The paper presents a clinical case of a patient with the consequences of spinal cord injury treated with the use of noninvasive electrical stimulation of the spinal cord in combination with mechanotherapy.

He article presents the estimates of the parameters of endoprosthesis, which allows to determine the advantages and disadvantages of various implants as systems for reconstruction and stabilization of the spinal motion segment, and creating conditions for bone fusion of vertebrae adjacent to the resected one. The results obtained in studying characteristics of the cages allow their division into 4 groups depending on the combination of features necessary for performing surgeries on the anterior and middle columns of the spine. Based on these data, the authors developed a design of vertical cylindrical telescopic endoprosthesis LAS. The above information increases the possibility of an objective evaluation of the mechanisms of probable postoperative complications and may facilitate the selection of the optimal design, taking into account characteristics of the clinical situation in each particular case.

Objective. To analyze the outcomes of surgery for congenital kyphotic deformities of the spine in patients over 10 years old.

Material and Methods. A total of 49 patients with congenital kyphosis were operated on. The age of the patients at the time of treatment was at least 10 years (mean 14.8 years), the follow-up period - at least 2 years (mean 3.8 years). All patients were operated on using third generation segmental instrumentation with hook and hybrid fixation.

Results. Congenital kyphotic deformities are of high rigidity. The average magnitude of preoperative kyphosis was 92.9°, mobility - 27.5 %, during the operation it was corrected to 61.7° (33.5 %), postoperative progression was 4°. All anthropometric indicators have improved, the SRS-24 survey also showed positive patient-reported outcomes. At the same time, the complications are quite frequent, as well as initial involvement of the spinal canal content in the pathological process (11 patients).

Conclusion. Congenital kyphotic deformities should be detected as early as possible and timely treated. 

Objective. To analyze anatomical and anthropometric parameters of vertebrae measured by a navigation system in children with thoracic idiopathic scoliosis.

Material and Methods. A total of 20 patients aged 14-18 years with Grade 3 and 4 (according to V.D. Chaklin classification) right-sided thoracic idiopathic scoliosis were examined. Anatomical and anthropometric features of the thoracic and lumbar vertebrae were assessed using CT data in the navigation system. The total Cobb angle of scoliotic curve, rotation of apical and periapical vertebrae, external transverse and longitudinal diameters of the roots of vertebral arches at the T₂-L₅ levels, and the coefficients of asymmetry of vertebral bone structures were determined.

Results. The angle of scoliosis deformity ranged from 33.7° to 107.9° (mean: 61.4°), the angle of rotation of the apical vertebra - from 9.3° to 40.2° (mean: 21.09°). Positive correlation between the magnitude of scoliotic arch deformity and asymmetry coefficients of longitudinal diameter of the arch roots of the apical vertebrae was found. A pronounced asymmetry of right and left transverse diameters of arch roots of the T₃-T₄ vertebrae, despite the absence of structural compensatory counter curve and torsional changes in these vertebrae.

Conclusion. There are certain regularities and correlations between the type of idiopathic scoliosis and the absolute and relative values of vertebral parameters not only at the top of the curve, but also throughout the whole curvature arch. 

Shortening vertebrotomy was proposed as an alternative method of surgical treatment for the recurrent tethered cord syndrome (TCS) in adults. Our clinical observation demonstrated regression of clinical manifestations of the disease after shortening vertebrotomy in a child with recurrent TCS. It is shown that shortening vertebrotomy may be the method of choice in the treatment of children with this disease when additional indications exist.

Objective. To analyze the results of treatment of degenerative spine disease with the use of nitinol rods for lumbosacral fixation as compared with conventional rigid fixation.

Material and Methods. The prospective randomized study included 75 patients (34 males, 41 females; mean age 43 years) with degenerative lesion at the L₅-S₁ level. Surgical treatment was performed with nitinol rods in 35 patients (Group 1), and with standard titanium rods in 40 patients (Group 2). Clinical and radiological results were assessed in 1.5 years after surgery.

Results. The VAS leg-and-back, ODI, and SF-36 scores showed improvement in patients of both groups such as a significant reduction in pain intensity and improvement in psychological and physical health. The X-ray examination showed the restoration of the lumbar lordosis in both groups. In Group 1, there was no evidence of screw instability, bone resorption around screws and the adjacent segment disease, and functional radiography demonstrated preservation of mobility (5.0° ± 1.2°). There were seven patients with pseudoarthrosis, and six - with adjacent segment disease in Group 2, surgical intervention was required in four of them.

Conclusion. Transpedicular fixation in the lumbosacral spine using nitinol rods is an effective technology allowing for mobility preservation in combination with stable fixation. 

The paper discusses the benefits and drawbacks of using titanium implants in spine surgery. Improved fixation of titanium implants in bone tissue is achieved by applying a variety of textured and nano-based coatings on their surfaces. Coatings made of osteotropic hydroxyapatite (HA)- and tricalciumphosphate (TCP)-based materials prevail over allogenic materials in many features. This permits to achieve positive results in bone defect osteoplasty. However, HA and TCP do not completely meet the needs of clinicians due to the lack of apparent osteoinductive properties. The guided bone regeneration requires creation of initial conditions for the ordered proliferation of osteogenic cells and capillaries in a predetermined space. A prerequisite for this is the presence of biologically active substances providing osteoinduction of osteoplastic material to form a matrix on which the bone tissue will develop. Candidate substances are various fractions of bone morphogenetic protein (BMP) which induce bone regeneration. The advantages of various physicochemical treatments of titanium implants (plasma, ion, sandblasting, ablative, etc.) are still debated, but their clinical use requires further research.

Objective. To evaluate clinical efficacy and safety of M6-L artificial disc in lumbar degenerative disc disease (DDD).

Material and Methods. A total of 109 patients with diagnosed lumbar DDD and spinal stenosis were operated on after 6 months of unsuccessful conservative treatment in 2011-2015. All patients underwent M6-L artificial lumbar disc implantation. Average follow-up period was 1.5 years (range: 4 months to 6 years). Patient satisfaction after treatment, regression of pain score, increase in activities of daily living, as well as radiographic parameters (recovery of intervertebral space height, mobility in the operated segment), and frequency of complications, reoperations and revision surgeries were evaluated.

Results. Good and excellent clinical outcomes were revealed in most of patients. The average VAS score of back and leg pain regression was 27 mm, improvement in daily activity - 24.3 points on ODI, increase in the disc space height - 7.6 mm, and mobility in the operated segment - 8.5°. Serious complications were not detected, spontaneous fusion at the operated level was noted in 2.0 % of cases, revision surgery due to implant migration (implant removal and ALIF with cage) was required in 0.9 % of cases.

Conclusion. Intervertebral disc arthroplasty with M6-L is a safe and highly effective procedure that maintains mobility in the operated segment and prevents adjacent disc degeneration. 

Objective. To analyze cases of pulmonary cement embolism and to determine possible causes of the complication.

Material and Methods. A heterogeneous group of 49 patients was retrospectively analyzed. Vertebroplasty was prescribed to the patients for restoration of vertebral support ability after osteoporotic compression fractures and hemangiomas, and as an auxiliary manipulation for transpedicular fixation of the osteoporotic spine. Thoracic computed tomography was performed and pulmonary cement embolism was revealed in the early or late postoperative periods.

Results. Pulmonary cement embolism was revealed in 7 (14 %) patients, two of them presented with massive pulmonary cement embolism. In one case it was caused by excessive injection of cement, and in the other - by anomalous anastomosis. In one case, the vertebroplasty was cancelled taking into account the results of venospodilography.

Conclusion. Attempts of maximum filling of the vertebral body and inadequate assessment of intertrabecular space volume, as well as anomalous anastomoses between the major blood vessels may cause clinically significant massive pulmonary embolism. Venospondylography performed before vertebroplasty may reveal the features of venous drainage of the vertebral body, which are the risk factors for massive cement embolism. 

The bone tissue engineering seeks alternative solution to the problem of skeletal injuries. Creation of a tissue-engineered equivalent of a bone tissue using multipotent cells, matrixes carriers of these cells and osteogenic factors is the cornerstone of this method. The process of creation of tissue-engineered bone analog begins with the production of a matrix for cell cultivation. The paper presents the review of the most promising materials and methods used for production of cellular matrices. The modern materials used in creation of cellular matrices replicate the groups of substances composing the natural extracellular bone matrix. Modern technologies of creation of cellular matrices seek to imitate a structure of natural extracellular bone matrix at the micro- and nano-levels. Simulating natural composition and structure is necessary to create optimum conditions for cell activity on a device, as well for creation of favorable physic-mechanical properties of the matrix.

The problem of early onset scoliosis (EOS) is one of the vital problems in the spine surgery. Common conventional method for treatment of this pathology does not exist, which makes thing worse. One of the leading experts in the world, Jean Dubousset not only possesses a wealth of clinical experience, but also puts forward new bright ideas promoting the advancement of spine medicine. Original approaches to strategy and tactics in the treatment of EOS patients are developed in many countries and regions of the world. The lecture of Jean Dubousset is dedicated to the French experience.