Objective. To perform comparative analysis of the accuracy of pedicle screw placement in spinal deformity correction in children with idiopathic scoliosis using 3D-CT navigation.

Material and Methods. Surgical treatment of 96 patients aged 14–18 years with Lenke type I and V idiopathic scoliosis was performed.
In the study group (n = 66), pedicle screws were inserted using the navigation station, in the control group (n = 30) – by the freehand method. The accuracy of pedicle screw position was assessed using postoperative CT images of the spine based on the Gertzbein scale.

Results. The total number of pedicle screws inserted in the study group was 1166, in the control group – 546. In the study group, position of screws was correct in 96 % (1119 screws) of observations and incorrect in 4 % (47 screws). In the control group, the correct position was noted only in 78 % (426 screws) of cases, and the number of incorrectly inserted screws was significantly larger – 22 % (120 screws). In the study group, incorrectly inserted screws in the thoracic spine were detected in 4.8 % of cases, in the lumbar spine – in 2.5 %; in the control group, pedicle screws were incorrectly inserted in the thoracic spine in 35.1 % of cases, in the lumbar spine – in 10.1 %.

Conclusion. Using the navigation station during surgical intervention aimed at correcting the deformity of the spine in children with idiopathic scoliosis of various locations allows a significant increase in the number of correctly inserted pedicle screws used for instrumentation.

To analyze long-term results of surgical correction and postoperative quality of life in patients with Lenke type V and VI deformities of the spine.
Material and Methods. The treatment results of 61 patients (average age 15 years) with Lenke type V–VI spinal deformities and mean follow-up period of 3.3 years were analyzed. The average length of anterior fusion was 12.7 segments. The average length of the primary curve instrumented with pedicle screws was 4.9 segments.

Results. The primary curve was 56.6°, after surgical intervention it was reduced to 15.1° (73.3 % correction). Postoperative progression within 3.3 years was 2.1°. Thoracic countercurve was 40.6°, after surgery it was corrected to 15.0° (63.0 % correction). At the final follow-up examination, the thoracic curve was 17.3° (progression 2.3°). Thoracic kyphosis and lumbar lordosis were within the normal ranges. The frontal imbalance was 22.1 mm before surgery and 12.2 mm at the final follow-up examination. The SRS-24 questionnaire data showed a significant score increase in all seven domains.

Conclusion. Transpedicular fixation allows achieving a high degree of Lenke type V–VI spinal deformity correction with a stable result and significant improvement in the quality of life of patients.

Objective. To prove the safety and technical and mechanical validity of posterior screw fixation of the cervical spine in children and to compare different types of the cervical spine fixation based on our own treatment experience and literature data.

Material and Methods. A retrospective analysis of 47 patients under the age of 18 years who underwent various types of posterior instrumental fixation of the cervical spine was performed. Level of Evidence – III.

Results. The duration of postoperative follow-up varied from 2 months to 6.6 years (mean, 2.1 ± 1.6 years). A total of 186 screws were placed, the number of screws inserted in one patient reached 10 (mean, 3.9 ± 2.4). Postoperative complications were observed in 5 (10.6 %) patients.

Conclusion. Posterior screw fixation of the cervical spine provides biomechanically reliable stabilization of the segment, helps to achieve good correction of deformity and reduction of dislocations, shortens the period of rehabilitation, and is a safe method of surgical treatment in children.

Objective. To analyze results of surgical treatment and correction of deformities associated with flexion-distraction injuries of the subaxial cervical spine.

Material and Methods. A retrospective analysis of treatment results in 78 patients who underwent anterior and combined stabilization of subaxial dislocations in 2010–2016 was carried out. The data of clinical examination and of MRI and MSCT studies were subjected to statistical processing.

Results. Significant (p < 0.05) loss of the achieved intraoperative correction of shearing and kyphotic types of deformities was noted after 3 months in the group of patients with unilateral and bilateral articular process fractures treated by anterior spinal fusion.

Conclusion. Unilateral or bilateral articular process fractures accompanied by bilateral dislocations at the level of damaged spinal segment are risk factors for the loss of post-traumatic deformity correction achieved after isolated anterior stabilization.

A clinical case of surgical treatment of a female patient with posttraumatic syringomyelia which led to tetraparesis and dissociated sensory loss in the trunk and upper and lower limbs is presented.
Clinical manifestations of these spinal cord changes occurred 21 years after complicated fracture of the L1 vertebra associated with complex posttraumatic spinal deformity.
Multistage surgical intervention made it possible to restore liquorodynamics, perform the necessary correction of severe kyphotic deformity of the spine, and reduce the risk of torso imbalance. As a result, the syrinx practically disappeared at all levels of the study.

Objective. To perform retrospective analysis of the dynamics of neurological symptoms following complete reduction of the L5 vertebra in groups of patients with low-grade (I–II) and highgrade (III–V, ptosis) L5 spondylolitic spondylolisthesis.

Material and Methods. Thе study included 158 patients who underwent surgical treatment for the L5 spondylolitic spondylolisthesis.

Results. A pronounced positive dynamics was observed in the postoperative period after using the same surgical tactics in the treatment of both low- and high-degree spondylolisthesis. In isthmic spondylolisthesis, regression of pain syndrome and neurological deficit was longer in patients with high-grade spondylolisthesis in the early postoperative period. At 6 month and 1 year followup examination, there was no reliable difference between low- and high-grade spondylolisthesis.

Conclusion. The complete reduction of the L5 vertebra does not significantly impair the patient’s neurological status. The complete reduction of the displaced vertebra and the correction of the lumbar spine can predict the restoration of the sagittal balance with respect to the lumbar lordosis angle and the pelvic tilt, which results in restoration of the patient’s ability to work and early social adaptation.

Objective. To analyze statistical data on children with isolated spinal fractures and those combined with spinal cord injury, and to study the structure of injuries.

Material and Methods. Data on the number of children from 55 regions of the Russian Federation were studied, and the structure of spinal fractures and spinal column injuries combined with injuries of spinal cord and its elements was analyzed.

Results. The absolute number of spinal injuries varies between regions of the Russian Federation from 2075.20 ± 166.64 cases in the Novosibirsk region to the total absence of injuries in the Republic of Tyva. The average number of superficial injuries to the spine is 10.34 ± 11.55 cases, and of injuries of the spinal column – 6.05 ± 5.51 cases per 10 thousand children. On the average, 4.30 ± 3.90 compression fractures, and 0.20 ± 0.20 unstable and complicated spinal column injuries per 10 thousand children are observed.

Conclusion. On the territory of the Russian Federation, there is significant variation in the number of children with superficial injuries and spinal column injuries. The variety of data obtained indicates the difficulties in diagnosing and registration of patients with this type of traumatic injury.

Objective. To identify natural radiological parameters of degenerative spinal motion segments and biochemical changes in intervertebral disc tissues, which have a significant connection with the hernia recurrence after microdiscectomy.

Material and Methods. The MRI, radiography and biochemical parameters of the nucleus pulpous and annulus fibrosus tissues from patients operated for L4–L5 and L5–S1 herniation were assessed and statistically analyzed. Two groups of patients were examined: Group I (n = 50) – with recurrent hernias, Group II (n = 50) – without recurrence during three years.

Results. Significant correlation was observed between recurrent lumbar disc herniation after microdiscectomy and the following biomechanical parameters: height of the intervertebral disc (p = 0.001; r = 0.69), segmental sagittal range of motion (p = 0.001; r = 0.61), lumbar lordosis (p = 0.001, r = 0.78), stage of the intervertebral disc degeneration (p = 0.001; r = 0.46), and type of hernia (p = 0.001, r = 0.45). The quantitative and qualitative characteristics of proteoglycans/glycosaminoglycans of the nucleus pulposus and annulus fibrosus differed significantly in patients of the studied groups, but significant correlation with recurrent hernias was not found (r < 0.3).

Conclusion. The preserved intervertebral disc height, hypermobility of the spinal motion segment, the smoothness of the lumbar lordosis, moderate intervertebral disc degeneration, and the disc protrusion have significant connection with the recurrence of lumbar intervertebral disc herniation after microdiscectomy.

Objective. To assess the degree of influence of heterotopic ossification on the motion amplitude of the operated segment and on clinical outcomes in patients after total intervertebral disc replacement.

Material and Methods. Results of total replacement of the intervertebral disc with the M6-L prosthesis were analyzed in 74 patients aged 23–45 years. Follow-up period was 36 months. The motion amplitude of operated segments and the degree of heterotopic ossification were estimated. Clinical outcomes were analyzed based on pain syndrome severity according to the VAS and on the level of the back pain-related quality of life according to the Oswestry index.

Results. Signs of heterotopic ossification were found in 27 (36.4%) patients: Grade I – in 11 (14.8 %), Grade II – in 14 (18.9 %), and Grade III – in 2 (2.7 %). The mean values of the motion amplitude of operated segments, VAS score and Oswestry index in the group of patients without signs of heterotopic ossification were 11.2° ± 2.7°, 2.8 ± 1.2 cm and 17.3 ± 6.5 %, respectively, and those in the group of patients with signs of heterotopic ossification – 11.5° ± 1.2°, 3.4 ± 1.8 cm and 19.8 ± 7.3 %, respectively.

Conclusion. Heterotopic ossification following total lumbar disc replacement occurs in 36.4 % of cases. High grade of heterotopic ossification reliably affects the amplitude of segment motion, though there was no significant influence on clinical results in patients.

Objective. To analyze the results of differentiated surgical treatment of elderly and senile patients with lateral stenosis of the lumbar spinal canal.

Material and Methods. A total of 95 patients with nerve root compression and back pain were operated on. The analysis and complex evaluation of treatment results were carried out in two groups: Group 1 included 79 (84.15 %) patients with nerve root compression associated with lateral spinal canal stenosis without instability of the spinal motion segment; Group 2 – 16 (15.85 %) patients with clinically significant lateral lumbar spinal canal stenosis with one root compression and severe back pain syndrome caused by the spinal motion segment instability. The clinical and neurological status of patients was evaluated using VAS, ODI, and SF-36 questionnaires. Changes in the angle and depth of the lateral radicular recess and the instability of the spinal motion segment were assessed using CT and functional radiographic findings.

Results. Lateral stenosis in elderly and senile patients is presented as a combination of compressing factors in 47.2 % of cases. The increase in the angle of the lateral radicular recess up to 30–40° and in its depth up to 5 mm resulted in reduction of the pain syndrome in the leg and back, and improvement of the quality of life.

Conclusion. The use of differentiated surgical treatment tactics based on identification of the dominant clinical neurological syndrome provides good and excellent results in patients of the older age group in 83 % of cases.

The paper presents a review of the current literature devoted to estimation of outcomes of surgical treatment for degenerative changes in the spine using scales, tests and questionnaires.
The literature search in domestic and foreign bibliographic databases has been carried out, and the use of scales, tests and questionnaires in spinal surgery was analyzed. The review presents requirements for scales, tests and questionnaires, examines the evaluation of clinical and patient-reported outcomes, and describes the advantages of multifactorial outcome evaluation.
The multifactorial evaluation of outcomes is illustrated by the example of degenerative changes in the cervical spine, and includes a clinical case of surgical treatment for cervical myelopathy.
The limitations of scales, tests and questionnaires are also discussed.

The endplate is crucial for maintaining normal functioning of a healthy intervertebral disc. It provides structural support of the spine and regulates the flow of nutrients and the metabolic processes in the disc. With age and in the pathogenesis of diseases, the cartilage undergoes degeneration and calcification thus disrupting the access of nutrients to the cells and altering the biochemical and morphological structure of the endplate and metabolic processes throughout the disc. A number of evidences points to the existence of the endplate innervation, so its damage can be a source of chronic low back pain. The presented literature review highlights the questions of anatomy and physiology of vertebral endplates and describes relationships between changes in their morphological and molecular structures and degenerative lesion of intervertebral discs and chronic back pain syndrome. The material of the study included abstracts of articles from the PubMed database, articles published in The Journal of Bone and Joint Surgery, Spine, European Spine Journal and in other journals over the past 15 years. If necessary, books and articles of previous years were used.

Objective. To present the clinical course and outcomes of surgical treatment in patients with spinal epidural abscesses.

Material and Methods. Sixteen patients (7 males and 9 females) with clinical, neuroimaging and/or histological evidence of spinal epidural abscess were treated in 2015 and 2016 at our institution.

Results. The mean age of patients was 60.200 ± 10.387 years.
The period from disease onset to hospital admission ranged from 15 to 120 days. Upon hospitalization, only 3 patients (18.75 %) were neurologically intact. Seven patients (3.75 %) underwent interlaminotomy at one or more levels or hemilaminectomy. The remaining 9 patients (56.25 %) were treated with laminectomy, and 5 of them with additional posterior pedicle screw fixation. Disability decreased after surgery in 7 patients (43.75 %), and remained unchanged until hospital discharge in 7. Two patients (12.5 %) died.

Conclusion. Urgent surgery is the method of choice for patients with spinal epidural abscess. It allows decompression of neural structures, correction of spinal deformity by means of stabilization that aims at rapid mobilization of patients.

Objective. To evaluate the impact of surgical intervention and targeted therapy on the results of treatment and survival of patients with metastases of renal cell carcinoma to the spine.

Material and Methods. Retrospective analysis of 100 patients (76 men, 24 women, mean age 58.4 years) with renal cell carcinoma metastases to the spine was carried out. Metastasectomy (en block resection) was performed in 39 patients, palliative decompression and stabilization — in 61. Twenty six patients received adjuvant targeted therapy (7 with metastasectomy, 19 with palliative decompression). The pain syndrome (VAS), neurological status (Frankel scale), and survival time (from the moment of surgery till the lethal outcome or the last follow-up examination) were assessed. The Kaplan – Meier survival analysis and Log-rank test were performed. A p-value < 0.05 was considered significant.

Results. All patients demonstrated restoration of neurologic function and reduction of pain syndrome. There was no significant difference in survival time in patients with metastasectomy and palliative decompression (p = 0.47). Statistically significant survival benefit was observed in patients who underwent targeted therapy (p = 0.0019).

Conclusion. Targeted therapy increases survival time in patients with renal cell carcinoma metastases to the spine. Metastasectomy is advisable with additional targeted therapy.

Objective. To evaluate the effectiveness of dalargin and polyoxidonium as neurovegetative protection components, when performing decompression and stabilization operations in patients in the late period of spine and spinal cord injury.

Material and Methods. Perioperative parameters of central hemodynamics and stress hormone levels were analyzed in 68 patients operated on using technology of multi-stage treatment in one surgical session under three variants of general anesthesia with mechanical ventilation: sevoflurane, fentanyl, and rocuronium bromide in Group I (n = 23); sevoflurane, fentanyl, dalargin, and rocuronium bromide – in Group II (n = 21); and sevoflurane, fentanyl, polyoxidonium, and rocuronium bromide – in Group III (n = 24).

Results. The duration of operation was: 385.7 ± 54.8 min in Group I, 391.5 ± 43.5 min in Group II, 399.2 ± 51.2 min in Group III, and blood loss was 1008.7 ± 89.2 ml, 968.3 ± 71.8 ml, 1001.4 ± 80.3 ml, respectively. Statistically significant differences in cardiac output parameter from initial values were recorded during anterior spinal fusion procedure and at the stage of spinal deformity correction. There were no significant differences in hemodynamics between the groups. The greatest deviations in stress hormone levels were recorded in Group I at stages of anterior spinal fusion, deformity correction, and on the first day after surgery. The level of endogenous intoxication in Group I corresponded to high severity, in Groups II and III – to moderate severity.
The need for opioid analgesics was significantly lower in Groups II and III (p < 0.05).

Conclusion. Inclusion of dalargin and polyoxidonium into the anesthesia program allows achieving a required level of anesthetic protection of patients during operation, while maintaining adequate reactivity of the patient’s body defenses.