Objective. To evaluate the diagnostic value of clinical and instrumental criteria for tethered cord syndrome (TCS) by analyzing the outcomes of the main types of neurosurgical and orthopedic interventions.

Material and Methods. The retrospective continuous 3-center study included 120 patients operated for TCS in spinal dysraphism. Based on functional outcome assessment, patients were divided into three groups: patients in Group 1 underwent microsurgical redetethering, in Group 2 – shortening three-column vertebrotomy (Schwab 3–6) with correction of spinal deformity and instrumental fixation; and in Group 3 (control) – without reoperation. Groups were assessed for the nosological structure of dysraphism based on the neurosegmental level of damage according to Sharrard, frequency of surgical interventions, dynamics of motor status and spasticity according to the Ashworth scale, sensory impairment, urinary control and bladder tone according to urodynamic studies, MR signs of spinal cord tethering syndrome, types of musculoskeletal deformities, as well as treatment outcomes according to uniform assessment criteria.

Results. Statistically significant differences in the frequency of unfavorable outcomes depending on the type of surgery were shown. Redethetering was associated with an increased risk of unfavorable outcome (61%; p = 0.044), shortening vertebrotomy showed significant predominance of favorable outcome (p = 0.036): 7% unfavorable versus 27% favorable. Analysis of the initial diagnosis did not reveal significant differences between the study groups in terms of the types of dysraphism and neurosegmental level of damage, nosological structure, motor status assessment, the number of interventions performed to eliminate spinal cord tethering, as well as the frequency of spinal deformities. At the same time, the analysis of lower extremity pathology revealed statistically significant differences in patients with kyphosis (p < 0.01), leg deformities (p = 0.019), and hip dislocation (p = 0.001).

Conclusion. Redetethering in spinal dysraphism syndrome is associated with an increased risk of adverse outcomes; shortening vertebrotomy demonstrates the best results. Key prognostic factors for adverse outcomes are significant orthopedic deformities, including foot deformities and hip dislocations, which reflect the severity of damage to neural structures and serve as clinical markers for risk stratification. It is advisable to personalize unification of conventional approaches to treating tethered cord syndrome in spinal dysraphism; the interdisciplinary nature of the problem requires the development of standardized algorithms for managing these patients.

Objective. To identify the factors affecting the degree of lumbar countercurve correction, in order to predict the risks of its insufficient correction during surgical treatment of severe idiopathic scoliosis with a primary thoracic curve.

Material and Methods. The outcomes of treatment of 168 patients with idiopathic scoliosis with a median thoracic curve of 90.5° and lumbar countercurve of 62.0° operated on in 1999–2021, were analyzed. The median postoperative follow-up period was 4.6 years. Logistic regression models were used to identify predictors of insufficient lumbar countercurve correction.

Results. Taking into account the lumbar countercurve correction magnitude, patients were divided into two groups: less than 50% of the initial magnitude (n = 62; 36.9%) and more than 50% of the initial magnitude (n = 101; 60.1%). Significant differences were found in the groups in gender (men, 26.0% vs 11.9%), age (16.0 vs 14.0 years; p < 0.001), and countercurve mobility (36.7 vs 47.6%; p < 0.001). Building single-factor logistic regression models allowed identifying predictors of insufficient correction: countercurve more than 37.5°, age more than 15.8 years, male gender, and countercurve mobility less than 31.4%. A formula based on a multivariate model was developed to predict the risk of insufficient correction of the lumbar countercurve with a sensitivity of 73.8%.

Conclusion. The combination of factors including lumbar countercurve greater than 37.7°, its mobility less than 31.4%, male gender, scapular tilt less than 12.0°, and a plumb-to-umbilicus distance less than 5 mm allows for predicting the risk of lumbar countercurve correction of less than 50% with a diagnostic accuracy of 81.0%.

Objective. To perform comparative analysis of postural and functional radiographs of patients after correction of thoracic scoliosis using dynamic versus rigid fixation systems.

Material and Methods. This retrospective study included 105 patients (mean age 27 years) with idiopathic thoracic scoliosis (Lenke type 1). Selective fixation was performed using an anterior dynamic or posterior rigid system. Standard and functional radiographs
(lateral flexion, flexion/extension) were compared two years after surgery.

Results. Both techniques ensured correction of the main curve by 73–75% and the lumbar counter-curve by 62–64% (p ≤ 0.005). In the dynamic fixation group, 92% of sagittal functional range of motion (17.1° out of 17.6°) and 51.4% of coronal range of motion (22.1° out of 39,0°) were preserved in the instrumented area (p ≤ 0.005). Asymmetry was observed: 88.6% (19.6° out of 20.1°) of motion was preserved when bending toward the convex side, versus 27% (35.2° out of 42.1°) when bending toward the concave side. In the rigid fixation group, no motion remained in the fusion area. The total functional range of motion of the entire spine was higher with dynamic fixation than with rigid fixation: in the coronal plane 71.2° vs. 45.1° and in the sagittal plane 78.7° vs. 58.6° (p ≤ 0.005).

Conclusion. The dynamic fixation system provides stable deformity correction comparable to a rigid one but allows preserving up to 92% of sagittal and 51% of coronal mobility in the operated area with characteristic asymmetry. Rigid fixation leads to a complete motion loss in the fusion area and significantly lower total functional range of motion of the spine.

Objective. To perform comparative analysis of long-term clinical and radiological results of conservative therapy and surgical treatment of patients with uncomplicated fractures of the AOSpine type A3 vertebrae in the thoracolumbar junction.

Material and Methods. The research is a prospective comparative non-inferiority study with historical control. The inclusion criteria were patient age over 18 years, acute or subacute injury, uncomplicated AOSpine type A3 fracture at the T10–L2 level, and spinal canal stenosis of less than 50%. The conservative therapy group (CoT) received fracture immobilization with a rigid frame brace, followed by a two-phase rehabilitation course starting on the first or second day after diagnosis. The surgical treatment group (ST; n = 23) included patients who underwent anterior fusion or transpedicular fixation without decompression. The CoT group was followed for 12 months. The primary endpoint was the quality of life according to the Oswestry scale (ODI), secondary endpoints were the level of pain according to the VAS, the dynamics of the Cobb angle, spinal stenosis, as well as degenerative changes in the facet joints and intervertebral discs.

Results. Patients in the CoT group were on average 10 years older than those in the ST group upon admission (p = 0.049); other demographic and radiographic parameters did not differ significantly between the groups. At the follow-up, the median VAS pain scores in the CoT and ST groups were 0 and 2 points, (p < 0.001) and the ODI value was 4 and 12 (p < 0.001), respectively. The ST group demonstrated a smaller increase in the Cobb angle compared to the CoT group (0.7° and 4.9°, respectively) due to surgical correction of kyphosis and its maintenance using metal implants, as well as a twofold greater restoration of the spinal canal lumen (t-test; p = 0.007). However, the final spinal stenosis indices did not differ significantly between the groups. Ankylosis of the facet joints and intervertebral discs, both at the level of injury and in adjacent segments, was significantly more frequent after surgical treatment (χ² test; p < 0.001 and p = 0.001, respectively). Fracture union as a result of treatment was detected in 91.3% of patients in the ST group and in 88.2% in the CoT group (χ² test; p = 0.193).

Conclusion. Long-term treatment outcomes of uncomplicated AOSpine type A3 fractures at the thoracolumbar junction demonstrate that conservative therapy is comparable to surgical treatment for kyphotic deformity less than 14.9°, relative anterior vertebral body height greater than 51.8%, vertebral body index greater than 0.54, and spinal stenosis less than 43.9%. Rehabilitation should begin within 24 hours of diagnosis and continue in a rehabilitation center. Surgical treatment allows for better correction of kyphotic deformity and spinal canal stenosis, but it also promotes degenerative changes both in the fractured vertebra and in adjacent segments. The final decision regarding the choice of treatment method (surgical or conservative) should be made in consultation with the patient, taking into account the comparable clinical outcome, the need for deformity correction and the likelihood of complications.

Objective. To study the primary outcomes of surgical treatment of C2 odontoid fractures in children using the odontoid screw.

Material and Methods. The data of the anamnesis, physical examination, radiography and CT of the cervical spine of 5 children with a median age of 15 years (min – 5, max – 17) who underwent odontoid screw fixation for a C2 odontoid fracture were analyzed. Own data were compared with literature data.

Results. Four patients were diagnosed with a displaced odontoid fracture, and one developed a pseudoarthrosis despite conservative treatment. No neurological disorders were detected. The patients’ primary complaint was neck pain with movement. The median surgical time was 175 minutes with blood loss of 10 ml. No intra- or postoperative complications were recorded. Three months after surgery, pain relief and CT-confirmed consolidation of the odontoid process were noted.

Conclusion. Odontoid screw fixation of the C2 vertebra is suitable for use even in young children. The low complication rate and high percentage of primary consolidation with preserved rotational motion make it the method of choice for treating fractures and post-traumatic pseudoarthrosis of the odontoid process.

Objective. To present a rare case of severe cervical spine injury in a child, complicated by the development of fatal ischemic stroke.

Material and Methods. The course of complicated cervical spine injury in a 12-year-old child with ischemic stroke secondary to arteriopathy, manifested by cerebral artery dissection is described. The review and discussion present current understanding of the etiology, pathogenesis, clinical manifestations and diagnostic methods of both complicated cervical spine injury and the peculiarities of ischemic stroke in children. A search of scientific sources was conducted in the eLibrary, PubMed, and Google Scholar databases using the following keywords: injury, children, cervical spine, ischemic stroke, arterial dissection, and fibromuscular dysplasia.

Results. The patient sustained a cervical spine injury while playing. His neurological status upon admission was tetraplegia. Given the absence of spinal cord compression, no indications for surgical treatment were identified. Intensive care was administered in the intensive care unit. Cerebrovascular accident developed on the 12th day after the injury, rapidly progressing from coma I to coma III. The diagnosis of ischemic stroke due to severe arteriopathy was established based on the circumstances of the injury, clinical manifestations, and MRI and MSCT results. Despite intensive care, the patient died on the 28th day.

Conclusion. The presented clinical case confirms the association between cervical spine injury and the development of cerebral stroke in pediatric patients. The presence of connective tissue dysplasia is a significant risk factor for vascular complications. The development of acute cerebrovascular accident in the setting of traumatic injury that limits neurological assessment may contribute to a delay in the timely diagnosis of vascular events and increase the likelihood of an unfavorable outcome. Increasing awareness among specialists involved in the treatment of complicated spinal injuries in pediatric patients about the risk of cerebral vascular complications, as well as developing guidelines for the treatment of complicated cervical spine injuries adapted to different stages of childhood, can improve clinical outcomes in terms of stroke prevention.

Background. Complete cervical spinal cord injury (ASIA A) carries a grave prognosis with minimal neurological recovery. Surgical intervention remains controversial where presentation delays are common. This study analysed outcomes of complete cervical spine injury and developed a practical scoring system to guide surgical decision making at the NOHD, Kano, Nigeria.

Methods. A retrospective cohort study of 167 patients with traumatic complete cervical SCI (ASIA A) managed at NOHD between January 2018 and December 2024 was conducted. Data extracted included demographics, injury mechanism, time to presentation, MRI parameters (intramedullary lesion length, IMLL), haemodynamic management (mean arterial pressure, MAP), surgical timing, and 12 month neurological outcome. Multivariate logistic regression identified independent predictors of improvement. Significant predictors were weighted by regression coefficients to create a scoring system, validated by bootstrap resampling.

Results. Of 167 patients, 124 (74.3%) were male; mean age 42.8 ± 15.6 years. Only 22 (13.2%) patients showed any neurological improvement at 12 months, all of whom had incomplete baseline injuries. Independent predictors of favourable outcome were: time to surgery ≤7 days (OR 4.5; p < 0.001), admission MAP ≥85 mmHg maintained for first 72 h (OR 3.8; p=0.002), and IMLL ≤15 mm on MRI (OR 3.2; p=0.005). A 9 point scoring system was developed: surgery ≤7 days (4 points), MAP ≥85 mmHg (3 points), IMLL ≤15 mm (2 points). A score ≥6 predicted any neurological improvement with sensitivity 72% and specificity 86% (AUC 0.83).

Conclusion. Complete cervical SCI patients rarely recover, but a small subset with favourable predictors may benefit from surgery. The proposed scoring system emphasises modifiable factors-early decompression and haemodynamic optimisation – to guide resource allocation and patient counselling.

Objective. To analyze the features of the surgical technique and evaluate the effectiveness of intraoperative CT navigation in posterior screw fixation of the C1–C2 vertebrae using a clinical case as an example and a literature review.

Material and Methods. A clinical case is presented to provide a detailed description of the surgical technique for posterior screw fixation of the C1–C2 vertebrae under intraoperative navigation using a mobile cone beam CT scanner. A narrative review of the literature is also conducted.

Results. The described technique for performing posterior screw fixation of the C1–C2 vertebrae ensures precise positioning of the screws with minimal radiation exposure to the operating team, which increases the safety of such operations.

Conclusion. Effective use of cone beam tomography and optical navigation requires careful preoperative assessment of the acceptable screw insertion trajectory based on CT study and CT angiography, rigid head fixation on the operating table, the use of officinal navigation equipment and instruments, and preliminary staff training in surgical technique using simulation models.

Objective. To determine the possibilities of transforaminal lumbar interbody fusion (TLIF) in creating/correcting a segmental angle at a single lumbar level in case of its degenerative lesion.

Material and Methods. A retrospective analysis included data from prospectively enrolled patients with single-level degenerative stenosis and symptomatic spondylolisthesis. Open TLIF was performed in the first group (n = 31), and minimally invasive TLIF – in the second group (n = 20). Posterior screw fixation was performed in both groups. Both surgical options included intraoperative correction of the segmental lordosis. Radiographic results at discharge were assessed, and predictors of segmental lordosis value achieved after intervention were identified.

Results. The postoperative segmental lordosis was greater in the open TLIF group than in the minimally invasive group (8° [5.0; 9.0] vs 6° [4.0; 7.3]; p = 0.006). The preoperative segmental lordosis was a predictor of the achieved postoperative segmental lordosis (beta = 0.229–0.587; p < 0.05). The postoperative segmental lordosis value had a strong inverse correlation with the value of lordosis correction (r ranged from –0,719 до –0,488; p < 0.000).

Conclusion. The L4–L5 segment is the most commonly operated level in patients with degenerative stenosis and spondylolisthesis. The median postoperative segmental angle after TLIF (open or minimally invasive) is 7°, when using all arsenal available to the spine surgeon. The smaller the preoperative segmental angle, the greater the potential for intraoperative correction.

Objective. To evaluate the clinical efficacy of transforaminal endoscopic discectomy (TESSYS) for recurrent lumbar disc herniation initially removed by microdiscectomy.

Material and Methods. A retrospective observational case series study (n = 24) was performed. In 2024–2025, patients with recurrent disc herniation at L4–L5 (n = 14) or L5–S1 (n = 10) level underwent transforaminal endoscopic removal of the herniation (TESSYS). Recurrence was defined as repeated detection of herniated material at the same level and side with recurrence of radicular symptoms after a period of clinical improvement of 1 month or more. Outcomes were assessed using VAS (back and leg pain), ODI and MRC before surgery, at discharge, and after 3 and 12 months. Achievement of MCID for ODI, length of hospital stay, and complications were analyzed.

Results. The average age of patients was 48.3±11.0 years, and length of hospital stay was 1.46±0.66 days. Statistically significant improvement in VAS and ODI was observed at all follow-up stages (p < 0.001). By 12 months the VAS score for back pain decreased from 6.21±1.50 to 0.75±0.85, and for leg pain – from 6.92±1.06 to 0.38±1.06. The ODI score decreased from 58.50±14.08% to 4.54±7.56% by 12 months; MCID was achieved in 100% of patients. Muscle strength (MRC) increased from 4.00±1.29 to 4.71±0.69 by 12 months. No intraoperative complications (nerve root injury, dural tear, infection) were observed. In two patients (8.3%), transient paresthesia/dysesthesia was identified and resolved conservatively within 2 weeks; in one patient (4.2%), a recurrence at 10 months required decompression and stabilization surgery.

Conclusion. In the presented series, TESSYS demonstrated high clinical efficacy and safety for recurrent disc herniation; however, this interpretation is limited by the small sample size and the lack of own control group.