle in the ALIF group was 11.5° ± 2.1°, in the TLIF group – 3.9° ± 0.8° (p < 0.01).

Conclusion. ALIF and TLIF are effective methods of surgical treatment for recurrent single-level L5–S1 intervertebral disc disease. Despite the technical complexity and certain limitations of the anterior approach, ALIF can be considered as a preferred surgical approach for recurrent L5–S1 disc herniation, especially in patients with sagittal profile abnormalities, severe pain, and the need to restore the height of the intervertebral space.

Objective. To evaluate the intervertebral disc height and mobility of the operated segment in patients with cervical compression monoradiculopathy of degenerative etiology after anterior cervical foraminotomy (ACF) in the late postoperative period.

Material and Methods. The study included 50 patients (44 ± 9 years, 28–72 years) after ACF with a long-term postoperative period. The height of the operated and adjacent intervertebral discs was measured by the interbody distance and by Farfan method on CT scans before and after surgery. The mobility of the operated and adjacent segments was measured by the interspinous distance on functional radiographs. The follow-up period ranged from 3 to 93 months (mean 22 months).

Results. The height of the adjacent superior, operated and adjacent inferior intervertebral discs before surgery was 4.6 ± 0.9 mm, 4.6 ± 0.9 mm and 5.1 ± 0.9 mm and after surgery – 4.4 ± 0.9 mm, 2.8 ± 1.0 mm and 4.8 ± 0.9 mm, respectively. The mobility of the operated segment at the ACF level was 3.7 ± 2.4 mm, and of the adjacent superior and inferior segments – 7.1 ± 3.8 mm and 6.8 ± 2.4 mm, respectively. The mobility of the operated segment of 3 mm or more was detected in 38 (76%) patients (convincing mobility), and less than 3 mm – in 12 (24%) patients (questionable mobility). A combination of preserved disc (intervertebral disc height > 0 according to the Farfan method) and convincing mobility of the operated segment (≥3 mm) was detected in 25 (50%) patients. In 4 (8%) patients, the disc was preserved, but the segmental mobility was questionable. Disc collapse (intervertebral disc height = 0 according to the Farfan method) with questionable mobility of the operated segment was detected in 8 (16%) patients. In the remaining 13 (26%) cases, disc collapse was accompanied by convincing mobility of the operated segment.

Conclusion. The intervertebral disc and/or mobility of the operated segment were preserved in 84% of cases after ACF.

Objective. To analyze clinical and radiological results of two-stage surgical treatment of nonspecific spondylodiscitis with anterior debridement of the infection site and corporodesis using a container-type titanium implant filled with allograft material obtained from the femoral heads during primary endoprosthetics.

Material and Methods. A retrospective single-center study initially included 31 patients with spinal infection. After exclusion of two cases of tuberculous spondylodiscitis, the final study cohort consisted of 29 patients (13 men, 16 women; mean age – 64.7 years) with nonspecific spondylodiscitis of the thoracic and lumbar spine who underwent surgery between 2017 and 2022. All patients underwent a two-stage surgical intervention: anterior debridement of the lesion with placement of a titanium cylindrical cage filled with allobone material, followed by posterior transpedicular fixation. The minimum follow-up period was 18 months (mean 27.7 months). Clinical parameters (VAS, Frankel scale, MacNab scale), laboratory inflammatory markers, and the quality of bone fusion according to the Tan classification were assessed.

Results. The mean preoperative VAS pain score was 7.9; it decreased to 4.5 at discharge and to 1.9 at 18 months postoperatively (p < 0.001). Neurological improvement was observed in 14 (66.7%) of 21 patients with preoperative deficits, and complete regression in 8 (38.1%) patients. Radiographic assessment showed Grade I–II bone fusion according to Tan in 93.5% of patients. No cases of pseudoarthrosis or implant migration were observed. Excellent and good functional outcomes according to the MacNab scale were achieved in 83.8% of patients. Early infectious complications in the anterior approach area occurred in 9.7% of cases and were successfully managed with staged surgical treatment and VAC therapy. No generalized infection, implant removal, or deaths were recorded.

Conclusion. The use of allogeneic femoral head bone grafting in the treatment of nonspecific spondylodiscitis as part of a two-stage surgical approach provides reliable spinal segment stabilization, solid bone fusion, and significant clinical improvement. This method has demonstrated high efficacy and safety, and represents a valuable alternative to autografts, particularly in debilitated patients.

Objective. To review the current clinical use of patient-specific implants in spinal surgery concerning a problem solved, a disease treated, patients age, distribution of cases and publications by countries.

Material and Methods. A systematic search in PubMed/Medline, Google Scholar, and eLibrary databases was conducted. Reference lists of included articles were screened for additional publications. All articles in English and Russian with available full text describing clinical use of patient-specific implants in spinal surgery were includeds.

Results. 41 articles were included in final review with a total of 340 patients. Problems solved with individual implants were as follows: 1) C1–C2 reconstruction; 2) C1–C2 stabilization; 3) concave side distraction in subaxial cervical spine; 4) anterior reconstruction of subaxial cervical, thoracic, and lumbar spine; 5) sagittal or frontal balance correction; 6) zero-profile of the implant; 7) anterior and 8) posterior stabilization under unfavorable conditions. Types of implants used were as follows: 1) reconstructive implants for upper cervical spine bearing docking sites for C0 or C1; 2) implant-template for transarticular C1–C2 arthrodesis; 3) spacers for concave side distraction; 4) congruent interbody implants; 5) congruent body-substitute implants; 6) personified anterior plates; 7) bridge-type anterior implants; 8) “monolith” implants which reproduce serial devices without connecting nodes.

Conclusion. Personified implants were used when serial devices did not match the task at hand or anatomical features of individual patient. Pathologies treated were primarily degenerative disease and tumors in elderly persons.

The article presents a non-systematic review of 44 publications on sagittal balance of the cervical spine selected over the past 10 years. Currently, despite the abundance of parameters proposed for assessing the sagittal balance, no consensus has yet been reached regarding the mandatory use of specific criteria. Debates persist regarding both the boundaries of “normality” and the degree of clinical impact of even the most established parameters on a patient’s functional status. Data on the influence of various single- or multi-level surgical interventions on the cervical sagittal balance are inconsistent. Consequently, there is no consensus on the need and methods of correcting specific alterations in cervical sagittal profile parameters. As a result of the literature analysis, the following parameters of the cervical spine balance were identified, which are considered the main ones: cervical lordosis (CL), sagittal vertical axis (cSVA), T1 slope angle (T1S), the T1S-CL difference, and spinocranial angle (SCA). Reference ranges were defined for most of them: T1S – 18.5°–40°, cSVA – less than 40 mm, SCA – greater than 88.6°, and T1S-CL – less than 25° ± 5°. The impact of surgeries such as ACDF and laminoplasty on sagittal cervical balance is controversial: some authors report significant changes in parameters following both anterior decompression and laminoplasty, while others, on the contrary, indicate the absence of significant alterations.