Objective. To analyze clinical effectiveness of repositioning decompression of the dural sac and to justify a differentiated approach to the decompression for traumatic spinal stenosis caused by damages of lower thoracic and lumbar vertebral bodies.

Material and Methods. A total of 103 adult patients with injuries of the lower thoracic and lumbar spine accompanied by traumatic spinal canal stenosis were treated: 76 patients were included in the study group and 27 - in the control group. All patients underwent decompressive-stabilizing surgery with transpedicular fixation. In the study group, the priority was given to indirect repositioning decompression (more 50 %), in the control group - decompressive laminectomy (100 %).

Results. In the study group, long-term results of treatment were assessed as good in 38 (79.2 %) cases, satisfactory - in 8 (16.7 %), and poor - in 2 (4.2 %). In the control group, good results were obtained in 13 (72.2 %) patients, satisfactory - in 4 (22.2 %), and poor - in 1 (5.6 %).

Conclusion. Differentiated approach to decompression of the dural sac in patients treated for lower thoracic or lumbar spine injuries and traumatic spinal canal stenosis allowed avoiding laminectomy in 53.9 % of patients in the study group and performing anterior decompression consisting of subtotal corpectomy 1.9 times less often than in the control group. 

Objective. To study the mechanisms of spinal cord injury in children of different age groups.

Material and Methods. А retrospective analysis of the results of treatment of 217 children aged 1 to 15 years with traumatic injuries of the spine and spinal cord was performed. Group A included patients with spinal cord injury without damage to the spine (n = 139), and Group B - with spinal cord injury accompanied by spinal column injury (n = 78). McAffe сlassification of spinal injury mechanisms was used. Neurological deficit was evaluated according to the Frankel scale. Main causes and mechanisms of these injuries were studied.

Results. Principal mechanisms of spinal cord injury in children were as follows: distractive extension and compressive flexion for isolated SCIWORA-type injuries, and compressive flexion for the spine and spinal cord injuries.

Conclusion. The most pronounced neurological deficit is observed after exposure to compression-flexion mechanism of injury. Traction mechanisms of injury cause severe neurological disorders peculiar to SCIWORA syndrome.

Objective. To analyze the current level of early postoperative septic complications in a large retrospective series of patients with idiopathic scoliosis operated in the same clinic.

Material and Methods. The single-center retrospective database of 1973 patients who underwent surgical correction of idiopathic scoliosis with corrective segmental 3rd generation instrumentation during 1996-2013 was studied. In all patients, antibiotic prophylaxis was started 30 minutes before incision and lasted up to 72 hours after surgery. Cefazolin in age-specific dosage variances was used as antibiotic. Drainage of the area of surgical intervention was performed within two days after surgery.

Results. Surgical site infection occurred in 12 cases (0.6 %) within 90 days after surgery. Suppuration developed only in the area of posterior approach to the spine. The most common pathogen was S. epidermidis isolated in 68.0 % of cases. Implants and the achieved correction of spinal deformity were saved in 10 (83.0 %) patients.

Conclusion. Prevention of postoperative infections in surgery of idiopathic scoliosis is the most important task. It is necessary to carry out an early revision and debridement of the wound and strive to maintain implants if they are stable. 

The paper presents clinical examples of surgical treatment of female patients aged 3 and 13 years having congenital malformations of the lumbosacral spine, sacral aplasia, and tethered spinal cord. The patients underwent surgical treatment, with due account for spine malformation and presence of tethered spinal cord syndrome.

The paper presents the first part of literature review of the main methods of treatment of patients with infantile and juvenile scoliosis. Particular attention was paid to the results of treatment using various instrumentation with the possibility of stage correction.

Iliac crest bone autograft is most commonly used grafting material in spinal surgery. Despite the high efficiency of bone autograft in spinal fusion, its application is associated with a number of negative points including so called donor site morbidity, i.e. complications of bone graft harvesting. Major complications are associated with harvesting technique. The most significant minor complication is chronic postoperative pain which incidence is 28-31 %. Chronic donor site pain may be caused by muscle mobilization, external cortex destruction in the iliac wing, and nerve damage. The treatment of chronic donor site pain is still exclusively symptomatic. Main factors influencing the rate of iliac crest bone harvesting complications and preventive techniques are reviewed.

The paper presents detailed definitions, anatomical features and analytical data on the epidemiology and etiopathogenesis of isolated lumbar and cervical spinal stenoses and their combinations (tandem stenoses). Most widely used classifications of stenosing processes of the spine, modern X-ray imaging methods for diagnosis of spinal stenosis and approaches to surgical treatment are described.

Objective. To evaluate the effectiveness of a modified Wiltse approach to the lumbar spine for extraforaminal disk herniation.

Material and Methods. A total of 1020 patients with herniated lumbar intervertebral disc were operated on, out of them 30 (2.9 %) patients were diagnosed as having extraforaminal disc herniations most often observed at the L4-L5 (53.3 %) and L5-S1 (40.0 %) levels. Clinical manifestations included back pain in 20 patients (66.6 %) and radicular syndrome - in all patients, which was accompanied by movement disorders in 15 (50.0 %) cases and by sensitivity disorders in 9 (30 %). Evaluation of surgical results was performed in the early postoperative period and at 3 and 6 months after surgery. Clinical outcomes were assessed using modified MacNab criteria.

Results. Based on MacNab criteria, an excellent outcome was observed in 45 %, good - in 42 %, and satisfactory - in 13 % of cases at 6 months after surgery. The volume of intraoperative blood loss was on average 52.8 ± 30 mL, the average length of hospital stay was 2.6 days.

Conclusion. The modified Wiltse approach is an effective surgery to remove extraforaminal herniation in the lumbar spine, which allows achieving excellent and good results of treatment in 87 % of cases. 

Objective. To analyze the results of using titanium meshes for anterior fusion in spinal reconstruction in pediatric patients.

Material and Methods. Design: A retrospective cohort study from 2011 to 2014. Spinal reconstruction in 108 patients aged 8 months to 17 years was performed with titanium meshes filled with bone autografts. The indications for surgery were Pott’s disease (n = 41), non-specific chronic spondylitis and its sequences (n = 42), spinal tumors (n = 11) and congenital spinal deformities (n = 6). Additional posterior instrumentation was carried out in case of multilevel spinal reconstruction or for spinal deformity. Clinical and radiological FU results were evaluated at the 6, 12, 18 months after surgery with the analysis of infection reactivation risk, changes in the apical Cobb angle and dynamics of block formation in anterior fusion zone.

Results. No cases of infection reactivation or process aggravation were detected during 6 months after surgery. Two patients (with TB spondylitis and giant cell tumor) had deterioration of vertebral destruction with mesh instability in the period from 6 to 12 months after surgery. No one case of mesh stability preservation was associated with deformity progression. Solid bone block was formed in 97 % of operated patients at 12 months after surgery.

Conclusion. Using of meshes in reconstructive surgery on the spine in children does not increase the rate of postoperative complications even in infectious spondylitis, due to biological inertia of the non-resorbable material. 

The lecture represents Prof. J. Dubousset’s understanding of such fundamental problems of the modern spine medicine as the balance of the body in three-dimensional space, stability and alignment of the spinal column, and describes the methods of qualitative and quantitative assessment of these parameters. Attention is also paid to the prevention of junctional kyphosis and its justification from the author’s position.