The paper presents a literature review on the pathogenesis of traumatic spinal cord injury. Spinal and spinal cord injury is of particular significance in the structure of human traumatic injuries due to the severity of socioeconomic consequences, difficulties of treatment, and high rate of disability among injured persons. In recent years, there has been a clear upward trend in the frequency of injuries to the spine and spinal cord. The spinal cord is an essential part of the nervous system having great physiological significance for the integrative activity. The total effect of spinal cord injury can be estimated as the sum of primary destruction of the nervous tissue and secondary extensive apoptosis near the injury site and at a distance from it. This results in the development of complex structural and functional changes manifested in multiple neurotrophic, metabolic, dyscirculatory and infectious complications, which greatly aggravate traumatic disease as a whole and affect vital functions of a patient immediately after spinal cord injury and in the late period. The current understanding of possible ways of therapeutic intervention to improve the existing treatment strategy for patients with spinal cord injury is reviewed.

Objective. To analyze the diagnostic ability of radiologic methods for detecting changes in the middle osteoligament column caused by thoracolumbar spine injuries.

Material and Methods. Seventeen patients aged 21-45 years with compression and comminuted compression fractures of the thoracic and lumbar vertebrae were examined. The insertion of puncture needle into the frontal epidural space was performed under fluoroscopic (on the operating table) or CT control in accordance with the author’s method. Ultravist 240 at a dose of 2-3 ml was used as a contrast medium.

Results. Radiopaque medium filled the loose-tissue space between the posterior longitudinal ligament and the posterior part of the vertebral body. When the integrity of the ligament attached to the adjacent discs was preserved, only the existing space was contrasted. When the ligament was damaged, its disinsertion from the disc or bone fragment was revealed. The contrast medium enveloped a bone fragment retropulsed into the spinal canal, identified individual vessels or anterior venous plexus and anterior epidural hematoma, and visualized the signs of injury to spinal motion segment.

Conclusion. The contrast enhancement of the anterior epidural space of the spinal canal complements existing methods of radiologic diagnostics and allows more accurate assessment of traumatic changes in the elements of the middle osteoligament column of the spine, thus permitting to solve the issues of surgical treatment. 

Anterior decompression and stabilization interventions are pathogenetically conditioned and reasonable for significant traumatic or destructive lesions of the anterior and middle columns of the spine. Over the past few decades, a considerable number of instrumentation systems were developed and successfully introduced into clinical practice to improve the effectiveness of anterior spinal fusion. In this paper, an attempt is made to systematize the existing telescopic cages for anterior fusion depending on their mechanical properties and design features.

Objective. To assess the rate of gastrointestinal tract disorders in children with spinal deformities in the early postoperative period after surgical intervention, and to compare results of different diagnostics schemes and preventive treatment.

Material and Methods. The treatment outcomes in 125 patients aged 13 to 18 years admitted for surgical treatment of scoliosis and Scheuermann’s disease were analyzed. In Group I endoscopic examinations were performed in all patients before surgery and only in those with clinical manifestations in the postoperative period. In Group II examinations were performed in all patients before and after surgery regardless of clinical signs. Prevention of gastrointestinal complications was standard in Group I and extended in Group II.

Results. The incidence of gastrointestinal tract pathology was 98 % in Group I and 86 % in Group II. Patients in Group II had no severe (grade 3 and 4) erosive lesions in the postoperative period, the rate of grade 2 lesions decreased to 31 %. Erosive lesions were more frequent in patients with low body mass index (53.8 %).

Conclusion. Gastrointestinal tract disorders are a common problem in patients with spinal deformity after corrective interventions. It is advisable to carry out endoscopy and ultrasound examinations in the postoperative period to optimize preventive and curative measures for avoidance of severe lesions of the gastrointestinal tract. 

Currently, the use of implants has become an integral part of surgery for various pathologies of the spine. The incidence of infection after spinal instrumentation varies from 0.7 to 20.0 %. The development of this complication may adversely affect the remote results and increase the cost of treatment. The paper presents a review of the literature devoted to surgical site infection after spine surgery with metal implants and related to the factors influencing emergence and progression of the infection, its diagnosis and treatment.

The paper presents three cases of similar pediatric bony abnormality at the craniovertebral junction accompanied by torticollis and ischemic brain attacks. Two patients were operated on, and the outcomes are analyzed. Type of Publication: case series study. Level of Evidence - IV.

Literature review presents a detailed summary of main principles of laminoplasty for cervical stenosis complicated by myelopathic symptoms. The history of the method and its improvement are described. Data of domestic and foreign studies over the past 15 years are given. Results obtained in these studies were the basis for assessment of the method’s efficiency in comparison with other decompression techniques. Attention is paid to encountered complications and methods of their prevention.

Objective. To compare the outcomes of surgical treatment of patients with spondylodiscitis of the cervical spine.

Material and Methods. Results of surgical treatment of non-specific spondylodiscitis in the cervical spine were studied in dynamics in 22 patients with different degrees of neurological disorders; out of them 14 (63.6 %) had sepsis. In the acute phase of the local inflammatory process, the preference was given to necrosectomy of affected vertebrae and intervertebral discs with spinal canal decompression. In case of subacute and chronic course of the process, the simultaneous restoration of support capacity of the operated spinal motion segments was performed by various anterior fusion techniques.

Results. The immediate and long-term outcomes were assessed as good and satisfactory in 20 (90.9 %) out of 22 patients.

Conclusion. A reasonable method of one-stage surgical treatment of spondylodiscitis of the cervical spine is stabilization surgery using anterior fixation systems, which reduces the intensity of vertebral pain in the late period and the time of interbody block formation. 

The results of complex chemotherapy and surgical treatment of extra-renal rhabdoid tumor with involvement of the lung, ribs and spine in a 12-year-old child are presented. Long-term results with no evidence of continued growth of the tumor and metastasis were followed for up to 3 years from the start of treatment and 2 years 7 months after radical surgery with total (360°) two-level spinal reconstruction.

Objective. To study the long-term results of surgical treatment of intramedullary ependymomas.

Material and Methods. Spinal ependymomas were detected in 91 (20.2 %) cases of a total number of operated patients. Intramedullary location of the tumor was diagnosed in 41 (45.0 %) patients. Ependymoma was benign in 78.1 % of cases and anaplastic in 9 cases (21.9 %). Radical removal of the tumor was achieved in 36 (87.8 %) patients, subtotal resection was performed in 5 cases (12.2 %).

Results. Gross neurological symptoms persisted in the long-term period in 6 (24.0 %) patients. Structural changes in the spine associated with surgical intervention was found only in 12.0 % of cases, relapses and continued growth of the tumor - in 16.1 %. Early postoperative mortality was 4.8 % (2 patients out of 41 died). In the late postoperative period, four more patients died, so that the overall mortality was 14.6 %. Five-year survival rate of patients corresponded to 80.6 %.

Conclusion. Radical surgery is an effective treatment for intramedullary ependymomas. The prognosis of intramedullary ependymoma may be considered as favorable in case of radical removal of the tumor, its benign nature, and good functional outcome of surgical treatment. 

Forty nine neurosurgery residents completed the course of simulation-based training in the cervical and lumbar spine intervention technology during 2011-2014. Training was carried out on human cadavers and physical models. Most participants were able to realize the need for practising skills and make a progress in their mastering during the course.