Objective. To substantiate experimentally a method for preventing adjacent vertebra fractures during cement transpedicular fixation of vertebral fractures in osteoporotic patients.

Material and Methods. An experimental study included the assessment of overall strength of 10 cadaver blocks of Th₁₀-L₄ vertebral segments with simulated Magerl’s type A fracture at the L₁ level and transpedicular fixation at the Th₁₂-L₂ levels with four-screw system and cement augmentation. In five control blocks, only cement augmented transpedicular fixation was performed after the L₁ fracture simulation. In five blocks of the study group it was supplemented by vertebroplasty at Th₁₁ and L₃ levels cranial and caudal to the level of fixation. Load testing of the blocks was carried out by destruction under the influence of a vertically directed force.

Results. Vertical loading of anatomical specimens in the control group (average of 0.84 kN) caused Th₁₁ vertebral body fractures. In the study group, the vertebrae augmented by vertebroplasty were resistant to loading. Fractures occurred in the Th10 vertebral bodies (over the vertebra with vertebroplasty) under the average load of 1.91 kN.

Conclusion. Vertebroplasty of the vertebra overlying the level of transpedicular fixation is an effective way to prevent its fracture.

Objective. To present an algorithm for consistent application of neuromodulation techniques to improve the effectiveness of spastic syndrome relief and to specify its role in the rehabilitation of patients after spine and spinal cord injuries.

Material and Methods. The study included 105 patients with increased muscle tone after spinal cord injury. To relieve muscle spasticity, a staged therapy was performed including electrical stimulation of the spinal cord, simultaneous epidural drug therapy with electrical stimulation, and local hypothermia of the spinal cord.

Results. Positive results were obtained after each stage of neuromodulation therapy. They became a basis for the development of an algorithm of surgical treatment of patients with excessive muscle spasticity.

Conclusion. The proposed algorithm for consistent application of neuromodulation techniques in patients with spastic syndrome after spinal cord injuries allowed significant reducing the degree of spasticity and creating conditions for further rehabilitation in 88.6 % of cases.

Objective. To assess the outcomes in patients with disorders of the cervical spine treated by anterior subaxial cervical fusion with telescopic vertebral body replacement implant.

Material and Methods. The developed design of a telescopic vertebral body replacement implant for anterior interbody fusion at the subaxial level is described in details. The effectiveness of the implant was analyzed basing on the outcomes in patients of two groups. In patients of Group 1 (n = 21) the stabilization was carried out with the Mesh implant in conjunction with anterior plate fixation, and in patients of Group 2 (n = 12) - with the vertebral body replacement implant of the telescopic design.

Results. The obtained evidence showed the absence of postoperative complications associated with the violation of the operated segment stability and the loss of intraoperative correction of the sagittal profile of the cervical spine in patients of Group 2. The achieved correction of the spinal motion segment persisted throughout the entire period of observation. The recurrence of deformation of the anterior wall of the spinal canal causing compression of the epidural space and the spinal cord was not observed.

Conclusion. Telescopic systems can be considered the most effective and perfect in restoring the anterior spinal support. They optimize the process of sagittal profile correction by metered changing the distance between the vertebrae adjacent to the rejected one, which is the main advantage of the telescopic systems.

The paper presents a second part of literature review on basic methods of treatment of patients with infantile and juvenile scoliosis. Particular attention is paid to the results of treatment with the use of various instrumentation and with a possibility of stage correction.

The paper presents a case study of surgical treatment of a 14-year-old patient with multiple skeletal malformations, congenital kyphoscoliosis of the thoracic spine, non-fusion of vertebral arches and vertebral bodies from the C₅ to the sacrum (bodies are separated from arches with slit-like defects along the whole length), and spinal compression syndrome.

Objective. To analyze anatomical and anthropometric parameters of vertebrae in children with Lenke type V idiopathic scoliosis using 3D-CT navigation.

Material and Methods. The study included 15 patients aged 14-18 with thoracolumbar/lumbar idiopathic scoliosis of grades III and IV according to V.D. Chaklin. Anatomic and anthropometric features of the thoracic and lumbar vertebrae were assessed based on CT data in the navigation system. The total Cobb angle of the scoliotic curve, rotation of the apical and periapical vertebrae, external transverse and longitudinal diameters of the pedicles at the T₂-L₅ levels, and the coefficients of asymmetry of vertebral bone structures were determined.

Results. The angle of scoliosis ranged from 39.8° to 84.3° (average - 59.5°), the angle of rotation of the apical vertebra - from 17.7° to 50.5° (average - 34.6°). Anatomical dimensions of the transverse and longitudinal diameters of the pedicles on the concave and convex sides at the apex of a primary curve exceeded 4.0 mm. A strong correlation between the apical vertebral rotation, the Cobb angle, and the coefficient of asymmetry of longitudinal diameters of the pedicles of the apical vertebra was revealed. The coefficient of asymmetry of pedicle areas is an integral indicator of the severity of asymmetry in scoliosis.

Conclusion. A different degree of asymmetry of the bone structures of the main arch apical vertebrae was revealed in the thoracic and thoracolumbar/lumber scoliosis.

Object. To identify the importance of main risk factors of early development of degenerative changes in adjacent spinal motion segments after the lumbar fusion.

Material and Methods. The study evaluated the treatment results in 354 patients who underwent fusion in the lumbar spine for degenerative-dystrophic disease. Two groups were compared: Group I included 26 patients with clinically significant adjacent segment disease (ASD) which developed during the first year after surgery, and Group II - 24 patients in whom ASD was identified at a later date.

Results. Significant degenerative changes in the overlying intervertebral disc (Pfirrmann grade 4 and higher) were found preoperatively in 16 (61.5 %) patients in Group I. In Group II, such degenerative changes were observed in 3 (12.5 %) patients. Besides, patients in Group I had higher mean index of the difference between pelvic inclination and lumbar lordosis (PI-LL), than patients in Group II (12.2° and 9.3°, respectively). Nine patients in Group I with Pfirrmann grade 4 to 8 degenerative changes demonstrated sagittal imbalance as Positive in 7 cases and Very Positive in 2 cases, according to Schwab classification.

Conclusion. Decompensation of the pre-existing degenerative changes in the conditions of increased load after fusion is crucial in early development of the adjacent segment disease. Patients with degenerative changes in the adjacent levels of grade 4 and higher according to Pfirrmann, as well as patients with PI-LL index more than 11° have a significantly higher risk of early ASD development.

The paper presents a literature review on contemporary problems of surgical treatment of low grade spondylolisthesis. The results of various surgical techniques including modern minimally invasive methods of treatment are provided. The importance of selecting a method of surgical intervention depending on the type of spondylolisthesis, sacro-pelvic balance, and global sagittal balance is indicated, as well as their influence on the quality of life of patients. Complications and causes of pseudoarthrosis development depending on different methods of interbody fusion are discussed. The choice of optimal treatment tactic is the main problem in surgery of low grade spondylolisthesis.

The paper presents an analytical review of the literature on the history of the development of clinical diagnostic approaches and methods of surgical treatment for intervertebral discs diseases in the lumbar spine.

To analyze the efficacy of different treatment regimens.

Material and Methods. Retrospective two-center cohort of 54 children with NBO, including 18 patients with vertebral lesions was studied. The level of evidence is 3.

Results. Vertebral form of the non-bacterial osteomyelitis is characterized by high frequency of multifocal bone lesions. The features of clinical and X-ray manifestations of the vertebral form of NBO, its diagnosis and medical treatment are presented. First of all NBO should be differentiated from infectious (tuberculosis) and neoplastic lesions of the skeleton. Non-steroid anti-inflammatory drugs are not effective for the relief of pain in the NBO vertebral form, preference should be given to bisphosphonates and TNF-a inhibitors. Indications and volume of surgical techniques for diagnosis and treatment of this pathology are specified.

Conclusion. Management of patients with the vertebral form of NBO should be interdisciplinary and carried out with the assistance of doctors of various specialties - pediatricians, rheumatologists, orthopedists, surgeons, phthisiatrician, etc.

Objective. To identify the features of m. psoas minor histogenesis in growing dogs under conditions of the development of spinal scoliotic deformity.

Material and Methods. Experiments were performed on 16 four-month-old mongrel dogs, males and females. In animals of Series I, the deformity was created by gangliotomy at five lumbar motion segments (L₂-L₆), in animals of Series II - by fixation of adjacent L₃-L₆ vertebral bodies with nickel titanium staples possessing thermochemical shape memory effect, and in animals of Series III - by implantation of titanium plates into the subchondral zone of vertebral growth plates, together with the staples. The control series included intact age-matched dogs. The X-ray examination of animals of Series I-III was performed in dorsoventral and lateral views at days 14, 30, 60, 90, and 180 after surgery. Paraffin and semi-thin sections of m. psoas minor from concave and convex sides of the lumbar scoliotic deformity zone were studied using light microscopy in 3 and 6 months after surgery.

Results. Standard signs of degenerative-dystrophic changes and reparation by restitution/substitution type characterize the histogenesis of m. psoas mino r. The most marked destructive changes in the muscles on both sides of the deformity retained in the long-term only in animals of Series III.

Conclusions. The study results can be used for evaluating the adaptation and plasticity potential of paravertebral muscles, as well as for developing models of the spine scoliotic deformity.

The lecture presents the views on the process of mechanical origin of scoliotic deformity of the spine and on a contribution of extraspinal departments of the locomotor system to this process.