Objective. To analyze cases of screw malposition following instrumented correction of deformity of the thoracic and lumbar spine.

Material and Methods. Retrospective analysis of 73 patients aged 3 to 58 years with thoracic and lumbar spine deformities was performed. Deformity magnitude measured 20° to 134° by Cobb angle (mean value was 61° ± 4°). A total of 1065 screws were inserted using free-hand method for the spine deformity correction. Malposition cases were detected by postoperative CT control of screw placement. Screw malposition was graded according to the following system: A - no malposition, B - malposition less than 2 mm, C - malposition between 2 and 4 mm, and D - malposition more than 4 mm.

Results. Insertion of 628 (59.0 %) transpedicular screws was performed correctly, and trajectories of 437 (41.0 %) screws were displaced. Malposition of 263 screws (24.0 %) was less than 2 mm, in 112 screws (10.5 %) it reached a safety limit of 4 mm, and in 62 screws (5.8 %) it exceeded 4 mm and was considered as dangerous with the potential for primary or delayed injury of neural structures and vessels.

Conclusion. Transpedicular fixation is a method of choice for surgical correction of spine deformity. Its application is associated with a risk of neurovascular complications. The most common and available free-hand screw insertion technique is safe enough, though requires appropriate surgical skill. 

Objective. To evaluate the accuracy of screw placement using preoperative 3D CT-based navigation with intraoperative fluoroscopic guidance compared with freehand placement.

Material and Methods. Intraoperative registration of patient anatomy to preoperative 3D-CT using anatomic landmarks was performed in 62 patients aged 12-18 years with mean deformity 67° (range, 52° to 80°). When registration accuracy was high, screw tracts were drilled under navigation guidance. When the error was >1.0 mm, registration was performed using posterior vertebral bone structures. The times required for tracker placement, registration, and screw track formation, as well as the number of passes were documented. Results were compared with outcomes in cases operated on with freehand screw placement.

Results. In the navigation group, 710 pedicle screws were placed. Mean times were 55 seconds for tracker placement, 94.5 seconds per vertebra for patient registration, 131.1 seconds for screw tract formation on the concave side of the deformity, and 129.5 seconds on the convex side. In the freehand group, 470 pedicle screws were placed. Average time for screw placement was 135.2 seconds, pedicle integrity was breached in 5.1 % of trajectories.

Conclusion. Intraoperative optic fluoroscopic navigation based on anatomic landmark registration to preoperative 3D-CT spine images enables precise pedicle screw placement.

Objective. To examine indicators of the alexithymia level in adoles- cents with idiopathic scoliosis.

Material and Methods. The study included 110 adolescents aged 12 to 16 years. Out of them 30 children had idiopathic scoliosis, and 20 - grade III-IV dysplastic scoliosis. The control group con- sisted of 30 adolescents without severe chronic diseases, and 30 - with rheumatoid arthritis. The Toronto Alexithymia Scale (TAS) and the Emotional Intelligence (EQ) Test were used in the study.

Results. Analysis of alexithymia severity levels in adolescent groups showed that high and middle levels of alexithymia prevailed in chil- dren with idiopathic scoliosis. Adolescents with psychosomatic dis- orders and idiopathic scoliosis had difficulties in identifying their own emotional experiences and related uncomfortable bodily sen- sations, including muscular tension.

Conclusion. Adolescents with idiopathic scoliosis and their peers with psychosomatic disorders are characterized by greater sever- ity of alexithymic features as compared to their healthy peers and adolescents with dysplastic scoliosis.

Inheritance of scoliosis has been studied for many decades, and it was found that it is usually complex, although the literature describes the families with a clear Mendelian principle of transmission of this disease through generations. Naturally, it was necessary to try to find the genetic basis of the disease, that is, genes whose mutations can cause the development of scoliosis. And such mutations may serve as markers of the disease assisting in its diagnosis before the onset of spinal deformities. In cases of hereditary disorders of the spine, deformities often continue to evolve even after surgery. In all cases it is important to know what causes led to the development of scoliosis, and such information is certainly important in assessment of the risk of developing disease in a patient, because it allows predicting the effects of a particular mutation, as well as choosing a strategy and tactics of the treatment.

Objective. To assess feasibility of the proposed anterior decompression and stabilization surgery without meningoradiculolysis for recurrent herniation of the lumbar intervertebral disc.

Material and Methods. Prospective randomized controlled study involved comparative evaluation of two essentially different surgical interventions performed in 130 patients with recurrent disc herniation during 2005-2012. The control group included 62 patients who underwent posterior decompression and stabilization surgery with meningoradiculolysis for the removal of herniated disc. The study group included 68 patients who underwent the proposed anterior decompression and stabilization surgery, which differs by an obligate opening of the spinal canal and intervertebral foramen to remove the disc herniation through an anterior approach without meningoradiculolysis.

Results. Immediate results of anterior and posterior decompression and stabilization operations are comparable, though posterior interventions are more frequently associated with iatrogenic injury to posterior nerve roots caused by intervertebral implant insertion and meningoradiculolysis required before the disc herniation removal. Long-term outcomes of anterior operations are reliably better.

Conclusion. Anterior decompression and stabilization operations for recurrent disc herniation compare favorably to posterior ones, since they are less traumatizing to the nerve roots and prevent herniation recurrence and epidural fibrosis progression.

The paper presents a review of basic devices for dynamic fixation, which were proposed and tested to date. Special attention is paid to the concept of instability, as well as to the development of adjacent segment syndrome after fixation with different devices. A total of 123 open-access available articles archived in evidence-based medicine databases (PubMed, Medline, etc.) during 2006-2013 were reviewed. Despite the large number of proposed devices, there is no perfect system of dynamic fixation which is able to prevent the development of adjacent segment syndrome to the full extent. There is a number of devices providing solid fixation while maintaining normal spinal segment biomechanics. However, reliable clinical results of their use are not yet available. Studying the problems of spinal biomechanics’ violation following spinal segment fixation, in authors’ opinion, will allow finding the key to solving the problem of adjacent segment syndrome.

Objective. To analyze results of the anterior spinal fusion with an interbody implant of nanostructured porous alumina ceramic in patients with degenerative diseases of the spine.

Material and Methods. Clinical trial included surgical treatment of three patients aged 28-46 years with cervical intervertebral disc disease and severe pain in the neck and upper extremity. A developed porous bioceramic implant was installed in the lower cervical spine through a classical anterior approach. The follow-up examination was carried out at 3, 6 and 12 months after operation.

Results. Patients had a regression of pain in the early postoperative period due to adequate decompression and stabilization at the level of the affected spinal segment. Sagittal size of the spinal canal at this level increased from 9.2 ± 0.3 mm to 10.1 ± 0.8 mm. Pain in the neck and arm disappeared completely in two patients after three months and in one patient after six months, The final follow-up showed the full motion recovery and the absence of sensitivity disorders.

Conclusion. The use of porous ceramic interbody fixator allows maintaining relationships in the spinal segment for the entire period of the bone block formation. To assess adequately the spinal cord structures is advisable to use the fixing devices of this material not producing artifacts in MRI. 

Objective. To assess the efficacy of dynamic stabilization with interspinous spacer after decompression of neural structures and curettage of the disc space in surgical treatment of patients with degenerative disc disease.

Material and Methods. A total of 100 patients operated on for degenerative lumbar disc disease were enrolled in the study. Patients were divided into two groups. All patients underwent microsurgical discectomy with curettage of the disc space and decompression of neural structures. Interspinous spacer was implanted additionally in patients from the study group. CT, MRI, and functional X-ray studies were performed before and after surgery. The quality of treatment was assessed using VAS and Oswestry questionnaire.

Results. There were no statistically significant differences in the rate of surgical complications between groups. Patients operated on with interspinous spacer had better outcomes, lower VAS and Oswestry scores, and decreased segmental range of motion during the first year after surgery.

Conclusion. The use of interspinous spacer provides relief of back pain, decrease in segmental instability, and improved quality of life of patients. Interspinous spacer does not affect the adjacent segment degeneration. 

Objective. To specify indications for application of interspinous spacers and to analyze results of surgical treatment of instability of the lumbar motion segment using dynamic interspinous stabilization.

Material and Methods. A total of 15 patients (5 males and 10 females, mean age 46 years) with instability of the lumbar spine were operated on with insertion of the authoring nitinol interspinous distraction device. Surgical treatment was performed for the instability of the lumbar spine. Postoperative follow-up at 6 and 12 months included orthopedic and neurologic examination, functional spondylography, and questionnaire survey of patients.

Results. Analysis of 6- and 12-month follow-up results showed statistically significant improvement in VAS, Oswestry, and SF-36 scores. The X-ray examination showed that the spacer installation preserved both the segmental motion and the intervertebral disc height. The obtained data testify to the comparability of application results of the authoring distraction device with those of other interspinous spacers.

Conclusion. The main indications for the use of interspinous distraction device are segmental instability, as well as prevention of secondary pathologic mobility in the operated spinal motion segment. Nitinol interspinous distraction device allows for elimination of segmental instability while preserving physiological range of motion.

Objective. To study the features of postoperative x-ray picture of anterior fusion formation after using different techniques of anterior stabilization of the spine in patients with spondylitis.

Material and Methods. A retrospective analysis of the radiological (X-ray and CT) data of 126 adult patients with infectious spondylitis who underwent anterior fusion with an autologous bone graft (Group 1), a titanium mesh cage filled with bone (Group 2), and an isolated titanium mesh (Group 3) during 2010-2013 was performed.

Results. The use of the titanium mesh cage filled with bone for anterior stabilization of the spine provides the earliest bone block formation without aggravation of infection process, loss in the block height, and increase in kyphosis, and minimizes the rate of postoperative complications. The fusion with the isolated titanium mesh cage resulted in the worst postoperative outcomes.

Conclusion. The use of the titanium mesh cage filled with bone is optimal for formation of the anterior bone block in radical reconstructive surgery. 

Objective. To analyze the influence of the sequence of anterior and posterior fusion procedures performed under combined anesthesia in a single surgical session on gas exchange and hemodynamics in patients.

Material and Methods. The performance of gas exchange and hemodynamic status was analyzed in 125 patients who underwent simultaneous two-stage combined intervention for post-traumatic spine deformity. All operations were performed under combined anesthesia with low flow sevoflurane. Patients were divided into two groups depending on the sequence of anterior and posterior fusion procedures: Group I (posterior-anterior sequence) included 60, and Group II (anterior-posterior sequence) - 65 patients.

Results. An open pneumothorax, mechanical compression of the lungs, and hyperextension of the spine are the main factors affecting the degree of deviations in hemodynamics and gas exchange, which require adjustment of mechanical ventilation and infusion rate parameters. The most statistically significant changes in analyzed indicators were registered in patients in Group I.

Conclusion. The anterior-posterior sequence of fusion procedure is more physiological treatment of patients comparing to the posterior-anterior one.