Objective. To compare the results of treatment of compression fractures of the thoracic and lumbar vertebrae in children by classical functional extension and by early orthotics with hyperextension braces.

Material and Methods. The study included 175 children aged 3 to 18 years with vertebral compression fractures of the thoracic and lumbar spine. In the study group (32 patients), early orthotics with a rigid hyperextension brace was used, in the control group (143 patients) - a standard Gorinevskaya - Dreving’s technique followed by wearing a semi-rigid brace.

Results. In the study group, the average vertebral compression ratio was 63 %, WI - 0.6-0.8, and vertebral body height restoration was observed in 90.5 % of cases. In the control group, the average compression ratio was 75 %, WI - 0.75-0.9, and abnormal wedging of vertebral bodies after the treatment was observed in 48.0 % of patients. In the study group, the length of hospital stay was reduced, the mode of physical activity in the early stages was increased with better and faster restoration of vertebral bodies in comparison with the control group.

Conclusion. Application of hyperextension braces shortens hospital stay, contributes to the complete restoration of the height and shape of the damaged vertebral body, and allows for more early returning the children to the familiar social environment. 

Objective. To analyze corrective opportunities of staged combined surgical treatment of posttraumatic deformities in the thoracic and lumbar spine.

Material and Methods. A total of 106 patients (58 men and 48 women) were operated on for posttraumatic kyphosis of the thoracic and lumbar spine using staged operations at the same session. The study included the assessment of radiological parameters, the analysis of clinical outcomes using Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS), and the estimation of intraoperative blood loss and complications.

Results. Segmental kyphotic deformity was on average corrected from 24.0° ± 8.7° to 10.5° ± 1.3° (P = 0.17), the mean deformity correction was 23.1°. The ODI and VAS scores changed significantly. The duration of multi-stage interventions was 227.5 ± 623 minutes, with blood loss of 407.5 ± 258.2 ml. There was no appearance of neurological symptoms or their worsening in the postoperative period. Complications were noted in 6 (5.6 %) patients.

Conclusion. Staged surgical treatment of posttraumatic deformities ensures high correction capability combined with the safety of interventions and low complication rates. 

The paper presents an analysis of the English-language literature on the results of surgical treatment of adolescent idiopathic scoliosis observed in the period from 5 to 30 years after surgery. Seventy-one selected publications were analyzed after division into two groups according to the used endocorrector: the Harrington distractor or CD instrumentation and other 3rd generation instrumentation. The 3rd generation instrumentation provides better deformity correction and its maintenance. Pseudarthrosis following fusion and complications associated with implants are approximately equifrequent in both groups. Surgical wound suppuration is more frequent in CDI Group, and reoperation - in the Harrington Group. Reproductive function of women after surgery does not differ from that in the general population. Health-related quality of life does not change depending on the remoteness of intervention. No significant dependence of pain syndrome on the location of lower instrumented vertebra and the time after surgery was observed.

Objective. To analyze the results of surgical correction of scoliosis in patients with syringomyelia.

Material and Methods. The study included 33 patients with syringomyelia and the enlarged spinal canal. Neurosurgical intervention was performed in 20 patients. The following operations were carried out: formation of a large occipital tank, draining and emptying of cysts, and resection of terminal filament. Nineteen patients were operated on using the CDI. Four patients are undergoing stage correction with VEPTR. In one case, instrumentation was not successful, and nine patients are receiving treatment at the Department of Neurosurgery.

Results. The study did not reveal any statistically significant relationship between sex, age, deformity apex, side of scoliotic curve, rate of progression, neurological symptoms and the presence of syringomyelia. It was noted that the neurological deficit begins to develop when a cyst width exceeds 4.5 mm, yet its length and location do not play a significant role. In the presence of cysts of up to 9 mm in width, clinical manifestation and neurological symptoms may be absent.

Conclusion. The proposed approach to the treatment of patients with spinal deformities, which have syringomyelia as a concomitant vertebral pathology can allow to achieve satisfactory results in scoliosis correction and to avoid neurological complications. 

Objective. To study pathogenetic significance of bone abnormalities of the craniovertebral junction (CVJ) for the insufficiency of the vertebrobasilar circulation by analyzing the long-term outcomes of surgical treatment and comparing them with preoperative data of patients.

Material and Methods. Long-term results of surgical treatment of 49 patients operated on for bone abnormalities of the CVJ in the period from 1985 to 2013 who had strongly proved clinical and instrumental signs of vertebrobasilar insufficiency (VBI) and responded the questionnaire. Decompression of the brain and vertebral arteries was performed through transpharyngeal approach developed by authors. Eleven patients with Kimmerle anomaly underwent resection of abnormal bone bridges on the arch of the atlas and arteriolysis of the vertebral artery.

Results. Surgery for craniovertebral abnormalities provided the improvement in 84.2 % of operated patients. Excellent and good results were observed in 12 patients (75.0 %) with unstable abnormalities and in 6 patients (27.3 %) with stable abnormalities (p < 0.01). All patients with Kimmerle anomaly got good to excellent treatment outcomes.

Conclusion. Decompression of the brain and vertebral arteries through transpharyngeal approach is a pathogenetically justified method of treatment of patients with vertebrobasilar insufficiency due to craniovertebral abnomalities. 

The paper presents a review of the current literature concerning the problem of degenerative scoliosis, its clinical manifestations, diagnosis, classification and approaches to surgical treatment. In connection with the aging of the population, improvement of surgical techniques and advance in anesthetic support, the problem of degenerative scoliosis is increasingly viewed with regard to possible options for its surgical correction. There are several factors that contribute to the formation of de novo scoliosis. They involve the facet joint tropism, asymmetric degeneration of the intervertebral disc, osteoporosis, myopathy, and long-existing antalgic scoliosis. Conservative treatment of degenerative scoliosis includes administration of non-steroidal anti-inflammatory drugs, brace treatment, and epidural and paravertebral glucocorticosteroid injections. When conservative therapy is fully ineffective and patient’s quality of life significantly decreases, the surgical treatment decision is made individually. The main issue of surgery is the choice of optimal surgical strategy which depends on careful evaluation of clinical symptoms and their pathologic substrate, and mandatory accounting for parameters of the global spinal-pelvic balance. Positive sagittal imbalance is associated with a significant reduction in quality of life, therefore it should be, whenever possible, surgically corrected.

Objective. To study the structure of complications after surgical treatment of degenerative lumbar stenosis and to analyze their influence on outcomes and indications for revision.

Material and Methods. A total of 513 patients with degenerative lumbar stenosis underwent decompression and stabilization of stenotic spinal motion segments including transpedicular fixation and fusion (TLIF or PLIF). All complications both during operations and in the early and late periods of follow-up were systematized.

Results. The total rate of complications was 26.51 %. The rate of early complications, including intraoperative ones was 12.67 %, and of late complications - 13.84 %.

Conclusion. Unsatisfactory outcome in the early postoperative period was associated with pulmonary embolism and suppuration of postoperative wound with generalization of the infection process. Unsatisfactory long-term results of treatment were most often caused by loosening of instrumentation and late suppuration.

The paper presents analytical review of the literature on the problem of surgical treatment of patients with intradural migration of intervertebral disc hernias and a clinical case of intradural herniated disc in the lumbar spine. Despite advances in neuroimaging and modification of methods and surgical techniques, this pathology is rarely diagnosed preoperatively. Its surgical treatment involves considerable technical difficulties and is associated with high rate of revision operations. The study material included abstracts of articles from the PubMed database and articles published in The Journal of Bone and Joint Surgery, Spine, European Spine Journal, and other journals over the past 15 years.

Objective. To analyze characteristic features of spinal lesions as a manifestation of late-onset neonatal sepsis.

Material and Methods. Medical histories, clinical, and instrumental data of 9 children operated on for consequences of spinal lesions associated with late-onset neonatal sepsis were studied. Design: retrospective clinical study. Level of evidence - IV.

Results. Neonatal sepsis occurred at the age of 5 days to 2.5 months after birth. Main clinical manifestations of the disease were caused by pneumonia observed in 7 of 9 children. Spinal lesion was diagnosed within 3-12 months after the disease onset. Its main manifestation was kyphotic deformity caused by the T₄-T₁₁ vertebral body destruction. Average age of children at surgery was 13.4 months (range: 7 to 21 months). All patients underwent two-stage surgical treatment including anterior fusion and posterior instrumentation of the spine. Long-term results were followed for up to 5 years.

Conclusion. Spinal lesions as a manifestation of late-onset neonatal sepsis are rare disorders, and are characterized by vast destruction of vertebral bodies and development of paravertebral and epidural abscesses in neurologically intact patients. However, they are diagnosed only after the onset of kyphosis. Verification of spondylitis etiology fails due to the prior massive antibiotic therapy and insufficient examination in the acute phase of sepsis. Surgical treatment of spondylitis caused by late-onset neonatal sepsis is carried out when the infection is under control, and aims at the anterior column reconstruction and the correction of kyphotic deformity. 

Objective. To assess the effectiveness of tranexamic acid in the surgical correction of idiopathic scoliosis.

Material and Methods. The study included a retrospective analysis of intraoperative and postoperative blood loss during surgical correction of idiopathic scoliosis in 198 patients. In 70 patients, the operation was performed without administration of tranexamic acid. In 58 patients, tranexamic acid was administered 15 minutes before the skin incision at a dose of 10 mg/kg, and continued uninterruptedly at a dose of 1 mg/kg/h. In 70 patients, tranexamic acid was administered continuously during the operation at a dose of 10 mg/kg. Patients underwent surgery in a prone position with full decompression of the anterior abdominal wall.

Results. The registered intraoperative blood loss in most cases corresponded to Class I (no more than 750 ml or 15 % of blood volume) and Class II (no more than 750-1500 ml or 15-30 % of blood volume) according to the WHO classification of severity. The volume of intraoperative blood loss was not statistically different between groups. Significant differences were detected only in assessing parameters of postoperative blood loss.

Conclusion. The use of tranexamic acid in surgical correction of scoliosis does not affect the bleeding index of tissues at the surgical site and the total intraoperative blood loss. Using tranexamic acid in spine surgery is a technological procedure allowing for significant reduction in postoperative blood loss.

Objective. To present experimental model of traumatic spinal cord injury and to assess the efficacy of ketamine for neuroprotection in multimodal treatment for spinal cord injury in acute phase.

Material and Methods. The study was performed in 60 rabbits with modeled acute spinal cord injury. The standard open spinal cord injury was inflicted in the lower thoracic spine with graduated impact strength and area using impact device. Further, the multimodal therapy was conducted. Motor function, reflexes, pelvic organ function, and skin sensitivity were assessed. Experimental animals were divided into several groups depending on ketamine therapy start time.

Results. The presented model of spinal cord injury is reproducible, graduated, same-type and similar to clinical injury. The model enables mastering the treatment for spinal cord injury sequelae. The method is easy to study and use, and does not require complex equipment. The study showed significantly better recovery of the motor function after early beginning of ketamine therapy.

Conclusion. Ketamine is an effective neuroprotectant in spinal injury, and its administration in the acute phase of traumatic spinal cord injury improves the results of treatment and prognosis. 

Any surgical exposure destroys the integrity of the patient’ body, for his own benefit. Sometimes, the spine intervention is performed for urgent life-saving indications and is guided by the Straightforward Principle. In other cases, there are no life-saving indications, but surgery aims to restore function and improve appearance. The first step includes careful preparation and planning of surgery. The main principle is a protection of neural structures of the spinal cord and its nerve roots. Slow incremental correction of spinal deformity is often more effective and safer than fast and dramatic one. The ultimate 3D-harmony of the whole spine as a part of the body is better than just a correction of the Cobb angle. The purpose of any surgical fusion is the achievement of 3D-balance both at the whole body level and at levels of junctional discs above and below the instrumentation. The lecture describes in details patient positioning, approaches, instrumentation and implants, main strategies for deformity correction, analysis of deformities (global and local), different ways of correction, most applicable corrective techniques (compression, distraction, translation, and axial rotation), and postoperative examination with particular emphasis on the spine alignment and the achieved balance. Each patient should be regarded as unique, and its treatment should be personalized. It is important to realize that the most effective and urgent treatment should be delivered in cases complicated by neurological symptoms.

The lecture, based on long experience of research, addresses controversial issues in spinal deformity together with some generalizations. The term of scoliosis is defined as a violation of the spine morphogenesis during the early embryonic development, which, in the process of growth, develops into spinal deformity with clinical variants depending on the degree of morphogenesis violation. The etiological factor of scoliosis is ectopic localization of neural crest-derived cells, which are not genetically deterministic to chondrogenesis and the growth process, in the vertebral body growth plates. The local violation of chondrogenesis in the vertebral body growth plates is a cause of the growth asymmetry and spinal deformity development. The variability of structural changes and the progression prediction depend on the degree of violation of morphogenetic processes laid down during embryogenesis. A phenotype of scoliosis is the primary scoliotic or kyphotic deformity of the spine with variants of the disease course depending on its stage. Research Perspective: the creation of an experimental model of scoliosis with clinical variants and the development of preventive correction of the studied pathology.