Objective. To systematize technical and tactical options of revision procedures in the surgical treatment for lower thoracic and lumbar spine injuries in order to reduce their invasiveness and technical complexity and to improve vertebral metric parameters of correction of injured spinal motion segments.

Material and Methods. Treatment results of 62 patients re-operated on for injuries of the lower thoracic and lumbar spine were examined.

Results. Good long-term results of treatment were obtained in 72.7 %, and satisfactory - in 27.3 % of patients.

Conclusion. The proposed differentiated tactics of revision surgery in the treatment of injuries of the thoracic and lumbar spine allowed to reduce invasiveness and technical difficulty of revision surgery as well as to improve vertebral metric parameters of correction of injured spinal motion segments. 

Objective. To assess the dynamics of neurological disorders in children with spine and spinal cord trauma in the thoracic and thoracolumbar spine, depending on the timing of surgery and the severity of spinal cord injury.

Material and Methods. A total of 36 children aged 3 to 17 years were operated on for injuries to the thoracic spine and thoracolumbar junction accompanied by neurological deficit. Thoracic spine was damaged in 16 (44.4 %), thoracolumbar junction - in 20 (55.6 %) patients. Patients were divided into four groups based on time to surgery. Spinal bone lesions were assessed according to Magerl’s classification, and neurological disorders - to the ASIA scale.

Results. Long-term results were followed for 5 years in all patients. Neurological function improvements in patients of Group 1 were observed in 1-2 days after surgery, Group 2 - in 2-3 days, Group 3 - in 5-7 days, and Group 4 - in 4-5 months. In Group 1 positive dynamics was observed as significant regression of sensory disorders, in Group 2 - as complete regression of neurological deficit in 2 patients, in Group 3 - as transition from C to D grade in 4 patients, from B to D grade in 2 patients, and 2 children had no regression. In Group 4 a regression of neurological disorders from B to C grade was observed in 6 children in 2-3 years, and 10 patients (A grade) had no improvement in neurological status.

Conclusion. Complete and rapid recovery of neurological functions in children with complicated fractures of thoracic and thoracolumbar spine is observed after surgical treatment performed within the first 6-12 hours after injury, when neurological deficit is mainly caused by compression of the spinal cord and its elements, and secondary circulatory and pathological changes have not yet expressed.

Objective. To assess the risk factors of bone cement leakage into the spinal canal.

Material and Methods. Results of 150 vertebroplasties were analyzed: out of them 56 procedures were performed through bipedicular and 94 - through unipedicular approach. The morphology of vertebrobasilar system was assessed by preoperative CT scans. After surgery the CT study was repeated to assess a degree of intracanal cement leakage and a needle-tip position relative to the midline. The correlation between cement leakage rate and mentioned predictors was estimated using logistic regression analysis.

Results. Surgical technique (unipedicular or bipedicular approach) did not influence the rate of intracanal cement leakage. The distance from the midline to the needle-tip and the type of vertebrobasilar system were found to be significant predictive factors.

Conclusion. The needle-tip position close to the midline and magistral type of vertebrobasilar system are risk factors of intracanal cement leakage during vertebroplasty, while the applied technique has no significant impact on complication rate. 

Objective. To analyze results of surgical treatment of patients with thoracic idiopathic scoliosis with lumbar counter-curve using hybrid instrumentations.

Material and Methods. A total of 86 patients (10 boys and 76 girls) with Lenke type III idiopathic scoliosis were operated on. The average age of patients was 15.3 ± 1.8 (range: 10.3-18.0) years, with mean follow-up of 3.5 ± 0.7 (range: 2.2-5.7) years. All patients underwent correction of spinal deformity by hybrid instrumentation with laminar fixation of the thoracic spine and lumbar transpedicular fixation of the thoracolumbar spine. Postoperatively, patients were interviewed using SRS-24 questionnaire.

Results. The average initial magnitude of primary thoracic curve was 63.4° ± 19.2°, immediately after surgery - 19.0° ± 10.0°; correction - 45.3° ± 15.5°; postoperative progression was 1.3° ± 3.7°. The initial magnitude of counter-curve was 41.0° ± 19.9°, immediately after surgery 10.4° ± 11.9°; correction 28.9° ± 17.8°; postoperative progression was 0.6° ± 2.1°. The tilt angle of the lower instrumented vertebra decreased after surgery from 21.2° ± 9.7° to 5.5° ± 4.2°, at the last follow-up examination it almost did not change - 5.4° ± 3.9°. The questionnaire results demonstrated a high degree of patient satisfaction with the treatment. Severe complications were not observed.

Conclusion. The use of hybrid instrumentation in the treatment of patients with thoracic idiopathic scoliosis and lumbar counter-curve allows achieving good correction of spinal deformity and sustain the achieved correction. 

Objective. To analyze long-term outcomes of surgical treatment of spinal column pathology in children with caudal regression syndrome.

Material and Methods. The study included 12 patients aged 1.5 to 9 years with caudal regression syndrome. To determine the type of caudal regression the Renshaw classification was used. Surgery involved correction of kyphotic deformity of the spine and elimination of instability, and spinal-pelvic fusion including instrumented fixation of the spinal-pelvic segment with restoration of sagittal profile and support ability of the spine and creation of bone block by placement of split cortical allografts along the spinal implant.

Results. Children with types III and IV caudal regression syndrome underwent spinal-pelvic fusion, which allowed achieving strong fixation of the spinal-pelvic segment and ensured its stability at patient’s verticalization.

Conclusion. Multi-anchor transpedicular instrumentation in combination with spinal-pelvic fusion with cortical allografts allows eliminating abnormal kyphosis, achieving bone block formation, and retaining the achieved result in the late postoperative period. 

Objective. To assess the results of surgery for congenital scoliosis of the spine in patients over 10 years old.

Material and Methods. The age of patients at the time of treatment was at least 10 years, follow-up period - at least 2 years. A total of 104 patients with mean age of 15.9 years were treated with mean follow-up period of 3.4 years.

Results. Congenital scoliotic deformities are highly rigid. The average Cobb angle of the primary curve was 76.7°, preoperative mobility - 19.7 %; during the operation the curve was corrected to 50.9° (25.8 %), postoperative progression was 4°. The secondary curve in 60 patients was 52.4°, its mobility - 37.4 %, the curve was corrected to 36.1° (31.1 %), postoperative progression was 5.4°. All anthropometric indicators have improved, and the SRS-24 survey also showed positive patient-reported outcomes. Complications were quite frequent, as well as initial involvement of the spinal canal content in the pathological process (12 patients).

Conclusion. Diagnosis of congenital scoliosis should be as early as possible. This will help to avoid many of the problems and improve the quality of life of patients. 

The current lineup of titanium implants and structures used in spine surgery is presented by meshes, cages, telescopic implants, transpedicular screws, plates and dynamic fixation systems. The review incorporates evolution of application and positive and negative properties of implants.

Objective. To analyze the relationship between radiographic parameters of spinal motion segment and clinical outcome of surgical treatment of patients with degenerative spondylolisthesis with multilevel lesions of intervertebral discs in the lumbar spine.

Material and Methods. The study included 90 patients with Meyerding grade I degenerative spondylolisthesis involving more than two adjacent lumbar intervertebral discs. In Group 1 (n = 45) the rigid interspinous fixation was used, in Group 2 (n = 45) - transpedicular stabilization.

Results. Significant positive nonparametric correlation was detected between the long-term surgical outcome evaluated with VAS and Oswestry scores and radiographic parameters: segmental angular amplitude, the angle of lumbar lordosis, and the degree of linear displacement of vertebrae. The rigid interspinous implant and pedicle fixation allow achieving minimum level of pain and good functional recovery with effective elimination of pathological linear displacement of vertebrae and formation of interbody bone block.

Conclusion. Linear displacement of vertebrae of no more than 8 mm and sagittal range of motion in the spinal motion segment of no more than 14° permit performing interbody fusion with cage and rigid interspinous fixation, and those no more than 13 mm and 16°, respectively, transpedicular stabilization and interbody fusion with cage. 

Objective. To study characteristics of postural balance in patients with degenerative dystrophic diseases of the lumbar spine in the early postoperative period and between 8 and 12 months after surgery.

Material and Methods. The study included the assessment of stabilometric parameters of postural balance, which were measured using Romberg test with eyes open/closed in 16 patients aged 26 to 60 years. All patients underwent decompression and stabilization surgery for compression and complex regional pain syndromes of degenerative disc disease of the lumbar spine.

Results. Visual control used by patients in performing stabilometric test with eyes open made it possible to reduce significantly the following parameters in 8-12 months after surgery: oscillatory movements of the center of pressure (CoP) in the frontal and sagittal planes by more than 1.8 times, the sum of CoP displacements by 1.57 times, the average speed of CoP displacement by 1.57 times, and the area of oscillations by 3 times. At the same time predominantly sagittal direction of the CoP movement was preserved that corresponds to the normal postural balance of the body in space.

Conclusion. Formation of the stable position of the body in space occurs at 8-12 months after surgical treatment only with the involvement of visual control. This necessitates the inclusion of the complexes of therapeutic exercises for rehabilitation of patients. 

Objective. To analyze the effectiveness of surgical, including urgent, treatment of patients with non-specific infection of the spine.

Material and Methods. A retrospective analysis of 93 hospitalized patients with non-specific infection of the spine was carried out. Eleven patients underwent the course of conservative therapy, and 82 - surgical treatment, out of them 49 for urgent indications. Clinical and radiographic outcomes were followed from 6 months to 3 years.

Results. Forty one patients had neurological disorders of varying severity on admission, complete recovery after treatment was observed in 28 of them, partial - in eight, an absence of changes - in two patients; three patients died within a period of 1 to 7 days after surgery. In all survived patients, the treatment resulted in definitive stabilization of affected segments due to bone block formation which occurred at different times; three patients were reoperated on for postoperative deep surgical site infections, one - for broken rod.

Conclusion. The best option of surgery based on lesion localization, infectious process extent and patient’s physical status, as well as an adequate antimicrobial therapy are the predictors of success in the treatment of non-specific infectious spondylitis. 

Objective. To estimate peculiarities and results of vertebroplasty for hemangioma of the cervical spine.

Material and Methods. A total of 18 patients (21 vertebrae) with cervical spine hemangiomas were operated on. Vertebroplasty was performed through anterolateral and posterior approaches under X-ray C-arm or CT guidance.

Results. Pain syndrome regressed in all patients. Pain intensity was 6.6 ± 0.2 on VAS before surgery and 2.4 ± 0.2 after surgery. Neck disability index (NDI) was 21.5 ± 1.2 before surgery and 8.6 ± 0.9 after surgery. No complications were noted.

Conclusion. The development of imaging techniques (CT, MRI) allows more frequent detection of cervical spine hemangiomas, and modern X-ray machines (EOC, CT) facilitate the vertebroplasty at all levels of the cervical spine. 

Purulent spinal epiduritis is a rare pathology without pathognomonic symptoms in clinical picture, therefore its diagnosis is difficult, even with the use of neuroimaging techniques. Two cases of purulent spinal epiduritis are presented with the analysis of diagnosis, clinical presentation and treatment. In both cases, surgical treatment was performed including laminectomy, incision, and drainage of abscesses. Postoperative period was uneventful. The treatment allowed achieving quick recovery and minimizing possible consequences of purulent epiduritis. The authors consider that the surgery is a method of choice for purulent spinal epidurirtis treatment.

Objective. To identify cell phenotypes in vertebral body growth plates from patients with idiopathic scoliosis.

Material and Methods. Cells were isolated from vertebral body growth plates both on convex and concave sides of the deformity in patients operated on for scoliosis. Cells were cultured and identified by methods of common morphology, neuromorphology, electron microscopy, immunohistochemistry, and PCR analysis.

Results. Cultured cells obtained from the convex side of the deformity were identified as chondroblasts. Cells isolated from growth plates on the concave side of the deformity were described as neuro- and glioblasts. Cells formed synapses, contained neurofilaments, and expressed neural and glial proteins, respectively.

Conclusion. Ectopic localization of neural crest-derived cells in vertebral body growth plates is the etiological factor for scoliotic disease.