Currently a practicing orthopedist is equipped with a large number of different implant systems to successfully perform anterior decompression and stabilization procedures in the spine. However, analysis of available literature shows that most investigations are focused on the results of clinical application of vertebral body replacement systems, while not enough attention is given to comparative evaluation of structural and functional characteristics of available implants. The paper presents a review of structural characteristics of various telescopic vertebral body replacement systems to determine their functional potential and improve efficiency of their application for anterior spinal fusion.

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The paper presents the tactics of early detection and treatment of idiopathic scoliosis adopted in Novosibirsk NIITO. Idiopathic scoliosis is a genetically determined disease. Its early detection requires screening of children and adolescents. The most effective conservative method is brace treatment. Surgical treatment is strictly differentiated depending on the age of a patient. Patients in the first decade of life are treated by multi-stage surgery with VEPTR instrumentation. Patients aged 11-13 years undergo one-step intervention using transpedicular fixation of the whole curve. Patients aged 14-20 years are treated in one- or two-stage intervention depending on the curve mobility. Deformities over 90° require multi-stage intervention with anterior and posterior mobilization of the spine.

The paper presents a case study of surgical treatment of a 2-year old patient with a rare congenital deformity of the thoracic and lumbar spine associated with multilevel aplasia of thoracic and lumbar pedicles.

Objective. To identify risk factors for development of proximal junctional kyphosis (PJK) in patients with idiopathic scoliosis treated with segmental posterior spinal instrumentation.

Material and Methods. Radiographs of 95 patients with idiopathic scoliosis operated on using segmental posterior spinal instrumentation were analyzed. Preoperative and postoperative spondylograms and images taken at the end of the second year of follow-up were evaluated. The PJK was defined as 10° or more increase in the angle of kyphosis between the caudal endplate of the upper instrumented vertebra and the cephalad endplate of two adjacent proximal vertebrae as compared with preoperative angle at the same level.

Results. The prevalence of PJK at the end of the second year of follow-up was 24 %. Before surgery the average value of the proximal transition angle was 6.7° ± 5.4° in patients with PJK (Group I) and 6.1° ± 4.6° in patients who have not formed PJK (Group II). Within two weeks after surgery, the angle increased to 15.0° ± 6.7° in patients of Group I and to 6.9° ± 4.4° in patients of Group II. Two years after surgery the angle was 23.0° ± 6.0° and 8.4° ± 5.6°, respectively.

Conclusion. Statistically significant risk factors were initial hyperkyphosis of the thoracic spine (>40°), significant change in thoracic kyphosis in the postoperative period, initial value of the proximal transition angle, distal location of the upper instrumented vertebra, and the use of hybrid fixation. 

Objective. To evaluate the results of chronic electrical stimulation of the spinal cord (SCS) in patients with pain syndromes following various operations in the spine.

Material and Methods. Implantation of chronic SCS systems was performed in 100 patients during 2001-2012. Average pain syndrome duration before application of neurostimulation was 5.5 years. In 12 patients, SCS was combined with peripheral nerve stimulation due to individual pain features. The indications for surgery were persistent pain of neurogenic nature in the back and limbs, and positive results of test stimulation. Pain severity, its influence on the quality of life, and needs for analgesics were assessed using the modified ten-point VAS. The Multivariate Verbal-Color Pain Test was used to assess a proportion of neuropathic, somatogenic and psychogenic components of pain syndrome. Results were assessed in the early postoperative period, at 6 and 12 months, and then once a year.

Results. In the early postoperative period 45 patients reported excellent, 37 - good, and 18 - satisfactory results. In the follow-up period results remained excellent in 28, good in 37, and satisfactory in 15 patients.

Conclusions. Epidural spinal cord stimulation is a highly effective method, which allows managing pain syndrome in the long-term follow-up. Chronic stimulation effects are completely reversible and safe. 

Objective. To compare the efficacy of classical and original methods of meningoradiculolysis for epidural fibrosis of the lumbar spinal canal.

Material and Methods. The study included 63 patients who underwent reoperation of the lumbar spine. Patients were randomly divided into two groups using a computer program: original method of meningoradiculolysis was performed in Group I (n = 32), and classical - in Group II (n = 31).

Results. The treatment results were evaluated up to 3 months after surgery. Good results amounted to 38.9 % in Group I and to 21.6 % in Group II (p < 0.05). In group II, a punctate injury to the dural sac occurred in 3 patients, which led to postoperative liquorrhea in one case, and temporary or permanent increase in neurological deficit was observed in four cases.

Conclusion. The modified method of meningoradiculolysis is technically more valid and safe in performing repeated interventions for epidural fibrosis in the lumbar spine. 

The paper presents three cases of sacrum fracture in the early postoperative period following surgery for L5 spondilolisthesis. The literature on sacrum fractures after surgical treatment of L5 spondylolisthesis was reviewed over the past 20 years. Risk factors and ways of prevention of this complication were analyzed.

Objective. To analyze the method of assessing the parameters of the sagittal spinal sacral balance based on geometric evaluation of the lumbar spine and sacrum.

Material and Methods. The study included 100 patients divided into two groups. The study group included 54 patients with lumbar spinal stenosis at the L1-L5 level, and the control group - 46 healthy volunteers. All patients were examined by MRI. Lumbar lordosis was considered as a circular arc and described by both anatomical (lordosis angle) and geometrical (the chord length, the height of the circle segment, the central angle of the segment, and the circular radius) parameters. Two sacral parameters were measured: sacral slope and sacral inclination angles, characterizing the sacrum position in horizontal and vertical planes, respectively.

Results. The study revealed a significant correlation between anatomical and geometrical spinal sacrum parameters. The comparison of the study and control groups revealed significant differences in the parameters of the chord length, the height of the circle segment, and the sacral inclination angle. Two additional parameters were proposed: lumbar coefficient, as a ratio of the lordosis angle and the central angle of the segment; and sacral coefficient, as a ratio of the sacral slope and the sacral inclination angle. A modulus of the mathematical difference between sacral and lumbar coefficients was used to assess spinal sacral balance. Statistically significant differences for proposed coefficients were detected between groups.

Conclusion. The proposed method demonstrated a high sensitivity for degenerative diseases of the spine and may possess a high prognostic value. 

Objective. To analyze main causes of low back pain using data of clinical neurological and instrumental examinations and results of conservative and surgical treatment of patients.

Material and Methods. A total of 405 patients with acute low back pain were examined and treated. Changes in vertebral bone mineral density indicating osteopenia and osteoporosis were revealed in 247 of them. Most patients had bulging disc detected during MRI and CT examinations. Conservative orthopedic treatment was performed in 340, and surgical in 65 patients.

Results. Long-term results were evaluated in 35 patients in the surgical treatment group. Complete elimination of pain was registered in 30 of them, while five patients continued to suffer from pain in the trunk and extremities due to osteopenia and osteoporosis. They were treated with alendronates, bisphosphonates, calcium-based drugs, and vitamin D, and showed pain elimination. In the group of surgical treatment, the complete eradication of spinal instability symptoms was reported already the next day after surgery. Pain in extremities disappeared in all patients, though four patients were troubled by hypesthesia of some areas of foot skin, which regressed over time in two, and persisted in the other two patients.

Conclusion. The disc prolapse should not justify making a hasty decision on surgical treatment. In the overwhelming majority of cases, conservative orthopedic treatment has a positive effect. The basis of such treatment must be orthopedic immobilization and unloading of the spine, as well as measures for the normalization of bone mineral density. Surgical treatment should be undertaken only after failure of orthopedic treatment and followed by further measures to normalize mineral density of bone structures. 

b. To study the efficacy of differentiated surgical treatment for primary spinal neoplasms based on estimation of clinical condition of a patient, survival rate, and early postoperative complications.

Material and Methods. Surgery was performed in 55 out of 68 patients with primary spinal tumors involved in the study. The primary examination included CT and MRI study of the affected area of the spine. In some cases, a biopsy was performed.

Results. According to histological structure, spinal tumors were identified as aggressive hemangioma, chondrosarcoma, aneuyrismal bone cyst, plasmocytoma, chordoma, giant-cell tumor, or eosinophilic granuloma. Neurological status was characterized by local pain in 18 (38 %), and by pain combined with nerve conduction disorders in 20 (40 %) patients. In accordance with the spine instability neoplastic score (SINS), most patients had stable destructions of vertebra. Evaluation of neurological status did not reveal severe deficiency: 65 % of patients had grade D or E on Frankel scale.

Conclusion. Patients with tumors of the spine require careful choice of a multidisciplinary treatment. Increasing the life expectancy of patients with malignant tumors and improving the quality of life in patients with tumors of different histological structure are decisive factors in the choice of tactics and dictate the variability of approaches to treatment. 

Objective. To analyze the possibilities of using transforaminal approach in surgery for infectious lesions of the lumbar and lumbosacral spine.

Material and Methods. The study included 26 patients operated on for tuberculous spondylitis and nonspecific spondylodiscitis in the lumbar and lumbosacral spine. Patients in Group I (n = 12) underwent radical reconstructive surgery through anterior approach at the first stage, and single-step transpedicular fixation - at the second one. Patients in Group II (n = 14) underwent resection of vertebrae and fusion combined with transpedicular fixation through transforaminal approach.

Results. Mean operative time in Group I was 280 ± 12 min, in Group II - 221 ± 17 min. Correction of segmental kyphosis in Group I was 7.0° ± 1.4°, in Group II - 5.0° ± 0.9°, and loss of correction - 0.7° ± 0.3° and 0.9° ± 0.4°, respectively. Bone block formation occurred six months after surgery in 8 (66 %) patients in Group I and in 1 (7 %) patient in Group II, and 12-36 months after surgery in 12 (100 %) and 13 (93 %) patients, respectively. The level of pain according to Denis scale decreased in the late period to 0.4 ± 0.1 in Group I, and to 1.3 ± 0.1 in Group II. Quality of life assessed with the Oswestry scale was 27 ± 1 (Group I) and 39 ± 1 (Group II) 12 months after surgery.

Conclusion. Transforaminal approach is less time-consuming surgical procedure for the treatment of small forms of infectious disease of the spine. Nevertheless, the formation of interbody bone block is more efficient after radical reconstructive surgery through anterior or anterolateral approach. 

Spinal cord injury is an actual problem of modern medicine. The late period after injury when a specific complex of structural and functional changes is developing in the victim’s body plays a special role. Deferred emergency surgery is largely due to poor equipment of medical institutions in the provinces, and late detection of spinal fractures in severe polytrauma. The paper considers the relevance of an integrated approach to anesthesia for surgical treatment of patients in the late period of spinal cord injury using agents which inhibit pain impulses at different levels of the nociceptive system and reduce stress-induced response to surgical aggression in the late period of traumatic disease of the spinal cord.

Objective. To analyze a response of bone and liver tissue to the injection of bone cement into the formed vertebral body defect in rats.

Material and Methods. The study involved 65 male Wistar rats. In the study group, defect in the lumbar vertebra was created with a cutter through posteroexternal approach under ketamin anesthesia and filled with 0.1 ml of methyl methacrylate. Rats in the control group underwent only perforation of the vertebral body. Animals were sacrificed at 12 hours, 1, 3, 7, and 30 days after surgery. Changes in vertebral bodies and liver were investigated using morphological methods.

Results. It was found that the local toxic effects occur directly in the bone, bone marrow and blood vessels in the area of manipulation and beyond. In the liver, the maximum toxic damage of hepatocytes was determined on day 3 of the experiment, gradually decreased, but remained high on day 7. According to histological and morphometric data the toxic liver damage stopped by the 30th day of the experiment, though there were loci of productive hepatitis.

Conclusion. Methyl methacrylate monomer produces a local toxic damaging effect on bone and blood vessels that goes beyond bone filling, and sharply retards the process of bone regeneration. Destruction of vessels and response to the combined mechanical, thermal and toxic impacts contribute to more severe damage to the bone tissue.