Objective. To analyze results of final surgical treatment for scoliosis in the first decade of life.

Material and Methods. In 2008–2016, a total of 95 patients with infantile and juvenile scoliosis were operated on using VEPTR instrumentation.
The final stage of surgical treatment was performed in 14 patients (9 girls, 5 boys). The average age at the start of treatment was 5.4 ± 2.1 years, average follow-up period – 2 years (6–36 months).

Results. Average value of the primary scoliotic curve before surgery was 83.0° ± 14.8°, thoracic kyphosis 41.1° ± 11.9°, lumbar lordosis 49.5° ± 4.9°. At the last follow-up average value of the primary scoliotic curve was reduced to 56.8° ± 14.1°, thoracic kyphosis to 24.5° ± 8.5°, lumbar lordosis to 38.4° ± 5.1° (p < 0.05). Space available for lung before surgery was 84.5 ± 8.7 %, after surgery 94.8 ± 6.7 %, at the last follow-up it increased to 98.6 ± 5.4 %. Complications included 9 cases of instability of implant anchors and 1 case of suppuration. There were no neurological complications.

Conclusion. Stage correction using different instrumentations is a method of choice for surgical treatment of infantile and juvenile scoliosis.

Objective. To perform a retrospective analysis of early treatment results in patients with malformation and malsegmentation of vertebrae in the cervical and upper thoracic spine. Level of evidence – IV.

Material and Methods. The study included retrospective monocentre series of 8 patients aged 2–15 years. Inclusion criteria were: age at the time of surgery less than 15 years, deformity in the frontal plane, performed three-column osteotomyies, and presence of full X-ray history.

Results. Patients with multiple developmental abnormalities including vertebral malsegmentation and malformation as leading components prevailed in a series. Violations of the sagittal balance were not noted. Preoperative magnitude of the scoliotic curve ranged from 30° to 66 ° (mean value – 46.1°) according to Cobb, with a frontal imbalance in 6 (75 %) patients. After surgery, residual scoliosis magnitudes were from 3° to 34° (mean value – 15.3°), the frontal balance was restored in all cases. The amount of correction ranged from 49 to 90 % (mean 69.4 %). Neurological status of patients was clinically normal, deviations from the norm were insignificant and recorded only based on ENMG data.

Conclusion. The use of vertebrectomy outside the apical zone in children with multiple vertebral malformations in the cervical and upper thoracic spine allows an adequate deformity correction with restoration of the spine balance, and minimizing the risk of neurological complications due to the leading compression maneuver of correction. This reduces the area of instrumental fixation, which is important for maintaining axial growth.

At present, there are no reliable prognostic factors indicating the progressive nature of spondylolisthesis in children and adolescents. Often the main complaint is a pain syndrome, which is well arrested by conservative therapy, while the quality of life of patients without surgery is not significantly impaired. The presented review of the literature shows that it is better to correct scoliotic deformity at a younger age when indications arise. Isthmic spondylolisthesis and scoliosis should be considered as different pathologies. In the absence of convincing evidence that spondylolisthesis has caused the scoliosis development, indications for surgical treatment should be considered as those for individual pathologies.
Isolated correction of scoliotic deformity does not lead to a progression of scoliosis. Papers of Russian and foreign authors from e-Library, Medline and PubMed databases were reviewed. The evidence level in majority of papers is III(C), and in part of papers – II(B).

The paper presents a review of the current literature on instrumental fixation of the pediatric cervical spine and technical features of the application of described techniques in children. The posterior instrumental fixation of the cervical spine provides stability and increases fusion rates in children with cervical spine deformities or instability, and allows intraoperative reduction of vertebral displacements. A number of morphological and clinical studies proved the possibility of implantation of modern metal constructs in children. Given the small size of bone structures in children, each case requires careful preoperative planning, proper intraoperative positioning and strict adherence to surgical techniques.

Objective. To evaluate the use of minimally invasive lumbopelvic fixation (LPF) in the acute period of traumatic disease in patients with vertically unstable pelvic injuries.

Material and Methods. Three patients with vertically unstable injuries of the pelvic ring were operated on using LPF technique. Fixation of pelvic fractures was performed by a minimally invasive procedure with a system of transpedicular and iliosacral screws. The choice of the lumbopelvic system configuration depended on the sacral injury morphology.

Results. The average length of hospital stay was 22.7 ± 7.5 days.
Assessment of the functional status of the pelvis using Majeed scale was 92.0 ± 5.3 points. Before surgery, the neurological status was assessed by Gibbons scale, all victims received 1 point: decompression of sacral neural structures was not indicated. All the victims returned to the previous level of physical and professional activity in the period from 6 to 18 months. At the same time, control SCT of the pelvis was performed, which confirmed the union of pelvic fractures and the stability of instrumentation.

Conclusion. Successful restoration of the pelvic ring anatomy with subsequent stable fixation using minimally invasive internal osteosynthesis in the acute period of traumatic disease including lumbopelvic transpedicular stabilization allowed obtaining good anatomical and functional outcomes in patients with vertically unstable injuries of the pelvic ring.

An analysis of key publications devoted to transpedicular fixation of the cervical spine has been carried out. The installation of transpedicular screws in the cervical spine is a technically challenging procedure, the frequency of screw deviation from the optimal trajectory remains high even with the use of modern intraoperative technologies, and there is a risk of serious lifethreatening complications. The use of this technique allows achieving reliable three-column stabilization of the cervical spine through only posterior approach, which is the preferred or only possible option for a limited group of patients. According to literature data, screw displacement beyond the pedicle borders occurs, on average, in 15–20 % of cases, while clinically significant complications occur in 4–5 % of cases. Among 32 operated patients, one severe neurologic complication caused by vertebral artery compression by the screw was noted. Of the 79 installed screws, 18 (22.79 %) cases of lateral pedicle wall perforation were observed. There were no cases of the fixator instability, infection and radiculopathy due to compression by the screw.

Objective. To analyze treatment results in patients with fractures of thoracic and lumbar vertebal bodies after transpedicular vertebroplasty and fixation through minimally invasive percutaneous and open approaches.

Material and Methods. A total of 154 patients with uncomplicated type A2, A3 fractures of the thoracic and lumbar vertebral bodies were operated on. All patients were examined with X-ray densitometry, spondylography, and CT. Group 1 included 53 patients who underwent vertebroplasty with deproteinized bone graft and percutaneous transpedicular fixation. Patients of Group 2 (n = 41), Group 3 (n = 43) and Group 4 (n = 17) underwent open transpedicular fixation and vertebroplasty with deproteinized bone graft (Group 2) and titanium nikilide granules (Groups 3 and 4).

Results. Intraoperative blood loss during open vertebroplasty combined with short-segment transpedicular fixation exceeded that during percutaneous vertebroplasty.
Parameters of kyphotic deformity, the wedge index and the loss of correction did not differ significantly except for Group 4. Significant improvement in ODI and VAS scores was noted after percutaneous vertebroplasty as compared with control groups.

Conclusion. Transpedicular verteboplasty and transpedicular fixation, both open and percutaneous, performed for the treatment of type A2 and A3 spinal fractures provide reliable stabilization of the injured spinal segments, allow vertebral body height restoration to a greater extent and correction of the kyphotic deformity.

Objective. Comparative evaluation of the effectiveness of epidural pharmacotherapy and epidural laser therapy of dorsalgia.

Material and Methods. Sixty patients with dorsalgia (Group A) were treated using epidural pharmacotherapy with non-steroidal anti-inflammatory drugs, and 20 patients (Group B) – using epidural laser therapy with apparatus of low-intensity laser radiation.

Results. In both groups, epidural therapy resulted in a significant (p < 0.05) improvement. Positive results were noted including a decrease in the severity of motor, sensory and vegetative-trophic disorders, ranging from minor changes in the pain character and in the area over which sensitivity disorders and paresthesias spread to complete regression of dorsalgia manifestations. However, clinical and neurological examination at discharge showed more significant improvement in Group A patients.

Conclusion. Positive results and absence of negative consequences allow recommending epidural therapy of dorsalgia for wide use in public health practice

Objective. To analyze early results of surgical treatment in patients with lumbar spinal stenosis using minimally invasive techniques for reconstruction of the spinal canal and fixation of the spine.

Material and Methods. A total of 168 patients were treated with minimally invasive unilateral microsurgical decompression for spinal stenosis at the lumbar level.

Results. The average length of post-operative inpatient care was 5.8 ± 2.8 days. When assessing the pain intensity in the legs and lumbar spine, as well as in daily activity, positive dynamics was noted after 1 and 6 months. Of the installed 732 screws, 18 (2.4 %) screws were displaced into the spinal canal by less than 2 mm and 4 (0.5 %) – by less than 4 mm. Signs of persistent subcompensated spinal stenosis at the operated level were detected in 5 (2.9 %) patients. The average intraoperative blood loss was 121.1 ± 22.0 ml. All patients were activated at the first day after surgery.

Conclusion. Minimally invasive unilateral decompression, if necessary in combination with correction and fixation with percutaneous pedicle screw system and TLIF, eliminates factors causing compression of neural structures, reduces intraoperative blood loss, allows early activation of patients and shortens the length of hospital stay.

An analytical review of the literature on the problem of segmental spinal instability is presented. The relevance of the investigated field of spine surgery is beyond doubt. At present, a number of issues related to the definition of the concept of instability, its biomechanical basis, diagnostic criteria and treatment tactics remain debatable. The paper highlights the views of the world’s leading researchers on the understanding of various aspects of this pathology in spine surgery. The research materials were abstracts from the PubMed and Scopus databases, papers published in The Spine Journal, Spine, European Spine Journal, and in periodicals of Ukraine and Russia.

Objective. To analyze the structure and frequency of complications after surgical treatment of non-traumatic spinal disorders in children and to identify factors affecting the development of the disorders.

Material and Methods. The study included follow-up data of 218 children who underwent no less than 2-level reconstructions of the spine for infectious and neoplastic destruction, as well as for congenital malformations of the spine in 2005–2015. The average period of long-term follow-up was 5 years 4 months. Sixteen patients developed complications requiring repeated surgical treatment in the long-term period (at least 12 months). Clinical and X-ray factors that influenced the risk of developing long-term complications were studied.

Results. Four groups of complications were identified: recurrence (progression) of primary pathology (n = 5), pseudoarthrosis in the interface between bone graft and recipient vertebra (n = 6), proximal junctional kyphosis (n = 4), and bone graft resorption (n = 1). The influence of thoracic lesions on the risk of pathology recurrence (p = 0.039) and of lumbar spine surgery on earlier complication development (p = 0.016) and pseudoarthrosis formation (p = 0.047), as well as on earlier appearance of secondary deformities as compared to other complications (p = 0.035) was statistically proved. The predictor value of such factors as etiology, age, gender and material used for anterior fusion (bone alone or titanium mesh with bone autograft) was not confirmed.
Conclusion. The frequency of late complications after 360° vertebral reconstruction in children is 7.3 %, with most of them developing several years after surgery. Increase in surgical activity, number of operated patients and length of follow-up will possibly prove the presence of new predictors of complication development.

Objective. To analyze and compare the measured values of apparent diffusion coefficient (ADC) in tumors of the spinal canal with cell density and Ki-67 index of proliferative activity.

Material and Methods. The study included diffusion-weighted MR images of 36 patients with different types of tumors of the spinal canal. In the morphological study of tumors, the degree of malignancy according to the WHO classification, the value of the Ki-67 index, and cell density were assessed.

Results. The average ADC of the extradural tumors G = I–II and G = III–IV was 1390.0 ± 94.8 mm2/s and 821.3 ± 111.1 mm2/sec, respectively. For intradural extramedullary neoplasms G = I–II, the ADC was 1328.7 ± 172.1 mm2/sec, for G = III – 957.6 ± 50.7 mm2/sec. Intramedullary tumors G = I–II had an average ADC value of 1604.6 ± 28.7 mm2/sec, and tumors G = III – 1066.5 ± 74.2 mm2/sec. For extradural tumors G = I–II, the Ki-67 index varied from 2 to 4 %, and for tumors G = III–IV – from 12 to 27 %; in the group of intradural extramedullary tumors G = I–II – from 1 to 5 %, for tumors G = III – from 7 to 11 %; for intramedullary tumors G = I–II – from 2 to 6 %, and for G = III tumors – from 7 to 19 %.

Conclusion. The diffusion-weighted MRI with ADC counting can be used as an additional non-invasive method for preoperative evaluation of the proliferative potential of a number of spinal canal tumors.

Objective. To analyze risk factors for the development of increased blood loss during surgical correction of idiopathic scoliosis.

Material and Methods. A total of 395 patients with idiopathic scoliosis were operated on using hybrid instrumentation, in prone position, under inhalation multicomponent anesthesia. Four groups of patients were identified: Group I – blood loss below 15 % of total blood volume (TBV) (n = 201); Group II – blood loss 15–30 % of TBV (n = 133); Group III – blood loss 30–40 % of TBV (n = 42); and Group IV – blood loss more than 40 % of TBV (n = 19). In 92 patients, operations were performed under condition of incomplete decompression of the anterior abdominal wall, in 303 patients – under condition of complete decompression. Analysis included data on increased intra-abdominal pressure, the initial condition of the system regulating the aggregate state of blood, the presence of connective tissue dysplasia, and structural features of the bone tissue.

Results. Complete decompression of the anterior abdominal wall during posterior instrumental correction allows reducing the volume of intraoperative blood loss by 60 % and avoiding blood transfusion in 75.9 % of patients. Structural and chronometric hypocoagulation associated with the inhibition of lateral aggregation of fibrin, is a start functional state of the hemostasis system in 80.0 % of patients with idiopathic scoliosis.

Conclusion. The main importance in solving the problem of reducing the severity of intraoperative blood loss belongs to the correction of the revealed disorders in the system regulating the aggregate state of blood and the implementation of procedures aimed at preventing an increase in intra-abdominal pressure.

AOSpine Symposium of advanced level.
Pathology of transitional areas of the spine