Objective. To compare the efficacy and safety of using growth-friendly technologies and polysegmental final spinal fusion in the treatment of syndromic and neuromuscular deformities in children.

Material and Methods. The clinical, anamnestic, and radiographic data of 82 operated patients under 18 years of age with neuromuscular (n = 59) and syndromic (n = 23) scoliosis were analyzed. Deformity correction was performed in two variants: 1) final spinal fusion (n = 48) by means of long polysegmental CD fixation – Long Fusion (LF) – through an open approach using two- (n = 42), three- (n = 5), or four-rod (n = 1) system; 2) traditional growing rods (TGR; n = 34) in variant of one (n = 11) or two rods (n = 22), including their bilateral (n = 9) or unilateral (n = 13) installation on the concave side of the deformity. The spinal deformity magnitude (in degrees according to the Cobb scale) before and after surgery, surgery duration and blood loss were assessed.

Results. Both methods demonstrated effectiveness in correcting spinal deformity for each etiologic group. The key difference is the safety profile: a threefold reduction in intraoperative blood loss in the TGR group compared to the LF group (p < 0.001).

Conclusion. The TGR technique, developed for actively growing patients, can be effective for both younger (over 9–10 years old) and older (over 15 years old) adolescents with severe somatic symptoms which does not preclude delayed polysegmental stabilization or potentially remains an option for final surgery.

Objective. To establish a pathobiomechanical relationship between the initial parameters of sagittal balance and the formation of kyphotic deformity at the thoracic and lumbar levels in patients with ankylosing spondylitis.

Material and Methods. Data from a retrospective cohort study of 46 patients aged 18 to 70 years with axial form of ankylosing spondylitis and decompensated sagittal imbalance with loss of horizontal gaze were studied. All patients underwent digital teleradiography of the spine in a standing position with the calculation of a complex of spinopelvic parameters and assessment of functional status according to the Oswestry index (ODI).

Results. Analysis of sagittal balance parameters revealed that greater severity of kyphotic deformity is significantly associated with a greater value of the pelvic index (Pelvic Incidence -PI). A strong negative correlation was found between the ODI and the spino-sacral angle (SSA) at a mean value of the pelvic index (45°≤ PI <55°) and at its high index (PI ≥55). A critical link between quality of life and the gaze angle was also found at a high PI. For patients with a low PI, the main trigger of maladaptation was trunk translation, which correlates with the sacro-femoral distance. Combinations of a mean PI with a decrease in SSA ≤85° and a high PI with a decrease in SSA ≤117° were identified as reliable mathematical predictors of deterioration in functional capacity.

Conclusion. The formation of kyphotic deformity is determined by the baseline architectonics of the spinopelvic complex, and the proposed threshold values for the SSA angle allow for an objective prediction of the extent of patients’ functional capacity.

Objective. To perform comparative analysis of the results of pedicle screw fixation using the free-hand method under fluoroscopy control and intraoperative navigation in the surgical treatment of adult patients with idiopathic scoliosis.

Material and Methods. The study included 120 patients (102 women, 18 men) consecutively operated on from January 2020 to December 2024 and divided into two groups chronologically corresponding to the introduction of O-arm navigation technology. Group 1 included 60 patients (53 women, 7 men) in whom screw placement was performed using navigation and intraoperative CT control; Group 2 included 60 patients (49 women, 11 men) in whom screws were placed using the traditional free-hand technique with intraoperative X-ray control (C-arm) and postoperative CT assessment.

Results. The use of O-arm navigation significantly increased the accuracy of screw placement (90.87% vs. 85.57%; p < 0.001) and reduced the malposition rate (9.12% vs. 14.43%). Clinically significant displacements occurred in 1.1% of cases vs. 20.7% (p < 0.001), and the reoperation rate was 1.7% vs. 23.3%. Despite an increase in operative time by 25 minutes, blood loss and length of hospital stay did not differ, and deformity correction was significantly higher (57.76% vs. 47.87%; p < 0.001).

Conclusions. Intraoperative CT navigation improves the safety and effectiveness of spinal deformity surgery. The introduction of O-arm navigation technology significantly reduces the number of revision operations and critical malpositions without significantly changing the time of surgery and the amount of blood loss. 

Objective. To summarize and critically evaluate data on intraoperative neurophysiological monitoring in surgical correction of neuromuscular scoliosis with an emphasis on monitoring modalities, causes of alarm events and an algorithm of response actions.

Material and Methods. The study was carried out as a practice-oriented narrative review with an analytical synthesis of published data without conducting a formal meta-analysis; level of evidence – V. The search for sources was performed in PubMed/Medline, Scopus, Web of Science Core Collection, and the Russian Science Citation Index (RSCI) for the period from January 1, 2005 to September 22, 2025, with additional manual search.

Results. Key modalities included transcranial motor and somatosensory evoked potentials complemented by free-running and triggered electromyography (EMG) to monitor radicular events and to assess pedicle screw position. In cases of poor monitorability, epidural
responses (including D-wave) are possible as a backup tactic. Signal changes in neuromuscular scoliosis are determined by three groups of factors: perfusion–physiological, mechanical (correction maneuvers), and anesthesiological–technical. A stepwise alarm response algorithm is summarized: exclusion of technical causes, optimization of perfusion and anesthesia, assessment of relationship with the correction stage, and deciding on maneuver modification.

Conclusion. Multimodal intraoperative neurophysiological monitoring increases the safety of neuromuscular scoliosis correction; however, alarm criteria and treatment strategies should be individualized according to the underlying diagnosis, initial deficit, and stage of correction.

Objective. To develop and evaluate a model for predicting adverse outcomes of microsurgical untethering and vertebral shortening osteotomy in children with tethered spinal cord syndrome associated with spinal dysraphism.

Material and Methods. A retrospective cohort of 120 children with spinal dysraphism and tethered cord syndrome was randomly divided into a training set (Group 1: operated patients) and a test set (Group 0: non-operated children with follow-up data). A comparison of the training and test sets revealed no statistically significant differences in key characteristics, confirming the comparability of the groups. Demographic, clinical-neurological, and neuroimaging features were analyzed. The predictive performance of three models was evaluated: LASSO regression, decision tree, and eXtreme Gradient Boosting (XGB). Class balancing was performed using the SMOTE technique. Model quality was assessed using ROC-AUC, sensitivity/specificity, accuracy, and Brier score (with 95% confidence intervals); clinical utility was quantified using Decision Curve Analysis (DCA); and interpretation was based on feature importance and SHAP values for  the XGB model.

Results. LASSO yielded an ROC-AUC of 0.82 and an accuracy of 80.6 % on the test set, whereas the decision tree showed an ROC-AUC of 0.64 and an accuracy of 69.4 %. The best performance was achieved by XGB (ROC-AUC 0.97; accuracy 86.1 %), indicating an excellent level of discrimination. Key predictors of an adverse outcome included trophic disturbances, lower leg deformity, shortening vertebrotomy, filum terminale thickening ≥2 mm, and pelvic function parameters; DCA confirmed the model’s positive net benefit across a wide range of threshold probabilities.

Conclusion. The results align with current understanding regarding treatment outcomes for tethered spinal cord syndrome and the applicability of machine learning approaches in pediatric neurosurgery. The XGB ensemble model demonstrates high accuracy and clinical utility in predicting adverse outcomes in children with tethered spinal cord syndrome, making it a promising tool for risk stratification; it could be integrated into decision-support systems to help select the safest and most effective surgical strategy for spinal dysraphism.

Objective. To study clinical, including functional, outcomes after instrumentation removal in patients who underwent temporary posterior C1–C2 fixation without fusion for odontoid process fracture and to compare them with the results of treatment of patients without instrumentation removal.

Material and Methods. Design: Retrospective comparative study in a single-center cohort. Posterior C1–C2 fixation without spinal fusion was performed in 85 patients in 2009–2024. After applying the compliance criteria, 49 patients with C2 odontoid fracture were included in the comparative analysis, of which 22 underwent instrumentation removal after confirmed consolidation of the fracture, and in 27 patients the instrumentation was not removed. Age, sex, injury mechanism, fracture type, and time to fracture consolidation were assessed in both groups. Assessed parameters included pain intensity according to VAS, total neck rotation, rotational range of motion in the C1–C2 segment according to functional CT, as well as subjective stiffness during head rotation. The follow-up time points were 3, 6, and 12 months.

Results. At 6 and 12 months after instrumentation removal, patients showed a statistically significant decrease in pain intensity as compared with the group without removal. Total neck rotation in the removal group increased progressively and was significantly higher after 12 months than in patients with retained fixation. The removal group also showed a marked decrease in subjective stiffness. No clinically significant perioperative complications requiring additional treatment or repeat intervention were registered. The obtained data may be used in neurosurgery when choosing treatment tactics for patients with C2 odontoid process fractures, especially in cases where the priority is to preserve or restore the rotational function of the upper cervical spine.

Conclusion. Instrumentation removal after temporary posterior C1–C2 fixation and confirmed consolidation of C2 fracture is associated with partial restoration of rotational mobility, reduction of subjective stiffness, and decrease in pain intensity at follow-up periods of up to 12 months.

Objective. To develop and evaluate a system for automated analysis of standing anteroposterior and lateral spinal radiographs with subsequent calculation of sagittal balance parameters and determination of personalized target spinopelvic parameters based on the pelvic incidence (PI).

Material and Methods. A retrospective two-center study was conducted. The analysis included anonymized digital radiographs of the spine and pelvis in anteroposterior and lateral projections obtained in a standing position from 1,076 patients. A total of 973 fully annotated and expert-verified studies were used for training, validation, and testing. Automatic segmentation was performed using a U-Net architecture, followed by calculation of sagittal balance parameters with the possibility of deriving coronal parameters. A separate analysis of agreement between expert and automated measurements was conducted for the PI, PT, SS, GLL, and L4–S1 parameters. Segmentation quality was assessed using the Dice coefficient and IoU (Jaccard index). Inter-expert variability of annotations was additionally analyzed, and results were compared using “model–expert” and “expert–expert” schemes.

Results. On the test dataset, the mean Dice coefficient between the model and the expert was 90.1%, falling within the range of inter-expert variability (88.5–93.4%). A comparison of automated and expert measurements of PI, PT, SS, GLL, and L4–S1 parameters in a subset of 46 patients demonstrated high agreement between the methods: ICC(A,1) values ranged from 0.989 to 0.996; the 95% confidence intervals for ICC(A,1) ranged from 0.977 to 0.998; the mean absolute error ranged from 0.84° to 1.14°, and the proportion of measurements with an absolute difference of no more than 2.5° was 93.5–97.8%. The complete analysis cycle for a single patient required less than 3 seconds on a graphics processing unit (GPU). The prototype components successfully underwent pilot testing.

Conclusion. The developed system enables the automatic recognition of anatomical structures on spinal radiographs and the calculation of sagittal balance parameters with a high level of agreement with expert measurements. The system may be used to standardize radiographic measurements; however, its use in preoperative planning requires further clinical validation.

Objective. To present a rare case of lumbar vertebral body erosion caused by an aortic pseudoaneurysm and to conduct a non-systematic literature review to determine diagnostic methods and treatment tactics.

Material and Methods. The results of surgical treatment of a patient with contact erosion of the L2 and L3 vertebral bodies caused by a pseudoaneurysm of the abdominal aorta are presented. Surgical treatment was performed in two medical institutions in three stages: 1st –
abdominal aortic replacement, 2nd – pedicle screw fixation, and 3rd – resection of the destroyed vertebral bodies with structural supporting fusion using titanium mesh. A search for publications on a combined (vascular and orthopedic) approach to treating such conditions was conducted in eLibrary and PubMed.

Results. A favorable clinical and radiological outcome was achieved with a one-year postoperative follow-up period. Current trends in surgical reconstruction for thoracic and lumbar vertebral destruction due to aortic pseudoaneurysm are presented, including a description of the types of destruction, and the kind and stages of interventions.

Conclusion. Surgically significant erosions (involving more than 30% of the vertebral body bone mass) caused by an aortic pseudoaneurysm are an extremely rare and require differential diagnosis including mandatory CT, CT angiography, and ultrasound Doppler imaging to distinguish them from tumor and inflammatory vertebral destruction. Staged surgical reconstruction minimizes the risk of complications and is performed in hospitals specializing in cardiovascular and musculoskeletal surgery. This intervention eliminated the risk of aneurysm rupture, alleviated its traumatic effect on the spine, achieved stable fixation, regressed pain, and restored the patient’s functional activity, preventing disability.

Objective. To determine the clinical efficacy of bilateral microsurgical decompression through a unilateral approach in comparison with decompressive laminectomy and posterior screw fixation in patients with cervical spondylotic myelopathy.

Material and Methods. The study will include adult patients with neurological deficits caused by cervical compressive-ischemic myelopathy due to degenerative spinal canal stenosis. The study will include two groups of patients: a prospective (study) group undergoing bilateral microsurgical decompression of intracanalicular neurovascular structures through a unilateral approach, and a retrospective (comparison) group undergoing decompressive laminectomy with screw fixation. The duration of the study will be approximately two years. The dynamics of clinical, radiological, and neuroimaging data will be assessed at 3 and 12 months.

Expected Results. This study will clarify the efficacy parameters of bilateral microsurgical decompression of intracanalicular neurovascular structures through a unilateral approach in the cervical spine, and demonstrate the advantages of this technique over the conventional method of decompressive laminectomy with screw fixation at the cervical level. 

Scoliosis is a common orthopedic condition that, when progressive, requires surgical intervention. Congenital heart defects are another common pathology, often requiring surgery, most often (unlike scoliosis) for urgent or life-saving reasons. These two pathologies can and often do coexist, inevitably posing new challenges for surgeons, both cardiologists and spine surgeons. A systematic search of publications in the Pubmed/Medline electronic database was conducted using the keywords “scoliosis” and “congenital heart defect”. A total of 109 papers were identified, all with one exception in English. These papers are included in the historical and analytical literature review. An attempt was made to answer a number of questions: how often do scoliosis and congenital heart defects occur, how often is scoliosis combined with congenital heart defects, how often is congenital heart defect combined with scoliosis, what types of scoliotic deformities accompany the development of congenital heart defects, what are the mechanisms of scoliosis formation in combination with congenital heart defects, does the dynamics of the development of the musculoskeletal system change in children with congenital heart defects, and what are the results of surgical correction of scoliotic deformities against the background of congenital heart defects and of heart defects – against the background of scoliotic disease?

Scoliosis and congenital heart disease are large and important areas of clinical medicine. The combination of these pathological conditions is common, creating a new clinical entity that has not been fully studied. Surgical correction of one or both pathologies, when they coexist, presents a complex clinical challenge.

This paper presents a review of 36 patents for inventions and utility models related to spine surgery published in 2025. Technical solutions in the fields of devices and implants, surgical treatment methods, diagnostics, prognosis, and navigation are analyzed. Key patenting trends are highlighted: minimally invasive techniques, personalization, robotics, digital technologies, and regenerative medicine. State-run scientific and medical centers play a leading role in patenting activity.